A patient in labor arrives at labor and delivery complaining of intense pain with contractions in her lower abdomen and perineal area.
What does the nurse suspect?

The baby's head may be facing in the wrong direction.

The patient is most likely in the first stage of labor.

The patient is most likely in or nearing the second stage of labor.

The baby is distressed.

Answer and Explanation

The Correct Answer is C

Choice A rationale

While a baby’s head facing the wrong direction, such as an occiput posterior position, can cause back labor pain, it typically manifests as intense back pain, not just lower abdominal and perineal pain. The intense pain in the lower abdomen and perineal area is characteristic of the baby's head descending and applying pressure on the pelvic floor and surrounding tissues.

Choice B rationale

The first stage of labor is characterized by cervical changes (dilation and effacement) with pain typically felt in the uterine fundus and radiating to the lower back and abdomen. Intense pain specifically in the lower abdomen and perineal area, as described, suggests significant fetal head descent, which is more characteristic of the second stage of labor.

Choice C rationale

The second stage of labor begins when the cervix is fully dilated and ends with the birth of the baby. During this stage, the fetus's head descends into the pelvis, causing intense pressure and pain in the lower abdomen and perineal area as it presses on the pelvic floor, nerves, and surrounding structures. The patient's pain description strongly aligns with this process.

Choice D rationale

While fetal distress can cause changes in fetal heart rate and may be a concern during labor, it is not directly associated with the specific location of the patient's pain. Fetal distress is primarily a fetal issue, and its signs are seen in fetal monitoring, such as late decelerations or a non-reassuring fetal heart rate pattern, rather than in the specific location of the mother's pain.

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Correct Answer is B

Explanation

Choice A rationale

Suprapubic pressure is applied to the maternal abdomen, just above the pubic bone, with the goal of dislodging the anterior shoulder. This technique involves pushing down and laterally on the baby's shoulder to help it move from beneath the pubic bone, and is often used in conjunction with the McRoberts maneuver.

Choice B rationale

McRoberts maneuver involves the nurse assisting the patient by sharply flexing the legs back against the abdomen. This action straightens the lumbosacral lordosis and rotates the symphysis pubis cephalad, which changes the angle of the pelvic inlet and may free the impacted shoulder, facilitating delivery.

Choice C rationale

Fundal pressure is a dangerous and contraindicated maneuver for shoulder dystocia. It involves pushing on the top of the uterus, which can further impact the fetal shoulder, increasing the risk of serious fetal and maternal complications such as nerve damage or uterine rupture.

Choice D rationale

The Zavanelli maneuver is a highly invasive procedure used as a last resort in severe cases of shoulder dystocia. It involves pushing the fetal head back into the birth canal and performing a Cesarean section. This maneuver is performed by a physician, not the nurse, due to its complex nature.

A. A G2P1001 at 41 weeks gestation with a fetus in a transverse presentation. She has had one previous delivery, a spontaneous vaginal delivery at 42 weeks gestation. B. A 33-year-old G5P2204 at 37 weeks and two days gestation. Her previous deliveries were scheduled low-transverse cesarean sections. C. A 42-year-old G2P1001 at 38 weeks gestation carrying a fetus with an estimated fetal weight of 6 lbs 8 oz. Her first cesarean section was scheduled due to a breech position of the fetus. D. A 29-year-old G3P1011 at 39 weeks gestation. She has had one previous delivery, an emergent cesarean section with a classical vertical uterine incision.

Correct Answer is C

Explanation

Choice A rationale

This patient is not a good candidate due to the transverse fetal presentation. A fetus in a transverse lie cannot be delivered vaginally because the largest diameter of the fetus is positioned across the maternal pelvis. This presentation poses a significant risk of complications, including uterine rupture, necessitating a cesarean delivery.

Choice B rationale

This patient is not a good candidate because a history of multiple cesarean sections increases the risk of uterine rupture during a trial of labor. While a previous low-transverse uterine incision is generally considered a good candidate for TOLAC, the increased number of prior cesareans significantly raises the risk profile.

Choice C rationale

This patient is an ideal candidate for TOLAC. The previous cesarean section was for a non-recurring indication (breech presentation), not for a cephalo-pelvic disproportion. The estimated fetal weight is within a normal range, and the patient has a single previous low-transverse uterine incision, which is the safest type for a trial of labor.

Choice D rationale

This patient is not a good candidate for TOLAC because a previous classical vertical uterine incision has a significantly higher risk of uterine rupture during labor. This type of incision involves the contractile part of the uterus, and the scar is more likely to dehisce under the stress of uterine contractions, making TOLAC contraindicated.

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A patient in labor arrives at labor and delivery complaining of intense pain with contractions in her lower abdomen and perineal area. What does the nurse suspect?

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Naxlex Comprehensive Predictor Exams

From Gatbe S, Noyt L4 Smpson, poor ceaes Aomal and probem pregnanoies (h e Piladepna Chrh LNngstone), which technique is the nurse employing in the above picture to resolve shoulder dystocia?

Correct Answer is B

Explanation

Which of the following patients does the nurse recognize as a good candidate for a trial of labor after cesarean (TOLAC) and possible VBAC (vaginal birth after cesarean)?

Correct Answer is C

Explanation

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A patient in labor arrives at labor and delivery complaining of intense pain with contractions in her lower abdomen and perineal area.
What does the nurse suspect?