Angelica Jane A.

Suan Block CCC - NSG 124 March 12, 2024

Individual Activity #5: Short Answer for Nursing Care of the Client during Labor and
Delivery
TOTAL: 246~240
Rubric for Short Answer:
5- CORRECT ANSWER and EXPLANATION/ RATIONALE, with complete details.
3- CORRECT ANSWER and EXPLANATION/ RATIONALE, but lacking details.
1- INCORRECT ANSWER and NO EXPLANATION/ RATIONALE.
***1 point for Identification
I. Complications With the Power (The Force of Labor)
1. Differentiate Hypotonic from Hyertonic contractions. (5pts)

Hypotonic Contractions: Hypertonic Contractions:

In hypotonic contractions, the muscle
tension is insufficient to overcome the
resistance against it. This typically
occurs when the load or resistance is
too great for the muscle to overcome,
resulting in the muscle lengthening
under tension. Hypotonic contractions
are often seen in situations where the
load exceeds the muscle's capacity to
generate force, leading to muscle
elongation rather than shortening.
In hypertonic contractions, the muscle
tension is excessive, causing
sustained muscle contraction without
relaxation.This occurs when the
muscle generates more force than the
resistance it's working against, leading
to the muscle shortening under
tension. Hypertonic contractions are
often observed in situations where the
muscle is overactive or where there is
neurological dysfunction causing
sustained muscle activation.

2. What is the priority nursing intervention in caring for the client with hypertonic
uterine dysfunction? The nurse is told that the client is experiencing
uncoordinated contractions that are erratic in their frequency, duration, and
intensity. (5pts)
Provide pain relief measures. With uncoordinated contractions, more than
one pacemaker may be initiating contractions, or receptor points in the
myometrium may be acting independently of the pacemaker. Uncoordinated
contractions can occur so closely to get her that they can interfere with the blood
supply to the placenta. Because they occur so erratically, such as one on top of
another and then a long period without any. It may be difficult for a woman to rest
between contractions or to breathe effectively with contractions. Applying a fetal
and uterine external monitor and assessing the rate, pattern, restingtone, and
fetal response to contractions for 15 minutes (or longer if necessary in early
labor) reveals the abnormal pattern. Oxytocin administration may be helpful in
uncoordinated labor to stimulate a more effective and consistent pattern of
contractions with a better, lower resting tone.

3. What does a distinct abdominal indentation during the 1st stage of labor indicate?
(5pts)
In a difficult labor, particularly if the fetus is larger than the birth canal, the
round ligaments of the uterus become tense and may be palpable on the
abdomen. The normal physiologic retraction ring may become prominent and
observable as an abdominal indentation. Termed a pathologic retraction ring
or Band's ring, it is a danger sign that signifies impending rupture of the lower
uterine segment if the obstruction to labor is not relieved (Malee, 2003).
For this reason, it is important to observe the contours of the abdomen
Angelica Jane A. Suan Block CCC - NSG 124 March 12, 2024

periodically during labor. Fetal heartbeat auscultation automatically provides a

regular opportunity to assess a woman's abdomen. If an electronic monitor is in
place, it is necessary to make this observation deliberately.
It Appears as a horizontal indentation across the abdomen when labor is
obstructed caused by: CPD, Uncoordinated contractions in early labor, Obstetric
manipulation, and Oxytocin use.

4. What is the best exercise for a woman in labor pain? (1pt)

Breathing exercises and Pelvic rocking
Rationale: Pelvic rocking and breathing exercises are considered beneficial for
women in labor pain due to their potential to promote optimal fetal positioning,
alleviate back pain, and encourage pelvic mobility. Pelvic rocking movements can
help the baby move into an optimal position for birth, potentially easing labor pain
and aiding in the progress of labor. Additionally, the rocking motion can provide
relief for back discomfort, a common source of pain during labor. Furthermore,
engaging in pelvic rocking can help maintain and enhance pelvic mobility,
potentially facilitating the baby's descent through the birth canal. As for breathing
exercises, they are effective in promoting relaxation, reducing stress and tension,
and enhancing oxygen intake. Focused breathing techniques, such as slow, deep
breathing or rhythmic breathing, can assist women in managing the intensity of
contractions and ensuring adequate oxygen intake for both the mother and the
baby during labor. These exercises can collectively contribute to a more
comfortable labor experience and potentially aid in the progression of labor.

