A client, who is 39 weeks pregnant, has been admitted to the hospital for induction.
The doctor has prescribed misoprostol (Cytotec). Which statement by the client indicates a need for further education?

Choice C rationale:

It is a misconception that fetal movement decreases as delivery approaches. While the nature of the movements may change— becoming less like kicks and more like rolls or twists due to less space in the uterus—the frequency of movements should remain consistent. In fact, increased fetal movement can be a sign of labor approaching. Therefore, a pregnant client who believes that fetal movements will decrease closer to delivery needs further instruction to ensure they are aware of this important health indicator.

Here's a detailed explanation of why the other choices are correct:

Choice A: This statement is correct. Fetal kick counts can be performed at home, providing a convenient and comfortable way to monitor fetal well-being.

Choice B: This statement is also correct. A decrease in fetal movement, defined as less than 3 kicks in an hour, is a potential concern and warrants contacting a healthcare provider for further evaluation.

Choice D: This statement is accurate as well. Daily fetal kick counts are generally recommended to establish a baseline of the baby's usual activity pattern and to detect any significant changes that might indicate a problem.

Choice A rationale:

Amniocentesis is the most reliable and direct method to assess fetal lung maturity. It involves the extraction of a small sample of amniotic fluid from the amniotic sac, which surrounds the fetus in the uterus. This fluid contains various substances, including surfactant, which is a crucial substance produced by the fetal lungs that enables them to expand and function properly after birth.

By analyzing the levels of surfactant and other components in the amniotic fluid, clinicians can accurately determine the maturity of the fetal lungs. This information is essential in guiding decisions about potential delivery options, especially in cases of preterm labor or other complications that may necessitate early delivery.

Amniocentesis is generally considered a safe procedure, but it does carry some small risks, such as infection, bleeding, or amniotic fluid leakage. However, these risks are typically outweighed by the benefits of obtaining accurate information about fetal lung maturity when necessary.

Choice B rationale:

Fetal fibronectin (fFN) is a protein that is found in the amniotic fluid and cervicovaginal secretions. Elevated levels of fFN in cervicovaginal secretions between 22 and 34 weeks of gestation can indicate an increased risk of preterm labor.

However, fFN testing is not a direct measure of fetal lung maturity. It is used primarily as a screening tool to assess the risk of preterm birth, not to determine the readiness of the fetal lungs for delivery.

Choice C rationale:

Chorionic villus sampling (CVS) is a prenatal diagnostic test that involves taking a small sample of chorionic villi, which are tiny finger-like projections of placental tissue. This test is typically performed earlier in pregnancy (between 10 and 13 weeks gestation) to diagnose genetic abnormalities in the fetus.

CVS is not used to assess fetal lung maturity. It does not provide any information about the development of the fetal lungs or their readiness for birth.

Choice D rationale:

Alpha-fetoprotein (AFP) is a protein produced by the fetal liver. Elevated levels of AFP in the maternal blood can indicate an increased risk of certain birth defects, such as neural tube defects.

AFP testing is not used to assess fetal lung maturity. It does not provide any information about the development of the fetal lungs or their readiness for birth.