A nurse is caring for a patient in the first stage of labor and assesses that the patient is 6 cm dilated, 75% effaced, and the baby is at 0 station.
Based on these findings, the nurse would document that the patient is in what phase of the first stage of labor?

Choice A rationale

Preeclampsia is a hypertensive disorder of pregnancy that can lead to uteroplacental insufficiency. This condition would most likely cause late decelerations in the fetal heart tracing, as it results in decreased blood flow to the placenta and an inability to compensate during contractions. The tracing is not available, but the choice is being rationalized based on the most likely cause.

Choice B rationale

Placental abruption is the premature separation of the placenta from the uterine wall. This can lead to a variety of fetal heart tracing abnormalities, including severe variable decelerations, late decelerations, or a sinusoidal pattern, often accompanied by uterine hyperactivity. The resulting fetal distress is due to decreased placental surface area for gas exchange.

Choice C rationale

Breech positioning refers to a fetus presenting buttocks or feet first. While it can complicate labor and delivery, it is not a direct cause of a specific fetal heart rate pattern. Fetal heart rate changes in a breech presentation are typically related to cord prolapse or compression during labor, not the position itself.

Choice D rationale

Hypotension in the mother can lead to decreased placental perfusion, as seen with epidural anesthesia. This can cause late decelerations in the fetal heart rate tracing due to uteroplacental insufficiency. It is a common cause of fetal distress but is more directly related to maternal blood pressure than to a specific fetal heart rate pattern.

Choice E rationale

Cord compression is a mechanical issue that obstructs blood flow through the umbilical cord. It is the most common cause of variable decelerations, which are abrupt, visually apparent decreases in the fetal heart rate. The tracing, though not available, would likely show these variable decelerations in this context.

Choice A rationale

While monitoring for contractions is important, the most critical assessment is the fetal heart rate. Contractions can occur during and after the procedure, but their presence alone is not as indicative of fetal well-being or distress as a change in the fetal heart rate. The contractions themselves are expected and a direct result of the manipulation of the uterus.

Choice B rationale

Checking the amniotic fluid volume is typically done via ultrasound prior to the procedure to ensure there's enough fluid for the fetus to be mobile. A version is contraindicated if there is insufficient fluid (oligohydramnios). However, this is a pre-procedure assessment, and a real-time assessment during and after the procedure is focused on the fetal response.

Choice C rationale

During a version, the fetus is manually repositioned, which can cause transient umbilical cord compression or placental abruption. Monitoring the fetal heart rate is paramount to detect signs of fetal distress, such as bradycardia or persistent decelerations, which would necessitate immediate cessation of the procedure. This assessment is the most direct indicator of fetal tolerance.

Choice D rationale

Monitoring for vaginal bleeding is important post-procedure to detect a placental abruption, which is a potential complication. However, changes in the fetal heart rate are often the earliest and most direct sign of fetal compromise and should be monitored continuously, both during and immediately after the procedure. Vaginal bleeding may be a later sign.