5. What conditions necessitates induction of labor? (5pts)

● Hypotonic contractions: When a woman experiences hypotonic (weak)
contractions, particularly in the active phase of labor, it can lead to a prolonged or
stalled labor process. Induction of labor may be necessary to strengthen and
coordinate contractions, helping to progress the labor and facilitate a successful
vaginal delivery.
● Uncoordinated contractions: Uncoordinated contractions, also known as
dysfunctional labor, can result in ineffective uterine contractions that do not
adequately dilate the cervix or assist in the descent of the baby. Induction of
labor may be required to establish more coordinated and effective contractions,
promoting cervical dilation and descent of the baby for a successful delivery.
● Postterm birth: Postterm pregnancy, which refers to a pregnancy that has
extended beyond 42 weeks, carries an increased risk of potential complications
for both the mother and the baby. Due to the higher risk of fetal distress,
meconium aspiration, macrosomia (large baby size), and other adverse
outcomes associated with postterm birth, induction of labor is often
recommended to avoid these risks and facilitate the birth of the baby before
complications arise.

6. The drug of choice for induction of labor? (1pt)

Oxytocin (Pitocin)

7. What actions/ways augment the process of a woman’s labor? (5pts)

Administration of oxytocin, or amniotomy (artificial rupture of the
membranes), may be initiated to strengthen them. Augmentation of labor refers
to assisting labor that has started spontaneously but is not effective.
Augmentation of labor may be used if labor contractions begin spontaneously but
then become weak, irregular, or ineffective (i.e., hypotonic). Precautions
regarding oxytocin augmentation are the same as for primary oxytocin induction
 Angelica Jane A. Suan Block CCC - NSG 124 March 12, 2024

of labor. Be certain the drug is increased in small increments only and that fetal
heart sounds are well monitored during the procedure. You can also stimulate
one nipple for short periods between contractions for the release of oxytocin, a
hormone involved in the initiation and progression of labor.

8. What are the precipitating factors of Precipitate delivery? (5pts)

Precipitate birth occurs when uterine contractions are so strong a woman gives
birth with only a few, rapidly occurring contractions, often defined as labor that is
completed in fewer than 3 hours (Suzuki, 2016). Such rapid labor is likely to
occur with grand multiparity, or it may occur after induction of labor by oxytocin.

Multiple Gestation: Women Multiparity: Women who have Small Fetus: A

carrying twins or higher-order
multiples are at increased risk of
precipitate delivery due to the
presence of multiple fetuses.
Multiple gestations can lead to
increased uterine activity and
more rapid cervical dilation,
resulting in quicker labor
progression and delivery.
previously given birth are more
likely to experience precipitate
delivery, especially if their
previous labors were rapid.
Multiparity is associated with
increased uterine muscle tone
and more efficient contractions,
which can contribute to a faster
labor process.
smaller-than-average fetus
may be more easily
accommodated within the birth
canal, leading to quicker
descent and delivery.
Additionally, a smaller fetus
may require less stretching of
the cervix and vaginal tissues,
allowing for faster dilation and
effacement.

These factors contribute to the rapid progression of labor and delivery characteristic of
precipitate delivery. It's important for healthcare providers to be aware of these risk
factors and prepared to manage precipitate deliveries to ensure the safety and
well-being of both the mother and the baby.

9. What are the characteristics of Precipitate labor? (5pts)

A precipitate labor can be predicted from a labor graph if,during the active
phase of dilatation, the rate is greater than 5 cm/hr (1 cm every 12 minutes) in a
nullipara, or 10cm/hr (1 cm every 6 minutes) in a multipara. Contractions can be
so forceful they lead to premature separation of the placenta, or lacerations of
the perineum.

Faster Cervical Dilatation:
Precipitate labor is
characterized by rapid
cervical dilatation, often
progressing at a much faster
rate than typical labor. This
rapid dilation can occur within
a few hours or even minutes,
leading to a shortened first
stage of labor.
Tetanic Uterine Contractions:
Precipitate labor is often
associated with strong, intense,
and frequent uterine contractions.
These contractions may be tetanic,
meaning they are sustained
without the usual periods of
relaxation between contractions.
The intensity and frequency of
contractions contribute to the rapid
progression of labor
Sudden Birth of the Infant: One
of the hallmark features of
precipitate labor is the sudden
and rapid birth of the infant. In
some cases, the entire labor
process, from the onset of
contractions to delivery, can occur
within a few hours or less. The
rapid descent of the fetus through
the birth canal may result in a
sudden and unexpected birth,
sometimes catching healthcare
 Angelica Jane A. Suan Block CCC - NSG 124 March 12, 2024

providers and the mother by

surprise.

