Complications Occurring Before Labor and Delivery

A pregnant woman comes to the birthing center, stating she is in labor and does not know far along her pregnancy is because she has not had prenatal care. A primary care provider performs an ultrasound that indicates oligohydramnios. When the client's membranes rupture, meconium is in the amniotic fluid. What does the nurse suspect may be occurring with this client? 1 complications of a post-term pregnancy 2 complications of preterm labor 3 complications of placenta previa 4 placental abruption (abruptio placentae)

1 A post-term pregnancy carries risks for increased perinatal mortality, particularly during labor. Oligohydramnios and meconium staining of the amniotic fluid are common complications. Oligohydramnios increases the incidence of cord compression, which can lead to fetal distress during labor. Thick, meconium-stained fluid increases the risk for meconium aspiration syndrome

During a prenatal ultrasound, the client is discovered to have a succenturiate placenta. Following delivery of the fetus and placenta, which nursing assessment is most important? 1 assessment for hemorrhage 2 assessment for pain 3 assessment for a thrombus 4 assessment for shortness of breath

1 A succenturiate placenta can be first identified with a sonogram as the placenta is composed of several lobes instead of being one structure. A danger of this type of placental formation is that a lobe may tear and remain in the uterus after delivery. Assessment for hemorrhage is most important following delivery and in the postpartum period. NOT 2.3.4. While the other nursing assessments are important, due to the specific situation, the most important assessment relates to hemorrhage.

The nurse is preparing to talk to a group of pregnant women about elective induction and why it is not highly recommended. Which statements should she include in her presentation? Select all that apply. 1 It significantly increases the risk of cesarean birth. 2 It significantly increases the weight of the newborn. 3 It significantly increases instrumented birth. 4 It significantly increases the use of epidural analgesia. 5 It significantly increases the admissions to the neonatal ICU.

1.3.4.5. Evidence is compelling that elective induction of labor significantly increases the risk of cesarean birth, instrumented birth, use of epidural analgesia, and neonatal ICU admissions. NOT 2 Increased birth weight is not a factor

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? 1 Make sure the epidural medication is turned down. 2 Check for a full bladder. 3 Make sure the client is lying on her left side. 4 Assess vital signs every 30 minutes.

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

A pregnant client reports feeling pain similar to menstrual cramps. What should the nurse explain about this client's symptoms? 1 Exercise helps reduce the frequency of them. 2 If rhythmical, they could indicate preterm labor. 3 Lying down for a few hours will help them stop. 4 They are false labor and do not need to be reported

2 A rhythmic pattern of even very light but persistent contractions could be a beginning sign of preterm labor. NOT 4 Beginning as early as the 8th to 12th week of pregnancy, the uterus periodically contracts and then relaxes again. These sensations are Braxton Hicks contractions and can be similar to a forceful menstrual cramp. These contractions are not usually a sign of beginning labor but should be reported for evaluation. 1.3. Exercise or rest does not reduce the frequency of Braxton Hicks contractions

After teaching a review class to a group of perinatal nurses about various methods for cervical ripening, the nurse determines that the teaching was successful when the group identifies which method as surgical? 1 breast stimulation 2 amniotomy 3 laminaria 4 prostaglandin

2 Amniotomy is considered a surgical method of cervical ripening. NOT 1 Breast stimulation is considered a nonpharmacologic method for ripening the cervix. 3 Laminaria is a hygroscopic dilator that mechanically causes cervical ripening. 4 Prostaglandins are pharmacologic methods for cervical ripening

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? 1 hemorrhage 2 macrosomia 3 infection 4 dystocia

2 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. NOT 1.3.4. Hemorrhage, infection, and dystocia pose a risk to the mother, not the fetus.

A nurse is conducting a review course on tocolytic therapy for perinatal nurses. After teaching the group, the nurse determines that the teaching was successful when they identify which drugs as being used for tocolysis? Select all that apply. 1 nifedipine 2 magnesium sulfate 3 dinoprostone 4 misoprostol 5 indomethacin

2 Medications most commonly used for tocolysis include magnesium sulfate (which reduces the muscle's ability to contract) 5 indomethacin (a prostaglandin synthetase inhibitor) 1 nifedipine (a calcium channel blocker). These drugs are used "off label": this means they are effective for this purpose but have not been officially tested and developed for this purpose by the FDA. NOT 3.4. Dinoprostone and misoprostol are used to ripen the cervix.

