RML MAINS 2025
Obstetrics & Gynaecology
Hard
A term-pregnant woman arrives at the clinic reporting leakage of amniotic fluid. What should be the nurse's first action?
Appeared in: RML MAINS 2025
Explanation
- Leakage of amniotic fluid indicates rupture of membranes (ROM), which is a significant event in late pregnancy.
- The most immediate and life-threatening risk following ROM, especially if the fetal head is not engaged, is umbilical cord prolapse.
- Cord prolapse can compress the umbilical cord, cutting off oxygen supply to the fetus and causing severe distress or death.
- Assessing the fetal heart rate (FHR) is the fastest and most effective way to determine fetal well-being and detect signs of cord compression, such as bradycardia or severe variable decelerations.
- Therefore, assessing the FHR is the nurse's absolute first priority to ensure fetal safety.
Why Other Options Were Wrong
- Option A: Calling the doctor is a necessary step, but it should be done after the nurse performs a primary assessment. The nurse must first gather critical data, such as the FHR, to report the situation accurately.
- Option C: Waiting is passive and dangerous. It delays the crucial assessment for cord prolapse, which is a time-sensitive emergency.
- Option D: Performing a vaginal examination is not the first priority and should be limited after ROM to reduce the risk of introducing infection (chorioamnionitis).
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Priority nursing action following prelabor rupture of membranes (PROM) to guide bedside assessment, documentation, and the next nursing action.
- The nurse's rapid assessment and prioritization are critical in preventing irreversible fetal brain injury or death from hypoxia due to cord prolapse.
- This scenario highlights a core principle of obstetric nursing: always assess the fetus first in situations that can compromise umbilical cord integrity.
- What if the nurse detects fetal bradycardia (FHR less than 110 bpm) after ROM? The nurse must immediately declare an emergency, manually lift the presenting part off the cord with a sterile gloved hand, place the mother in a knee-chest or Trendelenburg position to relieve pressure, administer oxygen, and prepare for an immediate emergency cesarean delivery.
How to Approach the Question
- First, identify the question type. This is a priority-setting question asking for the 'first action'.
- Analyze the clinical situation: A term-pregnant woman has ruptured membranes ('leakage of amniotic fluid').
- Recall the most immediate, life-threatening complication associated with ruptured membranes. This is umbilical cord prolapse.
- Consider how to assess for this complication. Cord compression from a prolapse will cause changes in the fetal heart rate (FHR).
- Evaluate the options based on this priority. Option B directly addresses the assessment of FHR.
- Eliminate the other options. Calling the doctor (A) is secondary to assessment. Waiting (C) is unsafe. A vaginal exam (D) increases infection risk and is not the primary assessment for fetal well-being in this context.
Concept Tested & Keywords
- Concept Tested: Priority nursing action following prelabor rupture of membranes (PROM).
- Stem keywords: term-pregnant woman, leakage of amniotic fluid, first action
- Lead-in keywords: first action
- Clinical cues: Leakage of amniotic fluid at term is a critical cue indicating ruptured membranes and the immediate risk of cord prolapse.
Question ID
Q9hwteSTUeGJrkxmENeebX
Reference Book
E6 Obstetrics Williams p. 23-42
E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 34-42
Practise the full RML MAINS 2025
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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