You are completing the initial prenatal intake for your newly pregnant G3P2 client.
She states her last labor ended in an emergency cesarean section due to cord prolapse.
She asks if she would be a candidate for a TOLAC (trial of labor after cesarean). Based upon your assessment of her records, which of the following would be a contraindication for a TOLAC?
History of preeclampsia.
History of classical uterine incision during cesarean.
History of cord prolapse.
History of one cesarean section.
The Correct Answer is B
Choice A rationale
History of preeclampsia is a consideration in future pregnancies, but it is not an absolute contraindication for a trial of labor after cesarean (TOLAC). Each case should be individually evaluated based on the severity and recurrence risk.
Choice B rationale
History of classical uterine incision during cesarean is a contraindication for TOLAC due to the increased risk of uterine rupture during labor. A classical incision involves a vertical cut on the upper uterus, which is more prone to rupture compared to a lower transverse incision.
Choice C rationale
History of cord prolapse is a serious complication, but it does not inherently contraindicate TOLAC. Future labor and delivery plans should involve close monitoring and readiness to address any recurrence of cord prolapse.
Choice D rationale
History of one cesarean section is not a contraindication for TOLAC. In fact, many women with a single previous cesarean delivery are considered good candidates for a trial of labor, depending on other factors and the type of uterine incision. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Vacuum-assisted delivery is typically used when there is some progress in the labor process and the fetal head is engaged. In cases of cephalopelvic disproportion, vacuum assistance would be ineffective and potentially harmful.
Choice B rationale
Cesarean delivery is recommended in cases of cephalopelvic disproportion when the fetus cannot safely pass through the maternal pelvis. This surgical intervention helps to prevent complications for both the mother and the baby.
Choice C rationale
Antibiotic administration is used to prevent or treat infections but does not address the mechanical issue of cephalopelvic disproportion, which is preventing the progression of labor.
Choice D rationale
Discharge to home is not a safe option when cephalopelvic disproportion is suspected. Immediate intervention is necessary to ensure the health and safety of both the mother and the fetus.
Correct Answer is C
Explanation
Choice A rationale
Preparing the client for an urgent cesarean section is not immediately necessary unless there are signs of fetal distress or other complications. Hypotonic uterine contractions may be managed with medical interventions to stimulate labor.
Choice B rationale
Discussing the client's gynecoid-shaped pelvis is irrelevant to the immediate management of hypotonic uterine contractions. While pelvic shape can influence labor, the focus should be on addressing the uterine contractions.
Choice C rationale
Amniotomy, or artificial rupture of membranes, can help to increase the strength and frequency of contractions in clients with hypotonic uterine contractions. This intervention can stimulate labor progress.
Choice D rationale
Keeping the client on bedrest is not a primary intervention for hypotonic uterine contractions. Encouraging activity and medical interventions to enhance contractions are more appropriate.
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