Chapter 21: Nursing Management of Labor and Birth at Risk

A woman has been in labor for the past 8 hours, and she has progressed to the second stage of labor. However, after 2 hours with no further descent, the provider diagnoses an "arrested descent." The woman asks, "Why is this happening?" Which response is the best answer to this question? "Maybe your baby has developed hydrocephaly and the head is too swollen." "It is likely that your body has not secreted enough hormones to soften the ligaments so your pelvic bones can shift to allow birth of the baby." "More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal." "Maybe your uterus is just tired and needs a rest."

"More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal." Arrest of descent results when no descent has occurred for 2 hours in a nullipara or 1 hour in a multipara. The most likely cause for arrest of descent during the second stage is CPD. Rest should allow the uterine contractions to be more efficient. The hormones secreted during pregnancy allow ligaments to soften so bones can shift to allow birth. Ultrasound would have previously been diagnosed prior to the onset of labor.

Although many women envision a plan of how labor will go, sometimes complications happen, and their plan is no longer achievable. When this happens, what is the best question the nurse can ask the woman at this time? "Do you think your baby knows how you wanted your labor to progress?" "How do you handle events that do go your way?" "What do you consider your primary goal for the outcome of this pregnancy?" "Have you ever had your plans changed in the middle of the project?"

"What do you consider your primary goal for the outcome of this pregnancy?" If a complication of labor or birth occurs, identification of expected outcomes can be difficult because an outcome that must be included in planning may not be what the woman desires. Encouraging a couple to clarify their priorities when a complication occurs is helpful. Asking "if the baby knows" is trying to provoke humor and is inappropriate at this time. Asking if plans have ever changed in the middle of a project does not focus on the ultimate goal of delivering a healthy baby. Trying to find out how a client deals with unanticipated changes does not focus on the priority of a healthy baby.

The experienced labor and birth nurse knows to evaluate progress in active labor by using which simple rule? 2 cm/hour for cervical dilation 1/2 cm/hour for cervical dilation 1 cm/hour for cervical dilation 1/4 cm/hour for cervical dilation

1 cm/hour for cervical dilation In evaluating the progress in active labor, the nurse uses the simple rule of 1 cm/hour for cervical dilation.

A woman is to undergo labor induction. The nurse determines that the woman requires cervical ripening if her Bishop score is: 5. 9. 7. 6.

5. A Bishop score less than 6 usually indicates that a cervical ripening method should be used before labor induction.

Why is it important for the nurse to thoroughly assess maternal bladder and bowel status during labor? A full bladder or rectum can impede fetal descent. If the woman's bladder is distended, it may rupture. If the woman has a full bladder, labor may be uncomfortable for her. A full rectum can cause diarrhea.

A full bladder or rectum can impede fetal descent. Throughout labor the nurse needs to assess the woman's fluid balance status as well as check skin turgor and mucous membranes. In addition she needs to monitor the bladder and bowel status. A full bladder or rectum can impede fetal descent.

Before calling the health care provider to report a slow progression or an arrest of labor, several assessments need to be made. What other maternal assessment does the nurse need to make prior to calling the health care provider? Check for a full bladder. Make sure the client is lying on her left side. Assess vital signs every 30 minutes. Make sure the epidural medication is turned down.

Check for a full bladder. A full bladder can interfere with the progress of labor, so the nurse must be sure that the client has emptied her bladder.

The nurse is monitoring a woman who is receiving IV oxytocin to assist with uterine irritability. Which action should the nurse prioritize if the woman's contractions are determined to be 80 seconds in length after 1 hour of administration of the oxytocin? Continue to monitor contraction duration every 2 hours. Increase the flow rate of the main line infusion. Slow the infusion to under 10 gtts per minute. Discontinue the oxytocin infusion.

Discontinue the oxytocin infusion. If uterine contractions lengthen beyond 70 seconds, there is apt to be an interference with fetal circulation. Discontinuing the infusion allows contractions to shorten in length and allow fetal nourishment. The nurse would not increase the flow rate of the main line infusion or slow the infusion without the health care provider's prescription. Uterine contractions are monitored continuously.

