OB Chapter 23
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? Administer amnioinfusion. Assess fetal heart sounds. Administer oxygen at 10 L/min by face mask. Place the woman in Trendelenburg position.
Assess fetal heart sounds. 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. The other answers refer to therapeutic interventions to implement once cord prolapse has been confirmed.
The nurse is caring for a client in active labor. Which assessment finding should the nurse prioritize and report to the team? Unrelieved pain Bradypnea Bradycardia Sudden shortness of breath
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 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 mother has a small pelvic opening. Uterine contractions are weak and ineffective. The fetus is macrosomic. 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.
Immediately after giving birth to a full-term infant, a client develops dyspnea and cyanosis. Her blood pressure decreases to 60/40 mm Hg, and she becomes unresponsive. What does the nurse suspect is happening with this client? congestive heart failure amniotic fluid embolism aspiration placental separation
amniotic fluid embolism With amniotic fluid embolism, symptoms may occur suddenly during or immediately after labor. The woman usually develops symptoms of acute respiratory distress, cyanosis, and hypotension.
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? breast stimulation amniotomy prostaglandin laminaria
amniotomy Amniotomy is considered a surgical method of cervical ripening. Breast stimulation is considered a nonpharmacologic method for ripening the cervix. Laminaria is a hygroscopic dilator that mechanically causes cervical ripening. Prostaglandins are pharmacologic methods for cervical ripening.
A client in the active phase of labor is diagnosed as having a protracted labor pattern. Which pattern would the nurse assess as indicative of a protracted labor pattern? secondary arrest of cervical dilation (dilatation) arrest of the descent of the fetal head prolonged deceleration phase delayed descent of the fetal head
delayed descent of the fetal head Protraction disorders are characterized by delayed descent of the fetal head and delayed cervical dilation (dilatation). Prolonged deceleration phase, secondary arrest of cervical dilation, and arrest of the descent of the fetal head are characteristics of arrest disorder and not of protraction disorder.
The nurse is assisting a primary care provider to attempt to manipulate the position of the fetus in utero from a breech to cephalic position. What does the nurse inform the client the procedure is called? external rotation internal rotation vaginal manipulation external cephalic version
external cephalic version External cephalic version is the process of manipulating the position of the fetus in order to try to turn the fetus to a cephalic presentation.
The nurse is reviewing the physical examination findings for a client who is to undergo labor induction. Which finding would indicate to the nurse that a woman's cervix is ripe in preparation for labor induction? shortened firm closed posterior position
shortened A ripe cervix is shortened, centered (anterior), softened, and partially dilated. An unripe cervix is long, closed, posterior, and firm.
The nurse is caring for a client in the transition stage of labor. In which scenario would the nurse predict the use of forceps may be used to assist with the birth? The fetus is descending too slowly Abnormal position of the fetal head Reduce risk of complications To lessen the mother's pain
Abnormal position of the fetal head Forceps are mechanical devices which can be used to help deliver the fetus. Although no longer used routinely they are still used in certain situations to assist with the birth. One of those situations is when the fetus is in an abnormal position and the health care provider attempts to reposition the fetus to facilitate birth. The use of forceps is not to lessen the mother's pain or to speed up the process. The use of forceps is not without risk of complications, include perineal lacerations and injury to the fetus if the forceps are not used correctly.
The nurse is assisting with a vaginal birth. The client is fully dilated, 100% effaced, and is pushing. The nurse observes the "turtle sign" with each push and there is no progress. What does the nurse suspect may be occurring with this fetus? breech position nuchal cord shoulder dystocia umbilical cord prolapse
shoulder dystocia The "turtle sign" is the classic sign that alerts the practitioner to the probability of shoulder dystocia. The fetal head delivers, but then retracts similar to a turtle. The fetal head may wiggle from side to side and fail to rotate.
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: placental abruption (abruptio placentae). umbilical cord prolapse. amniotic fluid embolus. amniotic fluid infection.
umbilical cord prolapse. 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.
The nursing student demonstrates an understanding of dystocia with which statement? "Dystocia is diagnosed at the start of labor." "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."