10. What are the treatment management of Precipitate labor and delivery? (5pts)

Tocolytic: Tocolytic Emergency Delivery of the Episiotomy as Necessary: An

medications, such as
beta-adrenergic agonists or
calcium channel blockers, may
be administered to inhibit
uterine contractions and slow
down labor progression in
cases of extremely rapid or
precipitate labor. Slowing down
labor can help prevent
complications such as uterine
rupture, fetal distress, and
maternal exhaustion. Tocolytics
may be considered if labor is
progressing too quickly for safe
delivery or if there are concerns
about maternal or fetal
well-being.
Baby: In some cases of
precipitate labor, particularly
when labor is progressing too
quickly for safe transport to a
healthcare facility, emergency
delivery of the baby may be
necessary. This may involve
assisting with the birth at home or
in transit, ensuring that
appropriate measures are taken
to support the mother and baby
during the delivery process.
Emergency delivery may be
indicated if there are signs of
imminent birth, such as crowning
or maternal urge to push, and if
immediate medical assistance is
not available.
episiotomy is a surgical incision
made in the perineum (the area
between the vagina and anus) to
enlarge the vaginal opening and
facilitate delivery. In cases of
precipitate labor where rapid
descent of the baby may increase
the risk of perineal tearing, an
episiotomy may be performed to
minimize trauma to the tissues
and promote a controlled delivery.
However, episiotomy is not
routinely performed and is
reserved for situations where it is
deemed necessary to prevent
severe perineal trauma

11. What are the maternal and fetal risks of administering Oxyctocin for induction of
labor? (5pts)
Oxytocin can cause peripheral vessel dilation, which can lead to extreme
hypotension. The second side effect of oxytocin is that it can result in decreased
urine flow, possibly leading to water intoxication. Water intoxication in its most
severe forms can lead to seizures, coma, and death. Fetal risks include fetal
bradycardia. Fetal bradycardia is a potential risk of oxytocin induction due to
uterine hyperstimulation, which can compromise fetal oxygenation and lead to
distress. Prompt monitoring and intervention are crucial to mitigate this risk and
ensure optimal maternal and fetal outcomes.

12. What are the signs and symptoms of water intoxication caused by oxytocin?
(5pts)
Water intoxication means that fluid is pooling in interstitial spaces. This
increased tension leads to headache and vomiting and mental confusion. Urine
flow would be decreased. If you observe these danger signs in a woman during
induction of labor, report them immediately and halt the infusion. Water
intoxication in its most severe forms can lead to seizures, coma, and death
because of the large shift in interstitial tissue fluid.

13. Check all that apply:

Absolute contraindications to induction of labor are: (8 points)
 Angelica Jane A. Suan Block CCC - NSG 124 March 12, 2024

Placenta previa
Transverse lie and other fetal malpresentation
Prior classic uterine incision
Pelvic structure abnormality
Prolapsed umbilical cord
Active genital herpes
Invasive cervical cancer
Cephalic presentation

Rationale:
Placenta previa: Inducing labor in the presence of placenta previa can lead to severe
maternal hemorrhage due to the location of the placenta covering the cervix.
Transverse lie and other fetal malpresentation: Induction of labor when the baby is in
a transverse lie or another malpresentation can result in complications and may
necessitate a cesarean section for safe delivery.
Prior classic uterine incision: A classic uterine incision, which is a vertical incision on
the uterus, poses a significant risk of uterine rupture during labor, making induction
contraindicated.
Pelvic structure abnormality: Certain pelvic abnormalities can obstruct the passage of
the baby through the birth canal, making induction of labor inadvisable due to the
increased risk of complications.
Prolapsed umbilical cord: If the umbilical cord has prolapsed before the baby,
induction of labor is contraindicated as it can lead to compression of the cord,
compromising the baby's oxygen supply.
Active genital herpes: In cases of active genital herpes, the risk of transmitting the
infection to the baby during a vaginal delivery is high, and therefore induction of labor
may be contraindicated.
Invasive cervical cancer: In the presence of invasive cervical cancer, induction of labor
is generally contraindicated due to the potential of disrupting the cancerous tissue and
complicating the delivery process.

