North American Registry of Midwives (NARM) Practice Exam

During the modified Brandt-Andrews maneuver, what is monitored to determine if the placenta has separated?

1. The length of the umbilical cord

2. The color of the vaginal discharge

3. The fetal heart rate

4. The firmness of the abdominal wall

The correct answer is: The length of the umbilical cord

Monitoring the length of the umbilical cord during the modified Brandt-Andrews maneuver provides critical information about the separation of the placenta. When the placenta begins to detach from the uterine wall, it typically causes a tug on the umbilical cord as it separates. If the length of the cord changes or appears to extend during this maneuver, it is an indication that the placenta has likely detached. This aspect of monitoring is essential for midwives and healthcare providers in ensuring the safe delivery of the placenta and assessing maternal and fetal well-being in the postpartum period. The other options, while important in their own right, do not provide direct and immediate insight into the status of placenta separation during this specific maneuver. The color of vaginal discharge can indicate different conditions but is less specific for separation; fetal heart rate is critical in labor monitoring but does not relate to placental separation; and the firmness of the abdominal wall may provide some clues about uterine tone but doesn't directly indicate whether the placenta has separated.