A client who experiences premature rupture of membranes can expect to be put on pelvic rest. The nurse should explain to the client that pelvic rest involves which of the following? 1 staying in bed at all times 2 placing nothing in the vagina 3 staying in bed with bathroom privileges 4 staying off of the feet the majority of the day

2 Pelvic rest is a situation in which nothing is placed into the vagina (including tampons and the practitioner's fingers to perform a cervical examination). NOT 1.3.4. The other options (strict bed rest and bed rest with bathroom privileges) also might be ordered when a woman has premature rupture of membranes

A pregnant client is admitted to a health care facility with a diagnosis of premature rupture of membranes (PROM). Which test would the nurse expect to be used to predict fetal lung maturity when the client goes into labor? 1 reticulocyte count 2 lecithin/sphingomyelin ratio 3 Nitrazine test 4 test for antiphospholipids

2 The lecithin/sphingomyelin (L/S) ratio of the amniotic fluid helps predict the fetal lung maturity in a client with PROM who goes into labor. NOT 1 A reticulocyte count is used for testing sickle cell anemia. 3 The Nitrazine test aids in the diagnosis of PROM and differentiates the amniotic fluid that leaks out after PROM from the normal vaginal secretion. It does not aid in determining fetal lung maturity. 4 A test for antiphospholipids is done in diagnosing antiphospholipid syndrome, and does not aid in determining fetal lung maturity.

The nurse is caring for a client after experiencing a placental abruption (abruptio placentae). Which finding is the priority to report to the health care provider? 1 hematocrit of 36% (0.36) 2 45 ml urine output in 2 hours 3 hemoglobin of 13 g/dl (130 g/L) 4 platelet count of 150,000 mm3

2 The nurse knows a placental abruption places the client at high risk of hemorrhage. A decreased urine output indicates decreased perfusion from blood loss. NOT 1.3.4. The hematocrit, hemoglobin, and platelet counts are all within expected levels

A client at 7 months' gestation presents to the emergency department with reports of a large gush and continuous leaking of fluid from her vagina. She does have some slight pelvic pressure but denies any contractions. This client is showing clinical signs of which of the following? 1 precipitous labor 2 premature rupture of membranes 3 dystocia 4 all of the above

2 The woman with PROM usually presents to the delivery suite with reports of a large gush or continuous leakage of fluid from the vagina. She does not, however, report or present with regular uterine contractions because she is not in labor. NOT 3 Dystocia refers to the slow progression of labor 1 while precipitous labor refers to labor lasting less than 3 hours.

A woman at 40+ weeks' gestation is attending a clinic visit where the health care provider suggests they "strip the membranes" to hasten the start of labor. The clinic nurse should inform the woman to watch for and report which potential complication following this procedure? Select all that apply. 1 onset of a precipitous birth 2 bleeding from low placenta 3 leaking of clear fluid from the vagina 4 backache from pulled muscle 5 foul-smelling vaginal discharge noted on panties

2.3.5. Possible complications following "stripping the membranes" include bleeding from an undetected low-lying placenta, inadvertent rupture of membranes (clear fluid leaking from vagina), and the possibility of infection (foul-smelling vaginal discharge) if membranes should rupture

A pregnant woman at term is in the obstetrics unit for induction in the morning. Her membranes rupture, and the external fetal monitor shows deep variable decelerations. The nurse should immediately check the client for: 1 amniotic fluid infection. 2 amniotic fluid embolus. 3 umbilical cord prolapse. 4 placental abruption (abruptio placentae).