14. What conditions may place the patient at high risk for uterine rupture during the
birthing process? (5pts)

Traumatic Maneuvers of Multiple Gestation: Women Obstructed Labor: Obstructed

Forceps or Traction: Traumatic
maneuvers, such as excessive
force during the use of forceps
or vacuum extraction, can put
significant stress on the uterine
wall. This may lead to uterine
rupture, especially if the uterus is
already weakened or
compromised due to factors
such as previous uterine surgery
or trauma.
carrying twins or higher-order
multiples are at increased risk of
uterine rupture due to the greater
distension and pressure placed
on the uterus by multiple fetuses.
The increased uterine stretching
and strain increase the likelihood
of uterine wall weakness and
rupture, particularly during labor
and delivery.
labor, where the fetus is unable to
descend through the birth canal
despite strong uterine
contractions, can lead to
prolonged and intense uterine
activity. This prolonged pressure
on the uterus may increase the
risk of uterine rupture, especially
if the woman has other risk
factors such as previous uterine
surgery or a history of uterine
scarring

15. Risk factor for uterine rupture include: (5 points)

multi parity
overdistention of the uterus (multifetal pregnancy)
malpresentation
Angelica Jane A. Suan Block CCC - NSG 124 March 12, 2024

previous uterine surgery

Forceps delivery

Rationale:
Multiparity: Women who have given birth multiple times may have increased uterine
distensibility and potential weakening of the uterine wall, which can elevate the risk of
uterine rupture during subsequent pregnancies and deliveries.
Overdistention of the uterus (multifetal pregnancy): When the uterus is excessively
stretched due to carrying multiple fetuses (such as twins or triplets), the risk of uterine
rupture is heightened due to the increased strain on the uterine wall.
Malpresentation: Certain abnormal fetal presentations, such as breech presentation
(buttocks or feet first), can create challenges during delivery, potentially increasing the
risk of uterine rupture, especially if interventions such as forceps or vacuum extraction
are needed.
Previous uterine surgeries: Prior surgical procedures on the uterus, particularly
cesarean section and myomectomy, can weaken the uterine wall, leading to a higher
likelihood of uterine rupture during subsequent pregnancies and deliveries.
Forceps delivery: The use of forceps during delivery, especially if not carefully
managed, can put additional stress on the uterus and increase the risk of uterine
rupture due to the force exerted on the uterine wall.

16. Differentiate Incomplete from complete uterine rupture. (5pts)

Incomplete Uterine Rupture - Complete Uterine Rupture -

In incomplete uterine rupture, only the In complete uterine rupture, all layers of
inner layers of the uterine wall tear, while the uterine wall tear, resulting in a full
the outer layer (serosa) remains intact. thickness separation of the uterine
muscle.
This type of rupture may result in a partial
separation of the uterine wall, leading to a This type of rupture leads to a complete
localized area of weakness or bulging opening of the uterine cavity, allowing the
known as a uterine window. fetus and amniotic fluid to spill into the
abdominal cavity.
Symptoms may include sudden onset of
severe abdominal pain, vaginal bleeding, Complete rupture is a life-threatening
and signs of fetal distress. emergency for both the mother and the
fetus, as it can cause severe hemorrhage,
Incomplete rupture is less severe than maternal shock, and fetal demise if not
complete rupture but still requires prompt managed promptly.
medical attention and may necessitate
surgical intervention to prevent Symptoms often include sudden, severe
progression to complete rupture. abdominal pain, vaginal bleeding, loss of
fetal station, and signs of maternal
-leaves the perimetrium intact instability such as hypotension and
-Persistent tenderness over the lower tachycardia.
segment
-Disorganized uterine pattern -goes through endometrium, myometrium
-Fetal bradycardia & perimetrium
- Uterine contractions stop
- Signs of shock
- Change in abdominal contour
- Fetal parts are palpable thru the
abdominal wall
Angelica Jane A. Suan Block CCC - NSG 124 March 12, 2024

