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?

Choice A rationale

A fetus in the left sacroanterior (LSA) position has its sacrum, or buttocks, pointing toward the mother's left side and toward the front of her pelvis. The fetal heart is typically located in the fetal chest, and with a breech presentation (sacrum first), the fetal heart is located higher in the uterus, often above the umbilicus, which explains why the nurse hears the fetal heart rate in that location.

Choice B rationale

A fetus in the left occipitoanterior (LOA) position has its occiput, or back of the head, pointing toward the mother's left side and toward the front of her pelvis. In this vertex presentation, the fetal head is typically in the lower uterine segment, and the fetal heart would be heard below the mother's umbilicus, not above it.

Choice C rationale

A fetus in the right occipitoanterior (ROA) position has its occiput, or back of the head, pointing toward the mother's right side and toward the front of her pelvis. Similar to LOA, this is a vertex presentation. The fetal heart is typically heard below the mother's umbilicus and on her right side, not above it and on her left side.

Choice D rationale

A fetus in the right occipitoposterior (ROP) position has its occiput, or back of the head, pointing toward the mother's right side and toward the back of her pelvis. This is also a vertex presentation. The fetal heart would be heard below the mother's umbilicus and on her right side, not above it and on her left side.

Choice A rationale

Tocolytic drugs, such as beta-adrenergic agonists (e.g., terbutaline) or magnesium sulfate, work by inhibiting uterine contractions. They do not possess any antimicrobial properties or mechanisms to protect the fetus from infection. Prophylactic antibiotics, not tocolytics, are administered to prevent or treat infections, especially in cases of prolonged rupture of membranes. The primary action is solely on smooth muscle relaxation, not immune response.

Choice B rationale

Tocolytic drugs function as uterine relaxants, suppressing uterine muscle contractions to delay preterm birth. Tying the cervix closed, a procedure known as a cerclage, is a surgical intervention used to prevent miscarriage or preterm birth in women with cervical insufficiency. This is a structural solution, completely different from the pharmacological mechanism of tocolytics which acts on smooth muscle cells.

Choice C rationale

Tocolytic medications delay labor, providing a crucial window to administer antenatal corticosteroids like betamethasone or dexamethasone. These corticosteroids require 24 to 48 hours to be effective, crossing the placenta to accelerate fetal lung maturity by stimulating surfactant production. This reduces the risk of respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis in the preterm infant.

Choice D rationale

Tocolytic drugs do not prevent the rupture of membranes. The rupture of membranes, known as amniorrhexis, is a physical event caused by the breakdown of the amniotic sac. Tocolytics act on the uterine muscle to inhibit contractions, which is a different physiological process. They can sometimes be used after membranes have ruptured to delay delivery, but they don't prevent the rupture itself.