3 Because the client is not in labor, this development is considered premature rupture of membranes. The sudden onset of deep variable decelerations may indicate umbilical cord prolapse, which is an obstetric emergency that requires immediate intervention

After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between placental abruption (abruptio placentae) and placenta previa. Which statement will the nurse include in the teaching? 1 Placenta previa causes painful, dark red vaginal bleeding during pregnancy. 2 Placenta previa is an abnormally implanted placenta that is too close to the cervix. 3 Placental abruption results in painless, bright red vaginal bleeding during labor. 4 Placental abruption requires "watchful waiting" during labor and birth.

2 Placenta previa is a condition of pregnancy in which the placenta is implanted abnormally in the lower part of the uterus and is the most common cause of painless, bright red bleeding in the third trimester. not 3 Placental abruption is the premature separation of a normally implanted placenta that pulls away from the wall of the uterus either during pregnancy or before the end of labor. Placental abruption can result in concealed or apparent dark red bleeding and is painful. 4 Immediate intervention is required for placental abruption.

Which assessment finding will alert the nurse to be on the lookout for possible placental abruption (abruptio placentae) during labor? 1 macrosomia 2 gestational hypertension 3 gestational diabetes 4 low parity

2 Risk factors for placental abruption (abruptioo placentae) include preeclampsia, gestational hypertension, seizure activity, uterine rupture, trauma, smoking, cocaine use, coagulation defects, previous history of abruption, intimate partner violence, and placental pathology. NOT 1.3.4. Macrosomia, gestational diabetes, and low parity are not considered risk factors

The nurse is providing care to several pregnant women who may be scheduled for labor induction. The nurse identifies the woman with which Bishop score as having the best chance for a successful induction and vaginal birth? A 11 B 7 C 5 D 3

A. The Bishop score (0-13) helps identify women who would be most likely to achieve a successful induction. The duration of labor is inversely correlated with the Bishop score: a score over 8 indicates a successful vaginal birth. Therefore the woman with a Bishop score of 11 would have the greatest chance for success. Bishop scores of less than 6 usually indicate that a cervical ripening method should be used prior to induction

The nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption (abruptio placentae) are discussed. Which comment validates accurate learning by the parents? 1 "I need a cesarean section if I develop this problem." 2 "If I develop this complication, I will have bright red vaginal bleeding," 3 "Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain." 4 "Since I am over 30, I run a much higher risk of developing this problem."

3 Placental abruption (abruptio placentae) occurs when there is a spontaneous separation of the placenta from the uterine wall. It can occur anywhere on the placenta and will cause painful, dark red vaginal bleeding. If the abruption is small, the ob/gyn will try to deliver the fetus vaginally. But if severe bleeding occurs or there is fetal distress, a cesarean birth will be performed. Women older than 35 are also at higher risk for developing placental abruption

The nurse provides education to a postterm pregnant client. What information will the nurse include to assist in early identification of potential problems? 1 "Increase your fluid intake to prevent dehydration." 2 "Be sure to measure 24-hour urine output daily." 3 "Continue to monitor fetal movements daily." 4 "Monitor your bowel movements for constipation."

3 The nurse will teach the postterm client to monitor fetal movements daily to help determine if the fetus is experiencing distress. NOT 2 A 24-hour urine is needed for postterm clients; however, this is not collected daily. Although all pregnant clients should avoid dehydration, there is no indication this client needs to increase her fluid intake and this will not help identify potential problems. Monitoring bowel movements for constipation is not needed

A nurse is conducting an assessment of a woman who has experienced PROM. Which amniotic fluid finding would lead the nurse to suspect infection as the cause of a client's PROM? 1 yellow-green fluid 2 blue color on nitrazine paper 3 ferning 4 foul odor

4 A foul odor of the amniotic fluid indicates infection. NOT 1 Yellow-green fluid would suggest meconium. 2.3. A blue color on nitrazine paper and ferning indicate the presence of amniotic fluid.

Ripe vs Unripe Cervix

A ripe cervix is shortened, centered (anterior), softened, and partially dilated. An unripe cervix is long, closed, posterior, and firm.

Dinoprostone

Dinoprostone is a prostaglandin, a hormone-like substance that is naturally produced by tissues in the body. Dinoprostone topical is used in a pregnant woman to relax the muscles of the cervix (opening of the uterus) in preparation for inducing labor at the end of a pregnancy.

ferning

Microscopic appearance of amniotic fluid resembling fern leaves when the fluid is allowed to dry on a microscope slide; also called fern test.