"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.
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 "arrest of labor." The woman asks, "Why is this happening?" Which response is the best answer to this question? 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." "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." "Maybe your baby has developed hydrocephaly and the head is too swollen."
"More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal." Arrest of labor 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.
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? Early decelerations Late decelerations Variable decelerations Mild 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.
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? Prepare to assist with external version. Include a set of piper forceps when the table is prepped. 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 using external version 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? The fetus shows abnormal fetal heart rate patterns. 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.
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 monitoring the uterine contractions of a woman in labor. The nurse determines the woman is experiencing hypertonic uterine dysfunction based on which contraction finding? poor in quality. erratic. well coordinated. brief.
erratic. Hypertonic contractions occur when the uterus never fully relaxes between contractions, making the contractions erratic and poorly coordinated because more than one uterine pacemaker is sending signals for contraction. Hypotonic uterine contractions are poor in quality, brief, and lack sufficient intensity to dilate and efface the cervix.
A primigravida whose labor was initially progressing normally is now experiencing a decrease in the frequency and intensity of her contractions. The nurse would assess the woman for which condition? fetopelvic disproportion uterine bleeding a low-lying placenta contraction ring
fetopelvic disproportion The woman is experiencing dystocia most likely due to hypotonic uterine dysfunction and fetopelvic disproportion associated with a large fetus. A low-lying placenta, contraction ring, or uterine bleeding would not be associated with a change in labor pattern.
A nursing instructor is teaching students about fetal presentations during birth. The most common cause for increased incidence of shoulder dystocia is: increasing birth weight. longer length of labor. poor quality of prenatal care. increased number of overall pregnancies.
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 client is 2 weeks past her due date, and her health care provider is considering whether to induce labor. Which conditions must be present before induction can take place? Select all that apply. The fetus is in a longitudinal lie. Cephalopelvic disproportion is present. A presenting part is engaged. The cervix is ripe. Maternal blood pressure is normal. There is absence of eclampsia.
The fetus is in a longitudinal lie. A presenting part is engaged. The cervix is ripe. Before induction of labor is begun in term and postterm pregnancies, the following conditions should be present: the fetus is in a longitudinal lie; the cervix is ripe, or ready for birth; a presenting part is engaged; there is no cephalopelvic disproportion; and the fetus is estimated to be mature by date (over 39 weeks) or demonstrated by a lecithin-sphingomyelin ratio or ultrasound biparietal diameter to rule out preterm birth. Normal maternal blood pressure and absence of eclampsia are not conditions required for induction; in fact, severe hypertension and eclampsia are conditions that may necessitate induction.
A nurse is caring for a client in the labor and delivery unit. Immediately after fetal birth, a large amount of blood gushes from the client's vagina. The uterus is not palpable in the abdomen. The client's blood pressure drops significantly and the client becomes very pale. Which nursing action is completed next? Obtain vital signs. Administer oxygen by mask. Place the uterus back into the birth canal. Discontinue the oxytocin
Administer oxygen by mask. When uterine inversion occurs, a large amount of blood suddenly gushes from the vagina. The fundus is no longer palpable in the abdomen. The client begins to show signs of blood loss: hypotension, dizziness, paleness, or diaphoresis. The first nursing action is to apply oxygen. Then, the nurse will discontinue the oxytocin, because it makes the uterus more tense and difficult to replace. Next, the uterus will be replaced by the health care provider, typically while the client is under general anesthesia. The nurse should not attempt to replace the uterus. Vital signs will be obtained as often as every 15 minutes.
A shoulder dystocia situation is called in room 4. The nurse enters the room to help and the health care provider says to the nurse, "McRoberts maneuver." What does the nurse do next? Apply downward pressure above the pubic bone of the client, in an attempt to rotate the anterior shoulder Bring the client's knees back toward the shoulders, causing hyperflexion of the hips and rotation of the pubic symphysis Push the fetal head back into the uterus and prepare the client for cesarean birth Move the client into a hands-and-knees position, to straighten the sacral curve and release the posterior shoulder
Bring the client's knees back toward the shoulders, causing hyperflexion of the hips and rotation of the pubic symphysis To implement McRoberts maneuver, the nurse brings the client's knees back toward the shoulders, causing hyperflexion of the hips and rotation of the pubic symphysis. This maneuver enlarges the space for delivery of the fetal shoulders. Applying pressure above the pubic bone is suprapubic pressure. Pushing the fetal head back into the vagina is a Zavanelli maneuver. Since the fetal head has been delivered, it is not safe to move the client to a hands-and-knees position.