The perinatal educator is instructing on various emotions commonly experienced during labor. Which complication of anxiety is most important to stress? Shortness of breath Fetal tachycardia Gestational hypertension Dystocia

Dystocia Many women experience an array of emotions during labor, which may include fear, anxiety, helplessness, desire to be alone, and weariness. These emotions can lead to psychological stress, which indirectly can cause dystocia. Dystocia is a prolonged labor as the tense woman is fighting against the labor process. Shortness of breath may occur with a panic attack. Gestational hypertension occurs during pregnancy. Fetal tachycardia is not commonly associated with maternal anxiety.

The nurse is caring for a client suspected to have a uterine rupture. The nurse predicts the fetal monitor will exhibit which pattern if this is true? Late decelerations Mild decelerations Variable decelerations Early decelerations

Late decelerations When the fetus is being deprived of oxygen the fetus will demonstrate late decelerations on the fetal monitoring strip. This is an indication the mother is in need of further assessment. Early decelerations are a normal finding. Variable decelerations usually coincide with cord compression.

Shoulder dystocia is a true medical emergency that can cause fetal demise because the baby cannot be born. Stuck in the birth canal, the infant cannot take its first breath. Which maneuver is first attempted to deliver an infant with shoulder dystocia? McDonald maneuver McGeorge maneuver McRoberts maneuver McRonald maneuver

McRoberts maneuver McRoberts maneuver is an intervention that is frequently successful in cases of shoulder dystocia, and it is often tried first. McRoberts requires the assistance of two individuals. Two nurses are ideal; however, a support person or a technician can serve as the second assistant. With the woman in lithotomy position, each nurse holds one leg and sharply flexes the leg toward the woman's shoulders. This opens the pelvis to its widest diameters and allows the anterior shoulder to deliver in almost half of the cases.

A 26-year-old primigravida has brought her doula to the birthing center for support during her labor and birth. The doula has been helping her through the past 16 hours of labor. The laboring woman is now 6 cm dilated. She continues to report severe pain in her back with each contraction. The client finds it comforting when her doula uses the ball of her hand to put counterpressure on her lower back. What is the likely cause of the woman's back pain? Fetal macrosomia Breech presentation Occiput posterior position Nongynecoid pelvis

Occiput posterior position A labor complicated by occiput posterior position is usually prolonged and characterized by maternal perception of increased intensity of back discomfort. The lay term for this type of labor is "back labor."

The nurse is assessing a multipara client at 28 weeks' gestation who may be experiencing labor. Which findings should the nurse prioritize? Irregular mild contractions every 10 to 15 minutes Positive fetal fibronectin Cervical length of 2.7 cm Positive ferning

Positive fetal fibronectin Fetal fibronectin is a positive indicator of preterm labor, either active or imminent. The mother can be dilated and effacing for weeks prior to delivery, as long as there are no changes. Ferning is a positive sign of amniotic fluid leaking and irregular contractions do not indicate true labor. A cervical length of less than 2.5 cm at 20 to 26 weeks' gestation is associated with PTL.

The nurse is assessing a multipara woman who presents to the hospital after approximately 2 hours of labor and notes the fetus is in a transverse lie. After notifying the RN and primary care provider, which action should the LPN prioritize? Include a set of piper forceps when the table is prepped. Prepare to assist with external version. Assist with nitrazine and fern tests. Apply pressure to the woman's lower back with a fisted hand.

Prepare to assist with external version. Transverse lie is a fetal malposition and is a cause for labor dystocia. The fetus would need to be turned to the occipital position or be born via cesarean birth. Piper forceps are used in the birth of a fetus that is in the breech position. Nitrazine and fern tests are done to assess if amniotic fluid is leaking from the sac into the vagina. Counterpressure applied to the lower back with a fisted hand sometimes helps the woman to cope with the "back labor" that is characteristic of occiput posterior (OP) positioning.