A pregnant woman is admitted with premature rupture of the membranes. The nurse is assessing the woman closely for possible infection. Which findings would lead the nurse to suspect that the woman is developing an infection? Select all that apply. 1 fetal bradycardia 2 abdominal tenderness 3 elevated maternal pulse rate 4 decreased C-reactive protein levels 5 cloudy malodorous fluid

Possible signs of infection associated with premature rupture of membranes include elevation of maternal temperature and pulse rate, abdominal/uterine tenderness, fetal tachycardia over 160 bpm, elevated white blood cell count and C-reactive protein levels, and cloudy, foul-smelling amniotic fluid.

A client has been admitted with placental abruption (abruptio placentae). She has lost 1,200 ml of blood, is normotensive, and ultrasound indicates approximately 30% separation. The nurse documents this as which classification of abruptio placentae? 1 grade 2 2 grade 1 3 grade 3 4 grade 4

The classifications for placental abruption (abruptio placentae) are: grade 1 (mild) - minimal bleeding (less than 500 ml), 10% to 20% separation, tender uterus, no coagulopathy, signs of shock or fetal distress Grade 2 (moderate) - moderate bleeding (1,000 to 1,500 ml), 20% to 50% separation, continuous abdominal pain, mild shock, normal maternal blood pressure, maternal tachycardia Grade 3 (severe) - absent to moderate bleeding (more than 1,500 ml), more than 50% separation, profound shock, dark vaginal bleeding, agonizing abdominal pain, decreased blood pressure, significant tachycardia, and development of disseminated intravascular coagulopathy. There is no grade 4.

Magnesium toxicity: Assess every? HR? RR? Lung Sounds? DTR?

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

Tocolytic therapy prescribed if preterm labor occurs before?

Tocolytic therapy is most likely prescribed if preterm labor occurs before the 34th week of gestation in an attempt to delay birth and thereby reduce the severity of respiratory distress syndrome and other complications associated with prematurity.

Antiphospholipid syndrome

When antibodies attack phospholipids. This damage causes blood clots to form in the body's arteries and veins

Dystocia

difficult labor

A pregnant client late in her second trimester comes to the emergency department with complaints of painless, bright red vaginal bleeding. She states, "It started all of a sudden and now it seems to have stopped. Placenta previa is suspected. Which action should the nurse implement immediately for this client? 1 Determine fetal heart sounds using an external monitor. 2 Prepare the woman for an immediate cesarean birth. 3 Assist with insertion of internal monitoring to assess uterine pressure. 4 Prepare the client for a pelvic examination to assess rupture of membranes

1 For placenta previa, the nurse should attach external monitoring equipment to record fetal heart sounds and uterine contractions. NOT 3 Internal monitoring is contraindicated. 4 A pelvic or rectal examination should never be done with painless bleeding late in pregnancy because any agitation of the cervix when there is a placenta previa might tear the placenta further and initiate massive hemorrhage, which could be fatal to both mother and child. 2 The decision to deliver the fetus depends on the point at which a diagnosis of placenta previa is made and the age of the gestation. If labor has begun, bleeding is continuing, or the fetus is being compromised (measured by the response of the FHR to contractions), birth must be accomplished regardless of gestational age. If the bleeding has stopped, the fetal heart sounds are of good quality, maternal vital signs are good, and the fetus is not yet 36 weeks of age, a woman is usually managed by expectant watching

A woman in labor suddenly reports sharp fundal pain accompanied by slight dark red vaginal bleeding. The nurse should prepare to assist with which situation? 1 Premature separation of the placenta 2 Preterm labor that was undiagnosed 3 Placenta previa obstructing the cervix 4 Possible fetal death or injury

1 Premature separation of the placenta begins with sharp fundal pain, usually followed by dark red vaginal bleeding. NOT 3 Placenta previa usually produces painless bright red bleeding. 2 Preterm labor contractions are more often described as cramping. 4 Possible fetal death or injury does not present with sharp fundal pain. It is usually painless.

