A nurse is monitoring the labor of a patient who is receiving IV oxytocin (Pitocin) at 6 ml/hr. Which of the following clinical signs would lead the nurse to stop the infusion?

Maternal temperature of 101.4 F

Maternal blood pressure of 138/89

Change in fetal baseline heart rate from 125 to 90

Change in the maternal pulse from 80 to 93

Answer and Explanation

The Correct Answer is C

A. Maternal temperature of 101.4°F. A fever may indicate infection (chorioamnionitis), but it is not an immediate reason to stop oxytocin. The nurse should monitor for additional signs of infection and notify the provider, but the priority is fetal well-being.

B. Maternal blood pressure of 138/89. This blood pressure is not critically high and does not indicate a hypertensive crisis. Oxytocin can cause fluid retention and slight blood pressure changes, but this reading alone does not require stopping the infusion.

C. Change in fetal baseline heart rate from 125 to 90. A decrease in fetal heart rate (bradycardia) is a sign of fetal distress and requires immediate intervention. Oxytocin can cause uterine hyperstimulation, leading to decreased placental perfusion and fetal hypoxia. The priority is to stop oxytocin, reposition the mother, provide oxygen, and notify the provider.

D. Change in the maternal pulse from 80 to 93. A mild increase in heart rate is not uncommon during labor and may be due to pain, anxiety, or IV fluids. It does not indicate an emergency or the need to stop oxytocin.

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Correct Answer is B

Explanation

A. Oligohydramnios. Oligohydramnios, or low amniotic fluid levels, is not a primary complication of pregestational diabetes. It is more commonly associated with conditions such as fetal growth restriction, post-term pregnancy, and rupture of membranes rather than maternal hyperglycemia.

B. Congenital fetal anomalies. Poor glycemic control during preconception and early pregnancy increases the risk of congenital anomalies, particularly affecting the heart, spine, and central nervous system. Hyperglycemia during organogenesis (first 8 weeks of gestation) can lead to defects such as neural tube defects and cardiac malformations.

C. Intrauterine fetal seizures. Fetal seizures in utero are extremely rare and are not a common complication of maternal diabetes. While neonatal hypoglycemia after birth can lead to seizures, maternal hyperglycemia does not directly cause seizures in the fetus.

D. Polyhydramnios. While polyhydramnios (excess amniotic fluid) can occur in pregnancies complicated by diabetes due to fetal polyuria, it is more associated with later pregnancy. The question specifically asks about preconception and early pregnancy risks, making congenital anomalies the best answer.

A. Oral hypoglycemic medications B. Diet control and exercise C. Inhaled insulin D. Regular insulin injections

Correct Answer is B

Explanation

A. Oral hypoglycemic medications. While some oral hypoglycemic agents, such as metformin or glyburide, are used in gestational diabetes, the first-line treatment is always dietary modification and exercise. Medications are only introduced if blood glucose levels remain uncontrolled with lifestyle changes.

B. Diet control and exercise. The initial treatment for gestational diabetes focuses on controlling blood glucose through dietary adjustments, portion control, and regular physical activity. If lifestyle modifications fail to maintain glucose levels within the target range, insulin or oral medications may be introduced.

C. Inhaled insulin. Inhaled insulin is not commonly used in pregnancy because its safety and efficacy for gestational diabetes have not been well established. Insulin therapy, if needed, is typically administered via subcutaneous injection rather than inhalation.

D. Regular insulin injections. Insulin therapy is considered if diet and exercise alone fail to control blood glucose levels. However, it is not the first-line treatment, as many women can successfully manage gestational diabetes without requiring insulin therapy.

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A nurse is monitoring the labor of a patient who is receiving IV oxytocin (Pitocin) at 6 ml/hr. Which of the following clinical signs would lead the nurse to stop the infusion?

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