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? Attempt to push in one of the fetus's shoulders. Use McRoberts maneuver. Apply pressure to the fundus. 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 G2P1 woman is in labor attempting a VBAC, when she suddenly complains of light-headedness and dizziness. An increase in pulse and decrease in blood pressure is noted as a change from the vital signs obtained 15 minutes prior. The nurse should investigate further for additional signs or symptoms of which complication? Umbilical cord compression Uterine rupture Placenta previa Hypertonic uterus
Uterine rupture The client with any prior history of uterus surgery is at increased risk for a uterine rupture. A falling blood pressure and increasing pulse is a sign of hemorrhage, and in this client a uterine rupture needs to be a first consideration. The scenario does not indicate a hypertonic uterus, a placenta previa, or umbilical cord compression.
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? assessment for shortness of breath assessment for pain assessment for a thrombus assessment for hemorrhage
assessment for hemorrhage 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. While the other nursing assessments are important, due to the specific situation, the most important assessment relates to hemorrhage.
A woman who is 42 weeks' pregnant comes to the clinic. During the visit, which assessment should the nurse prioritize?
determining an accurate gestational age Incorrect dates account for the majority of postterm pregnancies; many women have irregular menses and thus cannot identify the date of their last menstrual period accurately. Therefore, accurate gestational dating via ultrasound is essential. Asking about contractions and checking for ruptured membranes, although important assessments, would be done once the gestational age is confirmed. Measuring the height of the fundus would be unreliable because after 36 weeks, the fundal height drops due to lightening and may no longer correlate with gestational weeks.
After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediately places the woman in which position? side-lying supine knee-chest sitting
knee-chest Pressure on the cord needs to be relieved. Therefore, the nurse would position the woman in a modified Sims, Trendelenburg, or knee-chest position. Supine, side-lying, or sitting would not provide relief of cord compression.
The nurse is caring for a woman undergoing cervical dilation. Which assessment finding would alert the nurse to the complication of vasa previa? rapid cervical dilation and effacement failure to dilate as labor and effacement progresses meconium-stained amniotic fluid noted painless bleeding at the beginning of cervical dilation
painless bleeding at the beginning of cervical dilation Painless bleeding at the beginning of cervical dilation (due to vessel tearing) is a sign of vasa previa. Rapid cervical dilation and effacement are indicative of precipitous birth. Meconium staining may be noted with a breech birth.
A woman in labor is experiencing dysfunctional labor (hypotonic uterine dysfunction). Assessment reveals no fetopelvic disproportion. Which group of medications would the nurse expect to administer? sedatives tocolytics corticosteroids uterine stimulants
uterine stimulants *For dysfunctional labor (hypotonic uterine dysfunction), a uterine stimulant such as oxytocin may be prescribed once fetopelvic disproportion is ruled out. Sedatives might be helpful for the woman with hypertonic uterine contractions to promote rest and relaxation. Tocolytics would be ordered to control preterm labor. Corticosteroids may be given to enhance fetal lung maturity for women experiencing preterm labor.
A woman in active labor has just had her membranes ruptured to speed up labor. The nurse is concerned the woman is experiencing a prolapse of the umbilical cord when the nurse notices which pattern on the fetal heart monitor? fetal heart rate (FHR) increase to 200 beats/min early deceleration with each contraction variable deceleration pattern late deceleration with late recovery following contraction
variable deceleration pattern Umbilical cord prolapse can be seen after the membranes have ruptured, when the FHR is displaying a sudden variable deceleration FHR pattern on a fetal monitor. It is not uncommon for FHR to increase following a procedure. Early deceleration with each contraction is seen when the fetal head is being compressed through the pelvic opening. Late deceleration with late recovery following contraction is associated with uteroplacental insufficiency (UPI).