The nurse would prepare a client for amnioinfusion when which action occurs? Maternal pushing is compromised due to anesthesia. Severe variable decelerations occur and are due to cord compression. Fetal presenting part fails to rotate fully and descend in the pelvis. The fetus shows abnormal fetal heart rate patterns.

Severe variable decelerations occur and are due to cord compression. Indications for amnioinfusion include severe variable decelerations resulting from cord compression, oligohydramnios (decreased amniotic fluid), postmaturity, preterm labor with rupture of the membranes, and thick meconium fluid. Failure of the fetal presenting part to rotate fully; descent in the pelvis; abnormal fetal heart rate patterns or acute pulmonary edema; and compromised maternal pushing sensations from anesthesia are indications for forceps-assisted birth, and not for amniofusion.

The nurse is caring for a client in active labor. Which assessment finding should the nurse prioritize and report to the team? Bradypnea Sudden shortness of breath Unrelieved pain Bradycardia

Sudden shortness of breath Sudden shortness of breath can be a sign of amniotic fluid embolism and requires emergent intervention. This can occur suddenly during labor or immediately after. The woman usually develops symptoms of acute respiratory distress, cyanosis, and hypotension. It must be reported to the care team so proper interventions may be taken. Other symptoms can include hypotension, cyanosis, hypoxemia, uterine atony, seizures, tachycardia, coagulation failure, DIC, and pulmonary edema.

A woman in active labor suddenly experiences a sharp, excruciating low abdominal pain, which the nurse suspects may be a uterine rupture since the shape of the abdomen has changed. The nurse calls a code, and a cesarean birth is performed stat, but the infant does not survive the trauma. A few hours later, after the woman has stabilized, she asks to hold and touch her infant, and the nurse arranges this. Later, the nurse's documentation should include which outcome statement? The parents just cannot believe their perfect infant died. The parents are exhibiting dysfunctional coping mechanisms related to the death of their newborn. The parents are beginning to demonstrate positive grieving behaviors. The parents continue to mourn the loss of their infant.

The parents are beginning to demonstrate positive grieving behaviors. An evaluation of proposed outcomes may reveal unhappiness because not every woman who experiences a deviation from the normal in labor and birth will be able to give birth to a healthy child. Some infants will die. Outcome achievement might include the client begins positive grieving behaviors (touching, counting toes/fingers, etc.) in response to the loss of the newborn. The other statements are probably accurate but are not written as outcome statements.

A laboring client is experiencing dysfunctional labor or dystocia due to the malfunction of one or more of the "four Ps" of labor. Which scenario best illustrates a power problem? The fetus is macrosomic. Uterine contractions are weak and ineffective. The mother has a small pelvic opening. The mother is fighting the contractions.

Uterine contractions are weak and ineffective. Labor dystocia indicates that the labor is progressing too slowly. Reasons for this are described as due to the "four P's", which are passageway, passenger, power and psyche. A power problem involves either ineffective contractions in either quality or quantity or the mother is too tired to push when needed.

Which finding would lead the nurse to suspect that the fetus of a woman in labor is in hypertonic uterine dysfunction? contractions most forceful in the middle of uterus rather than the fundus fetal buttocks as the presenting part lack of cervical dilation past 2 cm reports of severe back pain

contractions most forceful in the middle of uterus rather than the fundus Contractions that are more forceful in the midsection of the uterus rather than in the fundus suggest hypertonic uterine dysfunction. Reports of severe back pain are associated with a persistent occiput posterior position due to the pressure of the fetal head on the woman's sacrum and coccyx. Cervical dilation (dilatation) that has not progressed past 2 cm is associated with dysfunctional labor. A breech position is one in which the fetal presenting part is the buttocks or feet.

A client at 32 weeks' gestation has been admitted to the labor and birth unit with preterm labor. Which medication would the nurse be likely to administer to reduce the risk of complications in the preterm newborn? corticosteroids magnesium sulfate nifedipine indomethacin

corticosteroids Corticosteroids are given to help reduce or prevent the frequency and severity of respiratory distress syndrome in preterm infants delivered between 24 and 34 weeks' gestation. Medications most commonly used for tocolysis include magnesium sulfate, indomethacin, and nifedipine.

