When working with a woman who has just experienced a fetal demise you should offer supportive care, give her the opportunity to grieve, and provide for a chaplain to come in if the patient wants one. You know that the Chaplain is non-denominational and can also provide comforting words.

A. Midplane contracture of the pelvis. Pelvic contractures can lead to dystocia by restricting the fetal head's descent. A midplane contracture narrows the pelvic midsection, making labor prolonged and difficult. This is a common cause of dystocia.

B. Disproportion of the pelvis. Cephalopelvic disproportion (CPD), where the fetal head is too large for the maternal pelvis, is a well-known cause of dystocia. It often results in prolonged labor, failure to progress, and the need for cesarean delivery.

C. Low-lying placenta. A low-lying placenta does not directly cause dystocia. Instead, it may lead to placenta previa, which often requires cesarean delivery before labor even begins. Since it does not typically cause prolonged or difficult labor, it is the least common cause of dystocia.

D. Compromised bearing-down efforts as a result of pain medication. Excessive pain medication, especially epidurals or narcotics, can weaken maternal pushing efforts, leading to prolonged second-stage labor. This is a recognized cause of dystocia, particularly in multiparous women.

A. Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. While systemic analgesics do cross the placenta, they actually affect the fetus more readily than the mother because the fetal liver and kidneys are immature, making drug metabolism and excretion slower. This leads to prolonged effects on the newborn.

B. Effects on the fetus and newborn can include decreased alertness and delayed sucking. Opioid analgesics, such as fentanyl, meperidine, or morphine, can cause neonatal respiratory depression, reduced alertness, and difficulty initiating breastfeeding due to delayed sucking reflex. If administered too close to delivery, the newborn may require respiratory support or naloxone to reverse opioid effects.

C. Intravenous (IV) patient-controlled analgesia (PCA) results in increased use of an analgesic. PCA allows controlled dosing of pain medication, often leading to less total medication use because the patient receives smaller, more frequent doses rather than large, single doses. This helps maintain stable pain control without excessive sedation.

D. Intramuscular (IM) administration is preferred over IV administration. IV administration is preferred over IM because it provides faster pain relief and better dose control. IM injections have delayed absorption and an unpredictable effect, making IV the preferred route for labor analgesia.