Which of the following pictures represents a transverse lie of the fetus?

Choice A rationale

Checking urinary output is an important part of overall patient care to assess hydration status and kidney function. However, it is not a direct or immediate intrauterine resuscitation measure for addressing late decelerations, which are a sign of uteroplacental insufficiency and require interventions to improve oxygenation and blood flow to the fetus.

Choice B rationale

Cardiopulmonary resuscitation (CPR) is a life-saving procedure performed when a person's heart stops beating or they stop breathing. It is not an appropriate intervention for a laboring mother with late decelerations unless she experiences a cardiopulmonary arrest herself, which is not indicated by this fetal heart rate pattern.

Choice C rationale

Repositioning the mother onto her side, especially the left side, shifts the weight of the gravid uterus off the inferior vena cava and aorta. This action scientifically improves venous return to the heart and increases cardiac output, thereby enhancing blood flow and oxygen delivery to the placenta and fetus, which can resolve late decelerations.

Choice D rationale

Increasing IV fluids expands the maternal circulating blood volume, which can improve placental perfusion. This increase in intravascular fluid volume leads to a rise in maternal cardiac output and blood pressure, thereby increasing the flow of oxygenated blood to the intervillous spaces of the placenta, addressing the root cause of late decelerations.

Choice E rationale

Applying a non-rebreather oxygen mask to the mother at a flow rate of 8 to 10 liters per minute increases the oxygen saturation of the maternal blood. This higher concentration of oxygen is then delivered to the placenta, increasing the oxygen available for transfer to the fetus and thereby addressing the fetal hypoxemia that is causing the late decelerations. .

Choice A rationale

Normal fetal heart rate variability indicates a healthy, well-oxygenated fetus with a functioning autonomic nervous system. This is a reassuring pattern and would not be the expected outcome of a fentanyl injection, which is known to depress the central nervous system, leading to a decrease in variability.

Choice B rationale

Early decelerations are a benign physiological response caused by head compression during a contraction. They are characterized by a gradual decrease in heart rate that mirrors the contraction and are not associated with uteroplacental insufficiency or the effects of fentanyl.

Choice C rationale

The administration of a narcotic like fentanyl, a central nervous system depressant, can reduce fetal heart rate variability. Loss of variability coupled with late decelerations is a key indicator of uteroplacental insufficiency, which is a concern after some pain medication administrations and requires immediate intervention to improve fetal oxygenation.

Choice D rationale

Variable decelerations are abrupt decreases in the fetal heart rate caused by umbilical cord compression. The shape, depth, and duration of these decelerations are variable, and they are not typically the primary pattern associated with either uteroplacental insufficiency or the direct central nervous system depressant effects of fentanyl.