A nurse is teaching about the umbilical cord. Which of the following statements are correct? Select all that apply

Ambulation during the first stage of labor utilizes gravity to assist in the descent of the fetal presenting part into the pelvis. Vertical positioning increases the efficiency of uterine contractions and encourages pelvic expansion. It is a key component of active labor management to improve outcomes.

A. Prevents contractions: Walking actually tends to strengthen and regularize uterine contractions rather than preventing them. The pressure of the fetal head against the cervix during ambulation stimulates the release of endogenous oxytocin. It promotes physiologic labor progression.

B. Reduces Dilation: Movement and upright positions are associated with faster cervical dilation compared to the lithotomy or supine positions. Gravity helps the fetus exert consistent pressure on the internal os. This mechanical stimulation accelerates the effacement process.

C. Slows labor: Evidence suggests that being mobile can actually shorten the duration of the first stage of labor. Remaining sedentary can lead to stalled labor and increased maternal discomfort. Ambulation promotes optimal fetal positioning (occiput anterior), which facilitates a smoother delivery.

D. Promotes fetal descent: Walking helps the fetus navigate the pelvic inlet and descend through the mid-pelvis. The swaying motion of the maternal hips helps the fetus rotate and engage properly. This reduces the risk of dystocia and the need for operative interventions.

Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the enzyme cyclooxygenase, which is responsible for the synthesis of prostaglandins. Primary dysmenorrhea is caused by an excess of prostaglandin F2-alpha, which triggers intense uterine contractions and ischemia. Reducing these levels effectively alleviates menstrual cramping and associated systemic symptoms.

A. Antidepressants: While SSRIs are used for the emotional symptoms of premenstrual dysphoric disorder, they are not the first-line treatment for the physical pain of dysmenorrhea. They do not inhibit the uterine prostaglandins that cause the primary cramping. They address neurological rather than myometrial targets.

B. Insulin: Insulin is used to manage diabetes mellitus and has no clinical role in the treatment of menstrual pain. It does not affect uterine contractility or prostaglandin levels. Administering it to a non-diabetic client would cause life-threatening hypoglycemia.

C. Antibiotics: These agents treat infections like pelvic inflammatory disease, which can cause secondary dysmenorrhea. However, they are not used for the symptomatic relief of standard menstrual cramps. Antibiotics do not have analgesic or anti-inflammatory properties for non-infectious pelvic pain.

D. NSAIDS: Drugs like ibuprofen and naproxen are the gold standard for treating dysmenorrhea because they target the biochemical cause of the pain. By lowering prostaglandin concentrations in the menstrual fluid, they reduce uterine hypercontractility. This provides significant relief for most patients.