A client in preterm labor is receiving magnesium sulfate IV and appears to be responding well. Which finding on assessment should the nurse prioritize? depressed deep tendon reflexes tachypnea bradycardia elevated blood glucose

depressed deep tendon reflexes The nurse should assess the woman at least once hourly and report any dyspnea (not tachypnea), tachycardia (not bradycardia), productive cough, adventitious breath sounds, and absent or decreased deep tendon reflexes in a client receiving magnesium sulfate; these are all signs of possible magnesium toxicity. Elevated blood glucose is a potential adverse reaction if the woman is receiving terbutaline.

A nursing instructor is teaching students about fetal presentations during birth. The most common cause for increased incidence of shoulder dystocia is: increased number of overall pregnancies. increasing birth weight. poor quality of prenatal care. longer length of labor.

increasing birth weight. Shoulder dystocia is the obstruction of fetal descent and birth by the axis of the fetal shoulders after the fetal head has emerged. The incidence of shoulder dystocia is increasing because of increasing birth weights, with reports of it in as many as 2% of vaginal births.

A nursing instructor is teaching students about fetal presentations during birth. The most common cause for increased incidence of shoulder dystocia is: poor quality of prenatal care. longer length of labor. increased number of overall pregnancies. increasing birth weight.

increasing birth weight. Shoulder dystocia is the obstruction of fetal descent and birth by the axis of the fetal shoulders after the fetal head has emerged. The incidence of shoulder dystocia is increasing because of increasing birth weights, with reports of it in as many as 2% of vaginal births.

A nursing student has learned that precipitous labor is when the uterus contracts so frequently and with such intensity that a very rapid birth will take place. This means the labor will be completed in which span of time? less than 5 hours less than 3 hours less than 4 hours less than 8 hours

less than 3 hours Precipitous labor is completed in less than 3 hours.

A client is entering her 42nd week of gestation and is being prepared for induction of labor. The nurse recognizes that the fetus is at risk for which condition? dystocia hemorrhage macrosomia infection

macrosomia Fetal risks associated with a prolonged pregnancy include macrosomia, shoulder dystocia, brachial plexus injuries, low Apgar scores, postmaturity syndrome, cephalopelvic disproportion, uteroplacental insufficiency, meconium aspiration, and intrauterine infection. Amniotic fluid volume begins to decline by 40 weeks' gestation, possibly leading to oligohydramnios. Hemorrhage, infection, and dystocia pose a risk to the mother, not the fetus.

The nurse is admitting a client at 23 weeks' gestation in preparation for induction and delivery after it was determined the fetus had died secondary to trauma. When asked by the client to explain what went wrong, the nurse can point out which potential cause for this loss? premature rupture of membranes genetic abnormality placental abruption preeclampsia

placental abruption The most common cause of fetal death after a trauma is placental abruption (abruptio placentae), where the placenta separates from the uterus, and the fetus is not able to survive. Genetic abnormalities typically cause spontaneous abortion in the first trimester. Trauma does not cause preeclampsia (which is related to various issues in the mother) nor does trauma usually cause PROM.

A nurse is caring for a client who is scheduled to undergo an amnioinfusion. The nurse would question this prescription if which finding is noted upon client assessment? uterine hypertonicity active genital herpes infection blood pressure of 130/88 mm Hg decreased urine output

uterine hypertonicity The nurse should ensure that the client does not have uterine hypertonicity to confirm that amnioinfusion is not contraindicated. Other factors that enforce contraindication of amnioinfusion include vaginal bleeding of unknown origin, umbilical cord prolapse, amnionitis, and severe fetal distress. Active genital herpes infection is a condition that enforces contraindication of labor induction rather than amnioinfusion. Urine output and blood pressure do not determine a client's ability to receive an amnioinfusion.

