Immediately before an amniotomy, the external fetal heart rate monitor tracing shows a baseline of 145 bpm, moderate variability, and no decelerations.
Immediately following the procedure, the tracing shows a fetal heart rate of 100 bpm, moderate variability, and recurrent variable decelerations.
A moderate amount of clear, amniotic fluid is seen on the bed linens.
The nurse suspects which of the following complications has occurred?

The condition of imminent delivery is correct because the client, gravida 5 para 4 at 39 weeks gestation, is experiencing strong contractions and rectal pressure indicative of advanced labor stages. The physical examination supports active labor, with a firm, palpable uterus, and fetal heart rate present. The urgency of notifying the healthcare provider and encouraging bearing down aligns with labor management in advanced stages. Cervical dilation is essential to assess labor progression, and fetal heart rate monitoring ensures fetal well-being during delivery.

Actions and Parameters Rationale:

1. Notifying the healthcare provider immediately ensures timely medical intervention, crucial for safe delivery and management of any complications.
2. Encouraging the client to bear down with contractions aids the birthing process by utilizing the client’s natural efforts in the expulsion phase of labor.
3. Monitoring cervical dilation provides insight into how far along the client is in labor, helping to anticipate the time of delivery.
4. Continuous monitoring of fetal heart rate ensures the baby's well-being, detecting any distress during labor.

Incorrect Conditions:

1. Preterm labor (A): The client is at 39 weeks gestation, so the labor is not preterm.
2. Placental abruption (B): There are no signs of placental abruption, such as vaginal bleeding, uterine tenderness, or abnormal fetal heart rate patterns.
3. Prolapsed umbilical cord (C): There is no indication of a prolapsed cord, such as sudden fetal distress or visible/palpable cord.

Choice A rationale

Laminaria acts by absorbing fluid from surrounding tissue and expanding. It is made from dried seaweed and is used for cervical ripening. The expansion of Laminaria dilates the cervix mechanically, which can be useful for procedures like abortion or labor induction. The absorbent properties help create a natural dilation process.

Choice B rationale

Laminaria is not used for an amniotomy. Amniotomy involves rupturing the amniotic sac, usually done with a specialized tool like an amnihook. Laminaria, on the other hand, is used for its mechanical dilating properties, not for breaking the amniotic sac.

Choice C rationale

Laminaria is not a prostaglandin. Prostaglandins are hormone-like substances used to soften and thin the cervix, usually administered as a gel or insert. Laminaria works differently by physically expanding rather than chemically altering the cervix.

Choice D rationale

Laminaria is not a tablet that is swallowed. It is inserted into the cervical canal to promote dilation. Its mode of action is mechanical expansion, which is different from oral medications designed to induce labor or ripen the cervix.