A client presents to the emergency department reporting regular uterine contractions. Examination reveals that her cervix is beginning to efface. The client is in her 36th week of gestation. The nurse interprets the findings as suggesting which condition is occurring? 1 preterm labor 2 normal labor 3 dystocia 4 precipitate labor

1 Preterm labor is the occurrence of regular uterine contractions accompanied by cervical effacement and dilation (dilatation) before the end of the 37th week of gestation. If not halted, it leads to preterm birth. NOT 2 Normal labor can occur after the 37th week. 3 Dystocia refers to a difficult labor. 4 Precipitate labor is one that is completed in less than 3 hours from the start of contraction to birth

A client's membranes have just ruptured. Her fetus is presenting breech. Which action should the nurse do immediately to rule out prolapse of the umbilical cord in this client? 1 Assess fetal heart sounds. 2 Place the woman in Trendelenburg position. 3 Administer oxygen at 10 L/min by face mask. 4 Administer amnioinfusion

1 To rule out cord prolapse, always assess fetal heart sounds immediately after rupture of the membranes whether this occurs spontaneously or by amniotomy, as the fetal heart rate will be unusually slow or a variable deceleration pattern will become apparent when cord prolapse has occurred. NOT 2.3.4. The other answers refer to therapeutic interventions to implement once cord prolapse has been confirmed

A client at 35 weeks' gestation is now in stable condition after being admitted for vaginal bleeding. Which assessment should the nurse prioritize? 1 fetal heart tones 2 signs of shock 3 infection 4 uterine stabilization

1 When a client is admitted for vaginal bleeding and is stable, the next priority assessment is to determine if the fetus is viable. NOT 2.3.4. The other options are not a higher priority than fetal heart tones.

A pregnant woman is diagnosed with placental abruption (abruptio placentae). When reviewing the woman's physical assessment in her medical record, which finding would the nurse expect? 1 firm, rigid uterus on palpation 2 gradual onset of symptoms 3 fetal heart rate within normal range 4 absence of pain

1. The uterus is firm-to-rigid to the touch with abruptio placentae. It is soft and relaxed with placenta previa. Bleeding associated with abruptio placentae occurs suddenly and is usually dark in color. Bleeding also may not be visible. NOT 2 A gradual onset of symptoms is associated with placenta previa. 3 Fetal distress or absent fetal heart rate may be noted with abruptio placentae. 4 The woman with abruptio placentae usually experiences constant uterine tenderness on palpation

A pregnant client has received dinoprostone. Following administration of this medication, the nurse assesses the client and determines that the client is experiencing an adverse effect of the medication based on which client report? Select all that apply. 1 headache 2 nausea 3 diarrhea 4 tachycardia 5 hypotension

1.2.3. Adverse effects associated with dinoprostone include headache, nauseas and vomiting, and diarrhea. NOT 4.5. Tachycardia and hypotension are not associated with this drug

A nurse is preparing to teach a class to pregnant women about the signs of preterm labor and what to do if these occur. Which signs of preterm labor should the nurse include in the presentation? Select all that apply. 1 uterine contractions, cramping, low back pain 2 feeling of pelvic pressure or fullness 3 increase in vaginal discharge 4 nausea, vomiting, and diarrhea 5 feelings of stress 6 leaking of fluid from the vagina

1.2.3.4.6. Signs and symptoms of preterm labor include uterine contractions, cramping, or low back pain; feeling of pelvic pressure or fullness; increased vaginal discharge; nausea, vomiting, and diarrhea; and leaking of fluid from the vagina

During active labor, the nurse notes a decrease in the baby's fetal heart rate and consults with the health care provider. The provider concurs and prescribes application of oxygen via mask, increase in IV fluids, and repositioning. The nurse should communicate which piece of information to the woman when she protests about being "tied down" in bed with IVs? 1 "An IV line will assist the staff if your baby shows signs of distress." 2 "Increasing your oxygen level will also increase the infant's oxygen level." 3 "Changing your position to side lying can prevent hypotension from inferior vena cava compression." 4 "Remember, the goal is to increase the FHR so a healthy infant can be born."

