A boggy fundus is noted during the fundal assessment. What is the priority nursing intervention?

Cervical insufficiency involves the painless structural compromise of the cervix, leading to premature dilation and second-trimester pregnancy loss. It often results from previous surgical trauma or collagen disorders that weaken the cervical stroma. Management requires mechanical reinforcement to maintain uterine integrity until fetal maturity is achieved.

A. Prevent cervical dilation: A cerclage involves placing a non-absorbable purse-string suture around the cervix to provide mechanical support. This procedure compensates for the weakened tissue by physically holding the cervical canal closed under the weight of the enlarging fetus. It is a critical intervention to prevent mid-trimester miscarriage.

B. Increase fetal growth: The procedure is strictly an anatomical repair of the maternal cervix and has no direct influence on fetal metabolic processes. Fetal growth depends on placental efficiency and the transfer of maternal nutrients, which are not altered by the presence of a suture. It is not used for growth-related indications.

C. Stop contractions: Cerclage is not a tocolytic intervention and cannot pharmacologically inhibit myometrial activity. If active labor or contractions begin, the suture must be removed immediately to prevent cervical laceration or uterine rupture. Its role is passive and structural rather than active and muscular.

D. Induce labor: The primary goal of a cerclage is the exact opposite of induction, as it aims to prolong gestation and prevent early delivery. Inducing labor involves the use of oxytocin or prostaglandins to stimulate contractions. Cerclage is a preventative measure against premature cervical opening.

The nonstress test (NST) evaluates fetal oxygenation by monitoring the fetal heart rate response to spontaneous fetal movement. A reactive result requires 2 or more accelerations within 20 minutes, indicating a healthy autonomic nervous system. This non-invasive assessment detects potential placental insufficiency or fetal hypoxia.

A. Measure amniotic fluid: Quantifying fluid volume is performed via ultrasound to calculate the amniotic fluid index (AFI). While often paired with an NST to form a biophysical profile, the NST itself uses electronic fetal monitoring to track heart rate patterns only. It does not provide data on fluid pockets.

B. Determine fetal lung maturity: Lung maturity is assessed through an amniocentesis to measure the lecithin-sphingomyelin ratio or the presence of phosphatidylglycerol. The NST is a functional assessment of current oxygenation and neurological status, not a biochemical analysis of surfactant production in fetal lungs.

C. Assess fetal well-being: The primary goal is to confirm that the fetus is adequately oxygenated and has an intact central nervous system. Accelerations in response to movement indicate that the fetal brain is receiving sufficient perfusion. It is the first-line screening tool for high-risk pregnancies.

D. Detect genetic disorders: Screening for chromosomal abnormalities like Trisomy 21 involves maternal serum markers, cell-free DNA testing, or chorionic villus sampling. An NST cannot identify genetic sequences or structural malformations. It only monitors the physiological responses of the fetus at that specific moment.