A pregnant client's labor has been progressing slower than normal. The client is visibly anxious and tense, telling the nurse, "I am so worried about what is going to happen. And I am so tired and feel so helpless." Other underlying issues that may be contributing to the client's slow labor progress have been ruled out. Which response(s) by the nurse would be appropriate? Select all that apply. "I will have to stop giving you pain medicine because it is slowing your labor." "Let me leave you alone for a little while so you can get some rest." "Things are moving along but sometimes it can take a little longer." "Maybe dimming the lights or some soft music will help you relax a bit." "I will keep you updated often on how you and your baby are doing."
"Things are moving along but sometimes it can take a little longer." "Maybe dimming the lights or some soft music will help you relax a bit." "I will keep you updated often on how you and your baby are doing."
The nurse is caring for a primipara with PROM who appears extremely anxious and reveals that she is scared her birthing process will be extremely painful because it will be "dry". Which is the best response from the nurse? "This is true but you can receive pain medication to help relieve this." "Although the birth will be dry, it won't be painful." "Don't think so far ahead; concentrate on the problem at hand." "No birth is ever really dry, because amniotic fluid continues to be manufactured."
"No birth is ever really dry, because amniotic fluid continues to be manufactured." The nurse should let the client know that amniotic fluid is continuously formed; no birth is ever dry. The client will be given medication for pain as well as given the option to receive an epidural at the appropriate time. The nurse should not negate the woman's concerns by telling her to not worry about it. This would be a good time for informal teaching about the process and letting the woman know the options available to assist her through this process.
A nursing student is learning about fetal presentation. The nursing instructor realizes a need for further instruction when the student makes which of the following statements? "Transverse lie is the same as when the fetal buttocks present to the birth canal." "In most pregnancies at term the fetus presents head down." "Transverse lie is the same as when the shoulder presents to the birth canal." "Breech presentation is when the fetal buttocks present to the birth canal."
"Transverse lie is the same as when the fetal buttocks present to the birth canal." In most term pregnancies the fetus presents head down. In a breech presentation, the fetal buttocks, feet, or both present to the birth canal. Transverse lie is the same as shoulder presentation.
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.
Which intervention would be most important when caring for the client with breech presentation confirmed by ultrasound? auscultating the fetal heart rate at the level of the umbilicus continuing to monitor maternal and fetal status noting the space at the maternal umbilicus applying suprapubic pressure against the fetal back
continuing to monitor maternal and fetal status Once a breech presentation is confirmed by ultrasound, the nurse should continue to monitor the maternal and fetal status when the team makes decisions about the method of birth. The nurse usually plays an important role in communicating information during this time. Applying suprapubic pressure against the fetal back is the nursing intervention for shoulder dystocia and may not be required for breech presentation. Noting the space or dip at the maternal umbilicus and auscultating the fetal heart rate at the umbilicus level are assessments related to occipitoposterior positioning of the fetus.
A graduate nurse (GN) is caring for a woman being induced via oxytocin infusion. The client is currently reporting a headache and is vomiting. The graduate nurse thinks that the client is getting near the end of labor. However, the GNs preceptor intervenes by performing which interventions immediately after hearing this report? Select all that apply. increasing IV fluid rate administering IV ondansetron for the nausea/vomiting discontinuing the oxytocin infusion calling respiratory therapy to obtain ABGs on this client notifying the health care provider immediately
discontinuing the oxytocin infusion notifying the health care provider immediately A second side effect of oxytocin is that it can result in decreased urine flow, possibly leading to water intoxication. This is first manifested by a headache and vomiting. If the nurse observes these danger signs in a woman during induction of labor, she should report them immediately and halt the infusion. Ondansetron may be appropriate but is not the priority. The headache and vomiting are due to water intoxication, so fluids should be decreased not increased. At this point, ABGs are not the priority intervention.