4 If a woman develops a complication of labor or birth, actions to increase the fetal heart rate (FHR) or to strengthen uterine contractions are a priority and possibly an emergency. Interventions must be planned and performed efficiently and effectively, based on the individual circumstances. NOT 1.2.3. Focusing on IV lines, rationale for oxygen placement, or educating about changing position does not put the focus on the priority—a healthy baby

A nurse is teaching a pregnant woman at risk for preterm labor about what to do if she experiences signs and symptoms. The nurse determines that the teaching was successful when the woman makes which statement? 1 "I'll sit down to rest for 30 minutes." 2 "I'll try to move my bowels." 3 "I'll lie down with my legs raised." 4 "I'll drink several glasses of water."

4 If the woman experiences any signs and symptoms of preterm labor, she should stop what she is doing and rest for 1 hour, empty her bladder, lie down on her side, drink two to three glasses of water, feel her abdomen and note the hardness of the contraction, and call her health care provider and describe the contraction

A pregnant client undergoing labor induction is receiving an oxytocin infusion. Which finding would require immediate intervention? 1 fetal heart rate of 150 beats/minute 2 contractions every 2 minutes, lasting 45 seconds 3 uterine resting tone of 14 mm Hg 4 urine output of 20 mL/hour

4 Oxytocin can lead to water intoxication. Therefore, a urine output of 20 mL/hour is below acceptable limits of 30 mL/hour and requires intervention. NOT 1 FHR of 150 beats/minute is within the accepted range of 120 to 160 beats/minute. 2 Contractions should occur every 2 to 3 minutes, lasting 40 to 60 seconds. 4 A uterine resting tone greater than 20 mm Hg would require intervention

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? 1 Administer oxytocin in a 20 cc bolus of saline. 2 Administer oxytocin in two divided intramuscular sites. 3 Administer oxytocin diluted in the main intravenous fluid. 4 Administer oxytocin diluted as a "piggyback" infusion.

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

A client is admitted to the unit in preterm labor. In preparing the client for tocolytic drug therapy, the nurse anticipates that the client's pregnancy may be prolonged for how long when this therapy is used? A 2 to 7 days B 1 to 5 days C 6 to 10 days D 4 to 8 days

A Tocolytic drugs may prolong the pregnancy for 2 to 7 days. During this time, steroids can be given to improve fetal lung maturity, and the woman can be transported to a tertiary care center

Laminaria

A hygroscopic Laminaria cervical dilator is a device designed to dilate (stretch open) the cervical os by cervical insertion of a conical and expansible material made from the root of a seaweed (Laminaria digitata or Laminaria japonica)

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

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

A nurse is describing the risks associated with post-term pregnancies as part of an in-service presentation. The nurse determines that more teaching is needed when the group identifies which factor as an underlying reason for problems concerning the fetus? 1 aging of the placenta 2 increased amniotic fluid volume 3 meconium aspiration 4 cord compression

Fetal risks associated with a post-term pregnancy include macrosomia, shoulder dystocia, brachial plexus injuries, low Apgar scores, postmaturity syndrome (loss of subcutaneous fat and muscle and meconium staining), and cephalopelvic disproportion. As the placenta ages, its perfusion decreases and it becomes less efficient at delivering oxygen and nutrients to the fetus. 2 Amniotic fluid volume also begins to decline after 38 weeks' gestation, possibly leading to oligohydramnios, subsequently resulting in fetal hypoxia and an increased risk of cord compression because the cushioning effect offered by adequate fluid is no longer present. Hypoxia and oligohydramnios predispose the fetus to aspiration of meconium, which is released by the fetus in response to a hypoxic insult (Norwitz, 2019). All of these issues can compromise fetal well-being and lead to fetal distress

lecithin/sphingomyelin (L/S) ratio

Ratio of two components of amniotic fluid, used for predicting fetal lung maturity; normal L/S ratio in amniotic fluid is 2:1 or greater when the fetal lungs are mature.