A woman in active labor with a history of two previous cesarean births is being monitored frequently as she tries to have a vaginal birth. Suddenly, the woman grabs the nurse's hand and states, "Something inside me is tearing." The nurse notes her blood pressure is 80/50 mm Hg, pulse rate is 130 bpm and weak, the skin is cool and clammy, and the fetal monitor shows bradycardia. The nurse activates the code team because the nurse suspects the client may be experiencing which complication? an undiagnosed abdominal aorta aneurysm an amniotic embolism to the lungs compression on the inferior vena cava uterine rupture

uterine rupture If a uterus should rupture, the woman experiences a sudden, severe pain during a strong labor contraction, which she may report as a "tearing" sensation. Because the uterus at the end of pregnancy is such a vascular organ, uterine rupture is an immediate emergency. Signs of hypotensive shock begin, including a rapid, weak pulse, falling blood pressure, cold and clammy skin, and dilation of the nostrils from air starvation. Fetal heart sounds fade and then are absent.

A nurse is assessing the following antenatal clients. Which client is at highest risk for having a multiple gestation? the 38-year-old client whose spouse is a triplet the 19-year-old client diagnosed with polycystic ovary syndrome the 27-year-old client who gave birth to twins 2 years ago the 41-year-old client who conceived by in vitro fertilization

the 41-year-old client who conceived by in vitro fertilization The nurse should assess infertility treatment as a contributor to the increased probability of multiple gestations. Multiple gestations do not occur with an adolescent birth; instead, chances of multiple gestations are known to increase due to the increasing number of women giving birth at older ages.

The nurse is monitoring a client in labor who has had a previous cesarean section and is trying a vaginal birth with an epidural. The nurse observes a sudden drop in blood pressure, increased heart rate, and deep variable deceleration on the fetal monitor. The client reports severe pain in her abdomen and shoulder. What should the nurse prepare to do? Place the client in a knee-chest position. Prepare the client for a cesarean birth. Turn the client on her left side. Bolus the client with another dose of medication through the epidural.

Prepare the client for a cesarean birth. The findings are consistent with uterine rupture. An abrupt change in the fetal heart rate pattern is often the most significant finding associated with uterine rupture. Others are reports of pain in the abdomen, shoulder, or back in a laboring woman who had previous effective pain relief from epidural anesthesia. Falling blood pressure and rising pulse may be associated with hypovolemia caused by occult bleeding. The treatment is immediate cesarean birth.

The nurse assesses that a fetus is in an occiput posterior position. The nurse predicts the client will experience which situation related to this assessment? Shorter dilation (dilatation) stage of labor Experience of additional back pain Necessity for vacuum extraction for birth Need to have the baby manually rotated

Experience of additional back pain Most women whose fetus is in a posterior position experience back pain while in labor. Pressure against the back by a support person often reduces this type of pain. An occiput posterior position does not make for a shorter (dilation) dilatation stage of labor. OP position does not indicate the need to have the baby manually rotated, nor does it indicate a necessity for a vacuum extraction birth.

A woman is going to have labor induced with oxytocin. Which statement reflects the induction technique the nurse anticipates the primary care provider will prescribe? Administer oxytocin in a 20 cc bolus of saline. Administer oxytocin in two divided intramuscular sites. Administer oxytocin diluted in the main intravenous fluid. Administer oxytocin diluted as a "piggyback" infusion.

Administer oxytocin diluted as a "piggyback" infusion. Oxytocin is always infused in a secondary or "piggyback" infusion system so it can be halted quickly if overstimulation of the uterus occurs.

The nursing student demonstrates an understanding of dystocia with which statement? "Dystocia is diagnosed at the start of labor." "Dystocia is diagnosed after labor has progressed for a time." "Dystocia cannot be diagnosed until just before birth." "Dystocia is not diagnosed until after the birth."

"Dystocia is diagnosed after labor has progressed for a time." Nursing management of the woman with dystocia, regardless of etiology, requires patience. The nurse needs to provide physical and emotional support to the client and family. Dystocia is diagnosed not at the start of labor, but rather after it has progressed for a time.

