A nurse is teaching a client who is scheduled for an amniocentesis about the purpose of a lecithin/sphingomyelin ratio test.
Which of the following statements should the nurse make?

Fetal hypoxia occurs when oxygen delivery to the fetus is compromised. In this client, the contraction pattern of very frequent, prolonged contractions every 1–2 minutes lasting 90–120 seconds results in uterine tachysystole, which reduces uteroplacental blood flow during contractions. Normal contraction frequency is no more than 5 contractions in 10 minutes. Excessive contractions increase uterine tone, decrease relaxation time, and limit oxygen exchange, causing fetal heart rate changes like late decelerations and minimal variability. This leads to fetal hypoxia, a critical risk in labor complicated by these contraction abnormalities.

Rationale for incorrect Response 1 options:
Abruptio placentae is a sudden placental separation causing bleeding and pain, which is not directly indicated here, as there is no vaginal bleeding or sharp pain described.
Uterine tachysystole describes the contraction pattern itself rather than a complication; it is a cause, not the adverse outcome.
Chorioamnionitis is infection of fetal membranes, usually indicated by fever and uterine tenderness, neither present here.

Rationale for incorrect Response 2 options:
Gestational hypertension contributes to fetal risk but is not the immediate cause of the current fetal distress.
Fetal heart rate variability describes fetal condition but does not cause fetal hypoxia; rather, it signals it.
Intrauterine growth restriction indicates chronic fetal compromise but is not the direct cause of acute fetal hypoxia during labor contractions.

Take home points:

• Uterine tachysystole causes reduced oxygen delivery by limiting uterine relaxation time, risking fetal hypoxia.
• Fetal hypoxia manifests as late decelerations and minimal variability on fetal monitoring.
• Abruptio placentae and chorioamnionitis have distinct clinical signs, which differ from those caused by contraction abnormalities.
• Differentiating causes of fetal distress is vital for timely intervention during labor to prevent adverse outcomes.

A. The bladder is distended upon palpation: A distended bladder suggests urinary retention, not effective voiding. This may impair uterine contraction and increase the risk of hemorrhage.
B. The uterine fundus is 2 cm above the umbilicus: A high-rising fundus may indicate a full bladder that is displacing the uterus, often due to incomplete voiding.
C. The client does not feel the urge to urinate: Lack of urge may indicate altered bladder sensation, a potential complication after catheter removal and childbirth.
D. The client urinates 30 mL/hr: Urine output of ≥30 mL/hr is considered adequate and reflects effective voiding and kidney function, especially in the postpartum period.