Which of the following statements should a nurse include in vehicle safety education to the parents of a premature newborn?

Choice A reason: Spontaneous rupture of membranes indicates labor progression but does not directly guide oxytocin titration. Oxytocin stimulates uterine contractions, and titration depends on contraction strength and frequency, not membrane status. Rupture enhances labor but lacks specificity for adjusting oxytocin, as it does not reflect myometrial response or contraction adequacy.

Choice B reason: A Bishop score of 2 indicates an unfavorable cervix, suggesting the need for cervical ripening, not immediate oxytocin titration. Oxytocin efficacy depends on contraction patterns, not cervical readiness alone. The score assesses dilation and effacement, but titration requires monitoring uterine response, making this finding irrelevant for adjusting the infusion rate.

Choice C reason: Mild contractions indicate inadequate uterine response to 1 milliunit/min of oxytocin, warranting titration to 2 milliunits/min to achieve an expected labor pattern. Oxytocin stimulates myometrial contractions, and mild intensity suggests insufficient stimulation. Increasing the dose enhances contraction strength and frequency, aligning with labor induction protocols to promote effective labor.

Choice D reason: Contractions every 1 minute indicate hyperstimulation, risking fetal distress due to reduced placental perfusion. Oxytocin titration aims for contractions every 2-3 minutes. This frequency suggests excessive uterine activity, requiring a decrease or pause in oxytocin, not an increase, to prevent hypoxia and ensure fetal safety during labor.

Choice A reason: The Tdap vaccine (diphtheria-acellular pertussis) is recommended at 27-36 weeks to transfer maternal antibodies, protecting newborns from pertussis. Pertussis causes severe respiratory illness in infants, and maternal immunization boosts IgG antibodies, crossing the placenta to provide passive immunity until the infant’s vaccination, per immunological guidelines.

Choice B reason: Varicella vaccine, a live-attenuated virus, is contraindicated in pregnancy due to theoretical fetal risks. Live vaccines can cross the placenta, potentially causing congenital varicella syndrome, affecting fetal development. Vaccination is deferred until postpartum to avoid these risks, as the immune response could harm the fetus, per obstetric immunization protocols.

Choice C reason: Human papillomavirus (HPV) vaccine is not recommended during pregnancy, as its safety is unestablished. HPV vaccination prevents cervical cancer, not perinatal infections, and is deferred until postpartum. The vaccine’s inactivated nature poses no direct fetal risk, but lack of pregnancy-specific efficacy data prioritizes other vaccines like Tdap and influenza.

Choice D reason: Measles, mumps, and rubella (MMR) vaccine, a live-attenuated virus, is contraindicated in pregnancy due to risks of congenital rubella syndrome, which causes fetal anomalies. The immune response could theoretically affect fetal development, so vaccination is postponed until postpartum to ensure maternal immunity without compromising fetal safety, per immunization guidelines.

Choice E reason: Inactivated influenza vaccine is recommended during pregnancy, ideally in the second or third trimester, to protect against flu-related complications. Influenza increases maternal morbidity and preterm birth risk. The vaccine stimulates IgG production, crossing the placenta to provide neonatal immunity, reducing respiratory illness risks in both mother and infant, per obstetric protocols.