The client is anxious about her prolonged pregnancy. She informs the nurse she has been doing research on the Internet and has read about certain herbs that can help to induce labor. Which response from the nurse would be appropriate? "Why would you do something as stupid as that?" "Personally, I would use them, but I cannot tell you to." "Please talk to your primary care provider first to ensure it is safe." "There is no scientific evidence they work. You will just complicate your situation more."

"Please talk to your primary care provider first to ensure it is safe." It is important that the primary care provider knows if and when the client is using herbal supplements to ensure there will be no danger to the woman or fetus. The risks and benefits of these agents are unknown. None have been evaluated scientifically, and thus none can be recommended regarding their efficacy or safety. The statement about personal use is inappropriate because the nurse should not reveal personal information. Telling the client that the herbs will complicate the situation is inappropriate because the statement is judgmental and there is no information, whether positive or negative that the herbs can be harmful. The statement about doing something stupid is demeaning to the client.

A multipara woman at a birthing center is becoming very discouraged that her labor is taking so long. She is confused when her nurse-midwife indicates she has developed dystocia and needs to be transferred to a more advanced facility. What is the best response from the nurse to answer the woman's questions? "Your blood pressure is getting too high and needs treatment we can't provide here." "We need to consult with a surgeon in case a cesarean delivery is necessary." "Your difficult labor needs treatment we cannot provide here." "We don't have the medication you need."

"Your difficult labor needs treatment we cannot provide here." Birthing centers are designed to handle uncomplicated births; they have agreements with more complex facilities to accept their clients if the situation changes and more advanced treatment is needed. This client is showing signs of dystocia, which is a general term used to describe difficult or abnormal labor. The client needs to be in a more advanced medical facility that can provide the medication needed to address uterine and/or blood pressure complications. More importantly, this client may require a cesarean birth that would require a surgeon and operating room facilities to safely deliver the fetus.

A woman in labor is having very intense contractions with a resting uterine tone >20 mm Hg. The woman is screaming out every time she has a contraction. What is the highest priority fetal assessment the health care provider should focus on at this time? Monitor heart rate for tachycardia. Monitor fetal blood pressure for signs of shock (low BP, high FHR). Look for late decelerations on monitor, which is associated with fetal anoxia. Monitor fetal movements to ensure they are neurologically intact.

Look for late decelerations on monitor, which is associated with fetal anoxia. A danger of hypertonic contractions is that the lack of relaxation between contractions may not allow optimal uterine artery filling; this can lead to fetal anoxia early in the latent phase of labor. Applying a uterine and a fetal external monitor will help identify that the resting phase between contractions is adequate and that the FHR is not showing late deceleration.

The nurse is assisting with a G2P1, 24-year-old client who has experienced an uneventful pregnancy and is now progressing well through labor. Which action should be prioritized after noting the fetal head has retracted into the vagina after emerging? Use McRoberts maneuver. Apply pressure to the fundus. Attempt to push in one of the fetus's shoulders. Use Zavanelli maneuver.

Use McRoberts maneuver. McRoberts maneuver intervention is used with a large baby who may have shoulder dystocia and requires assistance. The legs are sharply flexed by a support person or nurse, and the movement will help to open the pelvis to the widest diameter possible. Zavanelli maneuver is performed when the practitioner pushes the fetal head back in the birth canal and performs an emergency cesarean birth. Fundal pressure is contraindicated with shoulder dystocia. It is outside the scope of practice for the LPN to attempt birth of the fetus by pushing one of the fetus' shoulders in a clockwise or counterclockwise motion.

A nurse is assessing a full-term client in labor and determines the fetus is occiput posterior. The client states that all her discomfort is in her lower back. What intervention can the nurse provide that will help alleviate this discomfort? Have the health care provider administer a pudendal block. Apply a warm washcloth to the lower back. Place the client supine with the head of bed elevated 30 degrees. Use a fist to apply counterpressure to the lower back.

Use a fist to apply counterpressure to the lower back. Counterpressure applied to the lower back with a fisted hand sometimes helps the woman to cope with the "back labor" characteristic of the occiput posterior position.

