A 36-week pregnant patient comes to the labor and delivery unit.
She states her water broke yesterday at this time. Because of her history, the nurse is concerned for which of the following?
Respiratory depression in the newborn.
Fetal hypoxia.
Maternal and fetal sepsis.
Precipitous labor.
The Correct Answer is C
Choice A rationale
Respiratory depression in the newborn is a condition often associated with maternal opioid use during labor, as these drugs can cross the placental barrier and affect the fetal central nervous system. The situation described, involving prolonged rupture of membranes (PROM) for 24 hours, does not directly cause respiratory depression. Instead, it significantly increases the risk of infection.
Choice B rationale
Fetal hypoxia is caused by a lack of oxygen reaching the fetus, which can result from issues such as placental abruption, cord compression, or maternal hypotension. While infection from prolonged rupture of membranes can indirectly lead to fetal distress, it is not the primary or most direct concern. The most immediate and significant risk is ascending bacterial infection from the vagina.
Choice C rationale
Prolonged rupture of membranes (PROM) for more than 24 hours significantly increases the risk of ascending bacterial infection from the vagina into the uterus. This can lead to chorioamnionitis, a bacterial infection of the amniotic fluid and membranes, which can then progress to maternal sepsis. The bacteria can also cross the placenta or be ingested by the fetus, leading to fetal sepsis.
Choice D rationale
Precipitous labor is defined as a rapid labor that lasts less than three hours from the onset of contractions to birth. This condition is not directly related to prolonged rupture of membranes. A history of precipitous labor is an independent risk factor for future rapid births, and prolonged rupture of membranes has no effect on the speed of cervical dilation and effacement.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
While many inductions of labor are performed for medical reasons, such as preeclampsia or post-term pregnancy, not all are. Elective inductions, performed for non-medical reasons, are also common, although they are associated with certain risks. The decision to induce labor is a medical one, but the indication is not always strictly medical, making this statement inaccurate.
Choice B rationale
A trial of labor (TOL) is a term used specifically for patients who have had a prior cesarean section and are attempting a vaginal delivery. It is also known as a TOLAC (Trial of Labor After Cesarean). Induction of labor is a broader term and refers to stimulating contractions before the spontaneous onset of labor. The two terms are not synonymous.
Choice C rationale
Induction of labor is a process initiated by methods like oxytocin infusion or prostaglandin gels. Internal and external version are procedures used to change the fetal presentation (e.g., from breech to cephalic) and are not methods for initiating labor. These procedures may be followed by induction, but they are not the induction methods themselves.
Choice D rationale
The Bishop score is a scoring system used to predict the likelihood of a successful induction of labor. It assesses five components: cervical dilation, effacement, consistency, position, and fetal station. A higher Bishop score (typically 8 or greater) indicates a more favorable cervix and a greater chance of successful induction, making this a crucial assessment tool.
Correct Answer is C
Explanation
Choice A rationale
This patient is not a good candidate due to the transverse fetal presentation. A fetus in a transverse lie cannot be delivered vaginally because the largest diameter of the fetus is positioned across the maternal pelvis. This presentation poses a significant risk of complications, including uterine rupture, necessitating a cesarean delivery.
Choice B rationale
This patient is not a good candidate because a history of multiple cesarean sections increases the risk of uterine rupture during a trial of labor. While a previous low-transverse uterine incision is generally considered a good candidate for TOLAC, the increased number of prior cesareans significantly raises the risk profile.
Choice C rationale
This patient is an ideal candidate for TOLAC. The previous cesarean section was for a non-recurring indication (breech presentation), not for a cephalo-pelvic disproportion. The estimated fetal weight is within a normal range, and the patient has a single previous low-transverse uterine incision, which is the safest type for a trial of labor.
Choice D rationale
This patient is not a good candidate for TOLAC because a previous classical vertical uterine incision has a significantly higher risk of uterine rupture during labor. This type of incision involves the contractile part of the uterus, and the scar is more likely to dehisce under the stress of uterine contractions, making TOLAC contraindicated.
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