The nurse is assessing a patient who is 28 weeks pregnant and complaining of intermittent back pain and pelvic pressure.
Which of the following should the nurse expect to be done? Select all that apply.

Choice A rationale

While monitoring for contractions is important, the most critical assessment is the fetal heart rate. Contractions can occur during and after the procedure, but their presence alone is not as indicative of fetal well-being or distress as a change in the fetal heart rate. The contractions themselves are expected and a direct result of the manipulation of the uterus.

Choice B rationale

Checking the amniotic fluid volume is typically done via ultrasound prior to the procedure to ensure there's enough fluid for the fetus to be mobile. A version is contraindicated if there is insufficient fluid (oligohydramnios). However, this is a pre-procedure assessment, and a real-time assessment during and after the procedure is focused on the fetal response.

Choice C rationale

During a version, the fetus is manually repositioned, which can cause transient umbilical cord compression or placental abruption. Monitoring the fetal heart rate is paramount to detect signs of fetal distress, such as bradycardia or persistent decelerations, which would necessitate immediate cessation of the procedure. This assessment is the most direct indicator of fetal tolerance.

Choice D rationale

Monitoring for vaginal bleeding is important post-procedure to detect a placental abruption, which is a potential complication. However, changes in the fetal heart rate are often the earliest and most direct sign of fetal compromise and should be monitored continuously, both during and immediately after the procedure. Vaginal bleeding may be a later sign.

Choice A rationale

Suprapubic pressure involves applying downward pressure just above the pubic bone on the mother's abdomen. This maneuver is used to dislodge the anterior fetal shoulder, which is wedged behind the symphysis pubis. The pressure helps to adduct the fetal shoulder, reducing its diameter and allowing it to pass beneath the pubic bone.

Choice B rationale

MacBeth's maneuver is not a recognized obstetric maneuver for resolving shoulder dystocia. Recognized techniques for this emergency include McRoberts maneuver, suprapubic pressure, and Gaskin's maneuver. The lack of a scientific basis or formal obstetric recognition makes this a non-viable option for clinical practice.

Choice C rationale

Fundal pressure, or applying pressure to the top of the uterus, is contraindicated in cases of shoulder dystocia. This action can further wedge the fetal shoulder against the symphysis pubis, increasing the risk of fetal injury, such as a brachial plexus injury, or causing uterine rupture. It is a dangerous and ineffective maneuver.

Choice D rationale

McRoberts maneuver is a first-line intervention for shoulder dystocia. It involves hyperflexing the mother's hips and bringing her thighs toward her abdomen. This position straightens the sacrum relative to the lumbar spine, which rotates the symphysis pubis cephalad, widening the pelvic inlet and allowing the anterior shoulder to pass more easily.