You are evaluating the fetal monitor tracing of your patient, who is in active labor.

Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 beats/min down to 80 beats/min.

You reposition the mother, provide oxygen, increase intravenous (IV) fluid, and perform a vaginal examination.

The cervix has not changed.

Five minutes have passed, and fetal heart rate remains in the 80s.
What priority nursing measures should you take?

Choice A rationale

Fundal massage is the primary intervention for postpartum hemorrhage caused by uterine atony. Souring a pad in 15 minutes indicates excessive bleeding, often due to a relaxed uterus. Massaging the fundus stimulates uterine muscle contractions, which constrict open blood vessels at the placental site. This action helps the uterus become firm and stops the hemorrhage. It is the fastest, non-invasive way to stabilize the patient before moving to secondary medical or pharmacological interventions.

Choice B rationale

Starting an intravenous infusion of Ringer's lactate is a supportive measure used to maintain circulating blood volume and replace lost fluids. While necessary if the patient becomes hemodynamically unstable or requires oxytocin administration, it does not address the root cause of the bleeding. The immediate priority is to stop the active blood loss through uterine contraction. Fluid resuscitation should follow or occur simultaneously with the physical assessment and stabilization of the uterine muscle tone.

Choice C rationale

Notifying the primary health care provider is essential when a patient experiences significant postpartum bleeding, but it is not the first action. The nurse must first perform life-saving interventions and gather assessment data to report. Delaying fundal massage to make a phone call allows continued blood loss, potentially leading to hypovolemic shock. Standard nursing protocols dictate that the nurse stabilizes the patient using standing orders or immediate physical interventions before seeking further medical direction.

Choice D rationale

Assessing vital signs provides data on the patient's systemic response to blood loss, such as tachycardia or hypotension. Normal blood pressure is typically 120÷80 mmHg and pulse 60 to 100 beats per minute. However, vital signs are often late indicators of shock in postpartum women due to increased blood volume. While important for the overall assessment, taking vitals takes more time than performing a fundal massage, which can immediately stop the source of the hemorrhage.

Choice A rationale

Pregnancy creates a hypercoagulable state due to increased coagulation factors and venous stasis from the enlarging uterus. Prolonged immobility during travel or work significantly raises the risk of deep vein thrombosis and pulmonary embolism. Walking every 2 hours promotes venous return by engaging the calf muscle pump, which helps prevent blood pooling in the lower extremities. This practice is essential for maintaining systemic circulation and ensuring optimal placental perfusion throughout the gestational period.

Choice B rationale

Safety restraints are mandatory for pregnant women to prevent maternal and fetal injury during motor vehicle accidents. The lap belt should be positioned low under the abdomen and across the bony pelvis, while the shoulder harness should be placed between the breasts. Research shows that maternal survival is the primary determinant of fetal survival in crashes. Avoiding seat belts increases the risk of ejection or blunt force trauma to the uterus during sudden deceleration.

Choice C rationale

Modern airport security metal detectors utilize low frequency electromagnetic fields to detect metallic objects. These devices do not use ionizing radiation, such as X-rays, which are known to be teratogenic in high doses. Extensive studies have confirmed that the non-ionizing energy emitted by metal detectors is safe for the developing fetus and does not cause chromosomal damage or developmental anomalies. Advanced imaging technology used at airports is also regulated to remain within safe limits.

Choice D rationale

Sitting for extended periods is contraindicated as it exacerbates venous congestion and increases the risk of edema and varicosities. Crossing the legs at the knees is particularly harmful because it further compresses the popliteal veins, obstructing blood flow and increasing the likelihood of thrombus formation. Pregnant women are encouraged to keep their legs uncrossed and to perform ankle pumps or frequent standing breaks to facilitate the movement of blood from the periphery back to the heart.