A woman experiences an amniotic fluid embolism as the placenta is delivered. The nurse's first action would be to: increase her intravenous fluid infusion rate. administer oxygen by mask. put firm pressure on the fundus of her uterus. tell the woman to take short, catchy breaths.

administer oxygen by mask. An amniotic embolism quickly becomes a pulmonary embolism. The woman needs oxygen to compensate for the sudden blockage of blood flow through her lungs.

A nurse assesses a client in labor and suspects dysfunctional labor (hypotonic uterine dysfunction). The woman's membranes have ruptured and fetopelvic disproportion is ruled out. Which intervention would the nurse expect to include in the plan of care for this client? preparing the woman for an amniotomy administering oxytocin encouraging the woman to assume a hands-and-knees position providing a comfortable environment with dim lighting

administering oxytocin Oxytocin would be appropriate for the woman experiencing dysfunctional labor (hypotonic uterine dysfunction). Comfort measures minimize the woman's stress and promote relaxation so that she can work more effectively with the forces of labor. An amniotomy may be used if the membranes were intact. It may also be used with hypotonic uterine dysfunction to augment labor. A hands-and-knees position helps to promote fetal head rotation with a persistent occiput posterior position.

A woman whose fetus is in the occiput posterior position is experiencing increased back pain. Which is the best way for the nurse to help alleviate this back pain? applying a heating pad to the back applying ice to the back applying counterpressure to the back performing acupuncture on the back

applying counterpressure to the back Counterpressure applied to the lower back with a fisted hand sometimes helps the woman cope with "back labor" associated with occiput-posterior positioning. The others are not recommended or used techniques for a woman in labor with back pain.

A fetus is experiencing shoulder dystocia during birth. The nurse would place priority on performing which fetal assessment postbirth? extensive lacerations monitor for a cardiac anomaly assess for cleft palate brachial plexus assessment

brachial plexus assessment The nurse should identify nerve damage as a risk to the fetus in cases of shoulder dystocia. Other fetal risks include asphyxia, clavicle fracture, central nervous system injury or dysfunction, and death. Extensive lacerations is a poor maternal outcome due to the occurrence of shoulder dystocia, which should be assessed and treated. Cleft palate and cardiac anomalies are not related to shoulder dystocia.

A client at 38 weeks' gestation has an ultrasound performed at a routine office visit and learns that her fetus has not moved out of a breech position. Which intervention does the nurse anticipate for this client? external cephalic version trial labor forceps birth vacuum extraction

external cephalic version External cephalic version is the turning of a fetus from a breech to a cephalic position before birth. It may be done as early as 34 to 35 weeks, although the usual time is 37 to 38 weeks of pregnancy. A trial birth is performed when a woman has a borderline (just adequate) inlet measurement and the fetal lie and position are good and involves allowing labor to take its normal course as long as descent of the presenting part and dilation (dilatation) of the cervix continue to occur. Forceps, which are not commonly used anymore, and vacuum extraction are used to facilitate birth when other complications are present, but they would be less likely to be used with a fetus in breech position.

At 31 weeks' gestation, a 37-year-old woman with a history of preterm birth reports cramps, vaginal pain, and low, dull backache accompanied by vaginal discharge and bleeding. Assessment reveals cervix 2.1 cm long; fetal fibronectin in cervical secretions, and cervix dilated 3 to 4 cm. Which interactions should the nurse prepare to assist with? bed rest and hydration at home hospitalization, tocolytic, and corticosteroids an emergency cesarean birth careful monitoring of fetal kick counts

hospitalization, tocolytic, and corticosteroids At 31 weeks' gestation, the goal would be to maintain the pregnancy as long as possible if the mother and fetus are tolerating the continuation of the pregnancy. Stopping the contractions and placing the client in the hospital allows for monitoring in a safe place if the woman continues and gives birth. Administration of corticosteroids may help to develop the lungs and prepare for early preterm birth. Sending the woman home is contraindicated in the scenario described. An emergency cesarean birth is not indicated at this time. Monitoring fetal kick counts is typically done with a postterm pregnancy.

