A nurse is monitoring a client in active labor who has an epidural in place.
Which of the following findings should be reported to the anesthesiologist immediately?

Choice A rationale: Assist the patient onto her left side

Positioning the patient on her left side helps improve uteroplacental blood flow by reducing compression of the inferior vena cava. This can enhance oxygen delivery to the fetus and mitigate late decelerations.

Choice B rationale: Assist with a vaginal exam for cord prolapse

Cord prolapse occurs when the umbilical cord slips ahead of the presenting fetal part, leading to variable decelerations rather than late decelerations. Since late decelerations indicate placental insufficiency rather than cord prolapse, this intervention is not necessary.

Choice C rationale: Discontinue the oxytocin infusion

Oxytocin is used to stimulate contractions, but excessive contractions can lead to uteroplacental insufficiency, causing late decelerations. Discontinuing oxytocin reduces uterine stress and improves fetal oxygenation.

Choice D rationale: Administer oxygen at 10 L/min via nonrebreather face mask

Providing high-flow oxygen increases maternal oxygenation, which in turn enhances fetal oxygen delivery. This intervention is a standard response to late decelerations.

Choice E rationale: Notify the health care provider

Late decelerations suggest fetal distress due to uteroplacental insufficiency, requiring urgent evaluation and possible escalation of care, such as intrauterine resuscitation or expedited delivery.

Choice F rationale: Stop the magnesium sulfate

Magnesium sulfate is administered for seizure prevention in preeclampsia and does not directly contribute to late decelerations. Therefore, stopping magnesium sulfate is not necessary in this situation.

Choice A rationale

Rubella immunization is contraindicated during pregnancy due to the theoretical risk to the fetus from the live attenuated vaccine. Administering the vaccine immediately after delivery ensures the mother develops immunity before subsequent pregnancies, protecting future fetuses from congenital rubella syndrome.

Choice B rationale

Administering the rubella vaccine during the first trimester of pregnancy is contraindicated because it is a live attenuated vaccine and poses a potential risk to the developing fetus, potentially causing congenital rubella syndrome which can lead to serious birth defects.

Choice C rationale

Administering the rubella vaccine during the third trimester of pregnancy is also contraindicated due to the potential risk to the fetus. While the risk might be lower later in pregnancy, it is still not recommended to administer live vaccines during gestation.

Choice D rationale

Waiting until the next attempt to get pregnant is not the optimal timing. The recommendation is to administer the rubella vaccine immediately postpartum to ensure the mother is immune before any future pregnancies, thus preventing potential harm to subsequent fetuses. .