A patient in active labor is told by the nurse-midwife that "the baby is in the flexed attitude.”. When she asks the nurse what that means, what should the nurse say?

Choice A rationale

The term "flexed attitude" describes the posture of the fetus, not its position relative to the pelvic inlet. The engagement of the presenting part is a measure of station, which indicates how low the fetus has descended into the pelvis. A fetus can be flexed without being engaged.

Choice B rationale

A transverse lie describes the fetal axis being perpendicular to the maternal spine. The attitude refers to the relationship of the fetal parts to one another, such as the position of the head relative to the chest. A fetus can have a flexed attitude in a longitudinal or transverse lie.

Choice C rationale

Breech presentation is when the fetal buttocks or feet present first into the pelvis. Attitude describes the posture of the fetal limbs and head. While a fetus in breech presentation can have a flexed attitude, the terms describe different aspects of the fetus's position and posture.

Choice D rationale

The flexed attitude is the normal and most common fetal posture during labor. This position is characterized by the fetal chin resting on its chest, with the arms and legs crossed over the abdomen. This posture allows the smallest diameter of the fetal head to present to the pelvic inlet, facilitating descent.

Choice A rationale

An ultrasound for cervical length is a crucial diagnostic tool for assessing preterm labor. A shortened cervix, typically less than 2.5 cm, is a significant risk factor for preterm birth. Measuring the cervical length helps to determine the probability of progressing to true labor and guides subsequent interventions, such as cerclage or progesterone therapy.

Choice B rationale

Amniocentesis, the sampling of amniotic fluid, is primarily used for genetic testing, assessing fetal lung maturity, or diagnosing fetal infection. It is not a standard procedure for a patient with intermittent back pain and pelvic pressure at 28 weeks gestation, as it carries risks, including inducing labor and infection, and isn't the first-line diagnostic for this presentation.

Choice C rationale

A glucose tolerance test is a screening tool for gestational diabetes, typically performed between 24 and 28 weeks of gestation. While the patient is at this gestational age, the test is not directly related to the symptoms of back pain and pelvic pressure, which are more indicative of potential preterm labor. The test wouldn't be a priority in this specific context.

Choice D rationale

A fetal fibronectin (fFN) swab is a diagnostic test used to predict the likelihood of preterm birth. The presence of fFN, a protein that acts as a "glue" for the fetal sac, in cervical or vaginal secretions between 22 and 34 weeks gestation suggests an increased risk of preterm labor within the next one to two weeks. It is a key tool in managing preterm labor.

Choice E rationale

Encouraging fluids and rest is a common initial intervention for a patient with symptoms of preterm labor. Dehydration can sometimes trigger uterine contractions, so rehydration may help to stop them. Resting can also reduce uterine irritability. This non-pharmacological approach is often the first step before more aggressive treatments are considered. *.