Sherpath: Chapter 17, Labor and Birth Complications: Intrapartum Complications

Question 1 of 9

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In which situation is there an increased likelihood for prolonged labor?

• • The woman is a teen mother.Advanced maternal age, not teen pregnancy, increases the likelihood of prolonged labor.
• Correct
  • The woman is nulliparous.A woman who has never before given birth vaginally is at increased risk for prolonged labor.
• • The woman has been diagnosed with an incompetent cervix.An incompetent cervix increases a woman’s risk for precipitous labor and delivery, not prolonged labor.
• • The woman has a history of postpartum hemorrhage.A history of postpartum hemorrhage does not increase a woman’s risk for prolonged labor.

Question 2 of 9

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A nurse caring for a patient immediately postpartum after a precipitate labor would monitor the patient for which possible postpartum complication related to her precipitate labor?

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  • Retained placentaA patient who experiences precipitate labor is at increased risk for retained placenta secondary to a rapid delivery.
• • InfectionA patient who experiences prolonged labor is at increased risk for infection.
• • Low Apgar scoresA baby who experiences prolonged labor is at increased risk for low Apgar scores.
• • Postpartum depressionPrecipitate labor does not increase a woman’s risk for postpartum depression.

Question 3 of 9

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Which conditions are possible causes of dysfunctional labor?

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  • Psychological dysfunction and fearMaternal psychological problems can lead to a cascade of physiologic responses that can prolong labor.
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  • Absence of a void in 6 hoursA full bladder is a possible cause because it causes maternal soft tissue obstruction.
• • Rapid descent of the fetal head and small partsRapid descent leads to precipitate labor, not prolonged or dysfunctional labor.
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  • An abnormally shaped maternal pelvisAn abnormally shaped maternal pelvis can cause dysfunctional contractions and slow labor progress.
• • Meconium-stained amniotic fluidDysfunctional labor can result in meconium-stained amniotic fluid. but the presence of meconium is not a cause of dysfunctional labor.
• • Use of oxytocin to augment laborUsing oxytocin can help treat a dysfunctional labor but will not cause it.

Question 4 of 9

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A nurse caring for a patient experiencing maternal exhaustion who desires a natural labor would implement which intervention to promote normal labor progress and decrease fatigue?

• • Limit intravenous fluids (IV) to prevent overhydration.Administering IV fluids as prescribed can help decrease maternal exhaustion by ensuring proper hydration and fluid and electrolyte balance.
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  • Encourage the patient to take a warm shower or bath.Hydrotherapy is an effective way to promote rest and relaxation in the laboring patient.
• • Insert an indwelling urinary catheter so the patient does not have to ambulate as frequently.An indwelling urinary catheter is not indicated in this situation and may even cause harm.
• • Restrict visitation to given time intervals to allow for sleep.Restricting visitors, especially support persons, may cause added stress to the patient.

Question 5 of 9

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A G4/P3 patient experiencing precipitate labor presents to the labor wing fully dilated and at +1 station stating that she feels a strong, involuntary urge to push. Which immediate intervention would the nurse take?

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  • Encourage the patient to push in a side-lying position.Birth is imminent, and the nurse is responsible for assisting with a safe delivery. A side-lying position enhances placental blood flow and reduces the effects of aortocaval compression associated with a supine position. Side lying slows the rapid fetal descent and minimizes perineal tears.
• • Initiate an oxytocin infusion to prevent postpartum hemorrhage.Oxytocin is not indicated before the birth of this infant, and initiating the infusion may even cause harm.
• • Assess for umbilical cord prolapse.Birth is imminent, and the patient is likely to deliver very soon. Umbilical cord prolapse, although very serious, is also rare. The priority at this time is to assist with a safe delivery in a safe position for the mother and baby.
• • Allow the fetus to rest and descend until birth is imminent.The patient is experiencing an involuntary urge to push, which suggests birth is already imminent.

Question 6 of 9

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Which measures should the nurse ensure are available and ready before a multiple gestation twin delivery?

