A nurse is caring for a client with gestational diabetes in active labor at 39 weeks gestation.
The client required insulin to control blood glucose levels after hyperglycemia was persistent with diet and exercise changes alone.
The client states "I often forgot to check my sugar levels, and I haven't checked them in the last couple days.”. The client had an estimated fetal weight (EFW) ultrasound one week ago with a result of EFW 4195 grams.
What labor complication is this client at risk for?

Choice A rationale:

Initiating an IV fluid bolus is not necessary at this time as the client’s vital signs are stable, and there is no evidence of dehydration or hypotension. The client’s blood pressure is within normal limits, and there are no signs of fluid imbalance.

Choice B rationale:

Discontinuing oxytocin infusion is not warranted as the current dosage of oxytocin is aiding in the progression of labor. The fetal heart rate is stable, and there are no signs of fetal distress or hyperstimulation of the uterus.

Choice C rationale:

Notifying the provider is important to keep them updated on the client’s progress and any changes in the labor process. This allows the provider to make informed decisions about further management and interventions if necessary.

Choice D rationale:

Repositioning the client to a lateral position can enhance uteroplacental perfusion and improve fetal oxygenation. It also helps in relieving maternal discomfort and promotes optimal fetal positioning for labor progress.

Choice E rationale:

Titrating the oxytocin infusion to 8 mu/min per order is appropriate as the current contraction pattern is not yet within the desired frequency and duration. Increasing the oxytocin dosage helps achieve effective labor contractions

Choice A rationale

History of preeclampsia is a consideration in future pregnancies, but it is not an absolute contraindication for a trial of labor after cesarean (TOLAC). Each case should be individually evaluated based on the severity and recurrence risk.

Choice B rationale

History of classical uterine incision during cesarean is a contraindication for TOLAC due to the increased risk of uterine rupture during labor. A classical incision involves a vertical cut on the upper uterus, which is more prone to rupture compared to a lower transverse incision.

Choice C rationale

History of cord prolapse is a serious complication, but it does not inherently contraindicate TOLAC. Future labor and delivery plans should involve close monitoring and readiness to address any recurrence of cord prolapse.

Choice D rationale

History of one cesarean section is not a contraindication for TOLAC. In fact, many women with a single previous cesarean delivery are considered good candidates for a trial of labor, depending on other factors and the type of uterine incision. .