A nurse is assessing a full-term newborn. Which of the following findings should the nurse report to the provider?

Maternal hypotension is a common complication of spinal anesthesia for cesarean section, and it can cause adverse effects on the mother and the fetus, such as nausea, vomiting, dizziness, decreased placental perfusion, fetal acidosis, and fetal distress¹². To prevent or treat maternal hypotension, various techniques have been used, such as fluid preloading or co-loading, vasopressors, lower limb compression devices, and left lateral tilt position¹². Among these, fluid administration is the most widely used and recommended

intervention¹²³. A bolus infusion of lactated Ringer's or other crystalloid solution can increase the intravascular volume and cardiac output, and counteract the decrease in blood pressure caused by spinal anaesthesia¹²³. The optimal timing and amount of fluid administration may vary depending on the individual patient's condition and response, but generally a bolus of 10 to 20 mL/kg is suggested before or during spinal anaesthesia¹²³.

The other options are incorrect because:
b) Applying oxygen via nonrebreather face mask at 2 L/min is not an effective intervention for maternal hypotension. Oxygen supplementation may be beneficial for improving fetal oxygenation in case of fetal distress, but it does not directly increase maternal blood pressure or cardiac output¹². Moreover, 2 L/min is a low flow rate for a nonrebreather face mask, which requires at least 10 L/min to deliver high concentrations of oxygen⁴.
c) Positioning the client in a knee-chest position is not a recommended intervention for maternal hypotension. This position may increase venous return and cardiac output in some cases, but it also increases intra-abdominal pressure and reduces uterine blood flow, which can compromise fetal oxygenation and well-being. A left lateral tilt position of 15 to 30 degrees is preferred to avoid aortocaval compression and improve placental perfusion¹².
d) Giving terbutaline subcutaneously is not an appropriate intervention for maternal hypotension. Terbutaline is a beta-agonist that relaxes the uterine smooth muscle and prevents preterm labor contractions. It has no direct effect on maternal blood pressure or cardiac output, and it may cause maternal tachycardia, palpitations, tremors, and hypokalemia as side effects. Vasopressors such as ephedrine or phenylephrine are more effective and safer drugs for treating maternal hypotension¹².

A client who has had two prior cesarean births is at an increased risk for uterine rupture during labor. Uterine rupture is a serious complication in which there is a complete or partial tear in the uterine wall, potentially leading to significant maternal and fetal morbidity or mortality.

The risk of uterine rupture increases with each prior cesarean birth due to the presence of a scar on the uterus. The scar tissue is weaker than the normal uterine tissue and can potentially rupture during contractions and labor. The risk of uterine rupture is particularly high if the client attempts a vaginal birth after cesarean (VBAC).

Option a) Precipitous labor refers to an extremely fast labor that lasts less than three hours from the onset of contractions to birth. While clients with prior cesarean births may be at increased risk for certain complications, such as uterine rupture, it does not necessarily increase the risk of precipitous labor.

Option b) Abruptio placentae is the premature separation of the placenta from the uterine wall before the birth of the baby. While it is a potential complication during pregnancy, it is not directly associated with prior cesarean births.

Option d) Failure to progress refers to a lack of cervical dilation or descent of the baby during labor. While prior cesarean births can increase the risk of certain labor complications, such as uterine rupture, they do not necessarily increase the risk of failure to progress.