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  • An operating room set up for vaginal and cesarean deliveryIn the event of an emergency or the need for an urgent cesarean delivery, multiple gestation deliveries are often done in the operating room, even when the planned delivery route is vaginal.
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  • Neonatal health care providers capable of advanced resuscitation for each babyWhether delivery is vaginal or cesarean, the neonatal care staff must be prepared for the care and possible resuscitation of multiple infants. Cord clamps, bulb syringes, radiant warmers, and resuscitation equipment must be prepared for each infant. A neonatal care team of nurses, a neonatal nurse practitioner, and a pediatrician or a neonatologist should be available for each infant, with another nurse caring for the mother.
• • A single infant warmer with supplies for each infantTwo infant warmers should be available in the event that resuscitation is necessary of one or both babies.
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  • Two separate infant warmers with separate supplies for each babyTwo infant warmers should be available in the event that resuscitation is necessary of one or both babies.
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  • A fetal monitor with the capacity to monitor two babies at the same timeDuring labor, each fetus’s FHR is monitored separately. While resting in bed, the patient should be in a lateral position to promote placental blood flow. Assessment of each FHR continues until delivery.

Question 7 of 9

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A G1/P0 gestational diabetic mother is undergoing induction of labor. She is in her 39th week of gestation, and she has been diagnosed with polyhydramnios. The nurse recognizes which patient cue as a risk factor for umbilical cord prolapse?

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  • PolyhydramniosAn excessive amount of amniotic fluid, as with polyhydramnios, increases the risk for umbilical cord prolapse in labor.
• • Being a primigravidaPrimigravidas do not have an increased risk for umbilical cord prolapse.
• • Gestational diabetesGestational diabetes increases a patient’s risk for a large infant, among other things, but does not increase the risk for umbilical cord prolapse.
• • Term gestationTerm gestation is not a risk for umbilical cord prolapse.

Question 8 of 9

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A G5/P4 laboring patient with suspected fetal intrauterine growth restriction has just experienced spontaneous rupture of membranes. On examination, the nurse notes that the cervix is dilated 3 cm and is 70% effaced and that the fetal station is 0. Fetal heart tracing shows recurrent and severe variable decelerations. Which explanation is the most likely cause for this change in fetal heart rate?

• • High fetal stationThis fetal station is 0, which means that the fetus is engaged in the maternal pelvis and is not high.
• Correct
  • Umbilical cord prolapseRecall that umbilical cord prolapse may be “hidden” or otherwise not palpable during a cervical or vaginal examination. This patient has a very small fetus, and she just experienced rupture of membranes, both of which are cues indicating an increase in the risk for umbilical cord prolapse. Variable decelerations and bradycardia also accompany umbilical cord prolapse.
• • Fetal intrauterine growth restrictionFetuses with growth restrictions may be more vulnerable to decelerations, but the most likely cause for the sudden change in fetal heart rate at this time is umbilical cord prolapse.
• • Grand multiparityGrand multiparity is not a known cause of sudden-onset, severe, recurrent variable decelerations.

Question 9 of 9

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During an emergency cesarean section, which interventions can help minimize maternal risk?

• • Eliminating surgical instrument counts to expedite the procedureIf time and personnel allow, surgical counts should not be eliminated, even in an emergent procedure. Eliminating counts would increase maternal risk.
• Correct
  • Administering antibiotics before skin incisionAdministering antibiotics prior to skin incision is a standard of care, and it helps to prevent postoperative infection.
• • Performing the Foley catheter insertion using clean technique to expedite the procedureEmergency or routine, a Foley catheter should always be inserted using sterile technique, not clean technique. Using clean technique increases maternal risk.
• Correct
  • Performing an interdisciplinary time-out before skin incisionAn interdisciplinary time-out allows for proper patient identification, interdisciplinary collaboration, and identification of patient-specific surgical risks and allergies, and it helps minimize maternal risk.
• • Having a prewarmed isolette available for the birthHaving a prewarmed isolette ready for the birth will help minimize the risk for neonatal hypothermia after an emergency cesarean section, but it does not decrease maternal risk.