A pregnant woman has just found out that she is having twin girls. She asks the nurse the difference between fraternal and identical twins. The nurse explains that with one set of twins there is fertilization of two ova, and with the other set one fertilized ovum splits. What type of twins result from the split ovum? neither type results from a split ovum both types can result from the split ovum fraternal identical

identical The incidence of twins is about 1 in 30 conceptions, with about 2/3 being from the fertilization of two ova (fraternal) and about 1/3 from the splitting of one fertilized ovum (identical).

A nurse is caring for a client who has been diagnosed with precipitous labor. For which potential fetal complication should the nurse monitor? cephalohematoma intracranial hemorrhage facial nerve injury facial lacerations

intracranial hemorrhage The nurse should assess for fetal complications such as head trauma associated with intracranial hemorrhage, nerve damage, and hypoxia in cases of precipitous labor. Facial and scalp lacerations, facial nerve injury, and cephalohematoma are all newborn traumas associated with the use of the forceps of vacuum extractors during birth. These conditions are not neonatal complications associated with precipitous labor.

A client at 33 weeks' gestation is calling the office with various reports and is very concerned. The nurse recognizes which report(s) as indicating the client is potentially going into preterm labor? Select all that apply. irregular contractions GI upset (nausea, vomiting, diarrhea) achiness in the thighs low, dull backache general sense of discomfort

low, dull backache general sense of discomfort GI upset (nausea, vomiting, diarrhea) achiness in the thighs There are various subtle symptoms of preterm labor that a woman may experience. They include change or increase in vaginal discharge; pelvic pressure; low, dull backache; menstrual-like cramps; feeling of pelvic pressure or fullness; GI upset; general sense of discomfort or unease; heaviness or aching in the thighs; uterine contractions, with or without pain; more than six contractions per hour; intestinal cramping, with or without diarrhea; and persistent contractions.

The nurse who works at the local health department is preparing to give a talk on post-term pregnancies. She wants to include the fetal risks. Which risks should she include? Select all that apply. shoulder dystocia macrosomia brachial plexus injuries failure to thrive cephalopelvic disproportion

macrosomia shoulder dystocia brachial plexus injuries cephalopelvic disproportion Fetal risks associated with a postterm pregnancy include macrosomia, shoulder dystocia, brachial plexus injuries, and cephalopelvic disproportion. Failure to thrive is more frequently associated with newborns who are of a low birth weight.

A woman is in the hospital only 15 minutes when she begins to give birth precipitously. The fetal head begins to emerge as the nurse walks into the labor room. The nurse's best action would be to: place a hand gently on the fetal head to guide birth. ask her to push with the next contraction so birth is rapid. assess blood pressure and pulse to detect placental bleeding. attach a fetal monitor to determine fetal status.

place a hand gently on the fetal head to guide birth. If a head is controlled as it emerges, trauma to internal vessels or to the maternal cervix is less apt to occur.

The nursing student doing a rotation in obstetrics is talking to her preceptor about dystocia. She asks what is meant by the term "expulsive forces," better known as the "powers." The preceptor correctly tells her that the "powers" include which factors? Select all that apply. presentation position mother's age fetal development analgesia

presentation position fetal development Dystocia can result from problems or abnormalities involving the expulsive forces (known as the "powers"): presentation, position, and fetal development. The others are not included in the "powers."

A client with a pendulous abdomen and uterine fibroid tumors has just begun labor and arrived at the hospital. After examining the client, the primary care provider informs the nurse that the fetus appears to be malpositioned in the uterus. Which fetal position or presentation should the nurse most expect in this woman? cephalic presentation occipitoposterior position transverse lie anterior fetal position

transverse lie A transverse lie, in which the fetus is more horizontal than vertical, occurs in the following instances: women with pendulous abdomens; uterine fibroid tumors that obstruct the lower uterine segment; contraction of the pelvic brim; congenital abnormalities of the uterus; or hydramnios. Anterior fetal position and cephalic presentation are normal conditions. Occipitoposterior position tends to occur in women with android, anthropoid, or contracted pelvis.