Which of the following pregnancy complications could explain the changes seen in the fetal heart tracing above?
Preeclampsia.
Placental abruption.
Breech positioning.
Hypotension.
Cord compression.
The Correct Answer is E
Choice A rationale
Preeclampsia is a hypertensive disorder of pregnancy that can lead to uteroplacental insufficiency. This condition would most likely cause late decelerations in the fetal heart tracing, as it results in decreased blood flow to the placenta and an inability to compensate during contractions. The tracing is not available, but the choice is being rationalized based on the most likely cause.
Choice B rationale
Placental abruption is the premature separation of the placenta from the uterine wall. This can lead to a variety of fetal heart tracing abnormalities, including severe variable decelerations, late decelerations, or a sinusoidal pattern, often accompanied by uterine hyperactivity. The resulting fetal distress is due to decreased placental surface area for gas exchange.
Choice C rationale
Breech positioning refers to a fetus presenting buttocks or feet first. While it can complicate labor and delivery, it is not a direct cause of a specific fetal heart rate pattern. Fetal heart rate changes in a breech presentation are typically related to cord prolapse or compression during labor, not the position itself.
Choice D rationale
Hypotension in the mother can lead to decreased placental perfusion, as seen with epidural anesthesia. This can cause late decelerations in the fetal heart rate tracing due to uteroplacental insufficiency. It is a common cause of fetal distress but is more directly related to maternal blood pressure than to a specific fetal heart rate pattern.
Choice E rationale
Cord compression is a mechanical issue that obstructs blood flow through the umbilical cord. It is the most common cause of variable decelerations, which are abrupt, visually apparent decreases in the fetal heart rate. The tracing, though not available, would likely show these variable decelerations in this context.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
General anesthesia, particularly with halogenated inhalational agents, can cause uterine atony. These agents act as uterine smooth muscle relaxants, which can prevent the uterus from contracting effectively after birth. A relaxed, or atonic, uterus is the most common cause of postpartum hemorrhage because it cannot compress the blood vessels at the placental site, leading to uncontrolled bleeding.
Choice B rationale
A pudendal block provides anesthesia to the perineum, vulva, and lower vagina by injecting an anesthetic into the pudendal nerves near the ischial spines. It does not affect the uterine muscle or its contractility. Therefore, a pudendal block would not contribute to uterine atony or increase the risk of postpartum hemorrhage from a relaxed uterus.
Choice C rationale
An epidural provides regional anesthesia by blocking nerve impulses in the lower spinal segments. While high concentrations of anesthetic agents can have a mild effect on uterine contractility, modern low-dose epidurals typically do not significantly impair uterine muscle tone. The risk of postpartum hemorrhage from uterine atony is not as high with epidural anesthesia as it is with general anesthesia.
Choice D rationale
Local anesthesia, such as a perineal infiltration for an episiotomy or repair, involves injecting an anesthetic directly into the tissues of the perineum. This localized effect does not circulate systemically in a way that would relax the uterine smooth muscle. Therefore, local anesthesia would not contribute to a relaxed uterus or postpartum hemorrhage.
Correct Answer is D
Explanation
Choice A rationale
While many inductions of labor are performed for medical reasons, such as preeclampsia or post-term pregnancy, not all are. Elective inductions, performed for non-medical reasons, are also common, although they are associated with certain risks. The decision to induce labor is a medical one, but the indication is not always strictly medical, making this statement inaccurate.
Choice B rationale
A trial of labor (TOL) is a term used specifically for patients who have had a prior cesarean section and are attempting a vaginal delivery. It is also known as a TOLAC (Trial of Labor After Cesarean). Induction of labor is a broader term and refers to stimulating contractions before the spontaneous onset of labor. The two terms are not synonymous.
Choice C rationale
Induction of labor is a process initiated by methods like oxytocin infusion or prostaglandin gels. Internal and external version are procedures used to change the fetal presentation (e.g., from breech to cephalic) and are not methods for initiating labor. These procedures may be followed by induction, but they are not the induction methods themselves.
Choice D rationale
The Bishop score is a scoring system used to predict the likelihood of a successful induction of labor. It assesses five components: cervical dilation, effacement, consistency, position, and fetal station. A higher Bishop score (typically 8 or greater) indicates a more favorable cervix and a greater chance of successful induction, making this a crucial assessment tool.
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