A client has been in labor for 10 hours, with contractions occurring consistently about 5 minutes apart. The resting tone of the uterus remains at about 9 mm Hg, and the strength of the contractions averages 21 mm Hg. The nurse recognizes which condition in this client? hypertonic contractions uncoordinated contractions hypotonic contractions Braxton Hicks contractions
hypotonic contractions With hypotonic uterine contractions, the number of contractions is unusually infrequent (not more than two or three occurring in a 10-minute period). The resting tone of the uterus remains less than 10 mm Hg, and the strength of contractions does not rise above 25 mm Hg. Hypertonic uterine contractions are marked by an increase in resting tone to more than 15 mm Hg. However, the intensity of the contraction may be no stronger than that associated with hypotonic contractions. In contrast to hypotonic contractions, these occur frequently and are most commonly seen in the latent phase of labor. Uncoordinated contractions can occur so closely together they can interfere with the blood supply to the placenta. Because they occur so erratically, such as one on top of another and then a long period without any, it may be difficult for a woman to rest between contractions or to breath effectively with contractions. Braxton Hicks contractions are sporadic contractions that occur in pregnancy before the onset of true labor.
A pregnant client at 28 weeks' gestation in preterm labor has received a dose of betamethasone IM today at 1400. The client is scheduled to receive a second dose. At which time would the nurse expect to administer that dose? tomorrow at 1800 tomorrow at 0800 tomorrow at 1400 today at 2200 tomorrow at 1200
tomorrow at 1400 Betamethasone is given as two intramuscular injections, given 24 hours apart. Because the woman got her first dose at 1400 today, then her second dose would be given at 1400 tomorrow. Corticosteroids given to the mother in preterm labor can help prevent or reduce the frequency and severity of respiratory distress syndrome in premature infants delivered between 24 and 34 weeks' gestation.
A client with a pendulous abdomen and uterine fibroids (uterine myomas) 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? transverse lie cephalic presentation anterior fetal position occipitoposterior 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 fibroids (uterine myomas) 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.
A pregnant client at 24 weeks' gestation comes to the clinic for an evaluation. The client called the clinic earlier in the day stating that she had not felt the fetus moving since yesterday evening. Further assessment reveals absent fetal heart tones. Intrauterine fetal demise is suspected. The nurse would expect to prepare the client for which testing to confirm the suspicion? triple marker screening amniocentesis human chorionic gonadotropin (hCG) level ultrasound
ultrasound A client experiencing an intrauterine fetal demise (IUFD) is likely to seek care when she notices that the fetus is not moving or when she experiences contractions, loss of fluid, or vaginal bleeding. History and physical examination frequently are of limited value in the diagnosis of fetal death, since many times the only history tends to be recent absence of fetal movement and no fetal heart beat heard. An inability to obtain fetal heart sounds on examination suggests fetal demise, but an ultrasound is necessary to confirm the absence of fetal cardiac activity. Once fetal demise is confirmed, induction of labor or expectant management is offered to the client. An amniocentesis, hCG level, or triple marker screening would not be used to confirm IUFD.
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 amniotic embolism to the lungs an undiagnosed abdominal aorta aneurysm uterine rupture compression on the inferior vena cava
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 woman with a history of crack cocaine use disorder is admitted to the labor and birth area. While caring for the client, the nurse notes a sudden onset of fetal bradycardia. Inspection of the abdomen reveals an irregular wall contour. The client also reports acute abdominal pain that is continuous. Which condition would the nurse suspect? umbilical cord prolapse amniotic fluid embolism shoulder dystocia uterine rupture
uterine rupture Uterine rupture is associated with crack cocaine use disorder. Generally, the first and most reliable sign is sudden fetal distress accompanied by acute abdominal pain, vaginal bleeding, hematuria, irregular wall contour, and loss of station in the fetal presenting part. Amniotic fluid embolism often is manifested with a sudden onset of respiratory distress. Shoulder dystocia is noted when continued fetal descent is obstructed after the fetal head is delivered. Umbilical cord prolapse is noted as the protrusion of the cord alongside or ahead of the presenting part of the fetus.