17. What are the typical signs and symptoms of uterine rupture? (5pts)
a. Presence of Maternal Hemorrhage: Uterine rupture often leads to significant
maternal hemorrhage due to the tearing of blood vessels within the uterine wall.
This can result in rapid blood loss, leading to hypovolemic shock and maternal
instability.
b. Presence of a Visible Retraction Ring: A visible retraction ring, also known as
Bandl's ring, may be observed during uterine rupture. This ring represents the
boundary between the upper, contracting portion of the uterus and the lower,
relaxed segment. It may be visible externally or palpable during vaginal
examination.
c. Report of Feeling a "Tearing Sensation": Women experiencing uterine rupture
may report a sudden, sharp tearing sensation in the abdomen or pelvis. This
sensation is indicative of the uterine wall tearing and may be accompanied by
severe abdominal pain.
d. Lack of Cervical Dilatation: In cases of uterine rupture, cervical dilatation may
be arrested or delayed despite strong uterine contractions. This is due to the
disruption of normal labor progress and the inability of the fetus to descend
through the birth canal.
e. Strong Uterine Contractions: Uterine rupture can trigger intense, tetanic
uterine contractions as the uterus attempts to expel the fetus and placenta.
These contractions may be more severe than normal labor contractions and may
not be relieved by maternal positioning or relaxation techniques.

18. What is the nursing priority in Amniotic fluid embolism? (5pts)

To administer oxygen, anticipate the need for an endotracheal tube intubation,
and prepare for cardiopulmonary resuscitation
Rationale: In amniotic fluid embolism (AFE), a rare but serious obstetric
emergency, nursing priority involves ensuring maternal oxygenation by administering
oxygen, anticipating the need for endotracheal intubation to secure the airway, and
preparing for cardiopulmonary resuscitation (CPR) to maintain circulation in cases of
cardiovascular collapse. These interventions aim to stabilize the mother and optimize
outcomes in this critical situation.

II. Problems With the Passenger

1. What are the indications or signs of symptoms that the fetal presentation is in
Occipitoposterior position? (5pts)
● Severe back pain, intense back pain in labor: In occipitoposterior position, the
baby's occiput (back of the head) is positioned towards the mother's back,
causing increased pressure and intense back pain during labor as the baby's
head presses against the mother's spine.
● Prolonged active phase and arrest of descent: The occipitoposterior position
can lead to a prolonged active phase of labor and arrest of descent due to the
baby's head being in a less favorable position for descending through the birth
canal, resulting in slower progress during labor.
● Abdominal examination: During abdominal examination, the lower part of the
abdomen is flattened, and the fetal limbs are palpable anteriorly and on the fetal
flank. This suggests that the baby's back is facing the mother's back, leading to a
flattened lower abdomen and the ability to feel the fetal limbs more prominently
on the mother's abdomen.
Angelica Jane A. Suan Block CCC - NSG 124 March 12, 2024

● Vaginal examination: Vaginal examination may reveal that the posterior

fontanelle is toward the sacrum, and the anterior fontanelle may be easily felt if
the baby's head is deflexed, indicating the occipitoposterior position.
● Ultrasound: Ultrasound can confirm the occipitoposterior position by visualizing
the baby's head and spine orientation, providing additional information to support
the diagnosis based on clinical symptoms and examinations.

2. What conditions of a laboring woman qualifies for “TRIAL LABOR”? (5pts)

● Prior cesarean delivery: The woman has had a previous cesarean delivery,
making her a candidate for TOLAC to attempt a vaginal birth after cesarean
(VBAC).
● Premature rupture of membranes: In the absence of contraindications,
premature rupture of membranes alone does not preclude a trial of labor, and the
woman may be considered for TOLAC if other factors are favorable.
● Cephalopelvic disproportion (CPD) ruled out: CPD, which refers to a
mismatch between the size of the baby's head and the mother's pelvis, has been
ruled out. This indicates that there are no clear anatomical barriers to a
successful vaginal birth, supporting the consideration for a trial of labor.
● Borderline measurement of pelvis: The borderline measurement of the pelvis
suggests that while there may be some anatomical considerations, they are not
definitive enough to preclude a trial of labor, especially if other factors are
favorable.
● No fetal distress noted: The absence of fetal distress is a positive indication for
a trial of labor, as it suggests that the baby is tolerating the labor process well
and there are no immediate concerns for the baby's well-being.

3. What is the priority nursing action after a rupture of membranes to determine

possible umbilical cord prolapse? (5pts)
Assess FHR when membranes rupture to rule out prolapsed cord, note time,
color, and amount of fluid; obtain a baseline maternal temp. Assessing fetal
heart rate (FHR) when membrane rupture helps rule out cord prolapse.
Documenting time, color, and amount of fluid provides information on fetal
well-being and infection risk. Obtaining baseline maternal temperature detects
fever, a sign of potential infection, enabling prompt intervention. These
interventions aim to ensure maternal and fetal safety during labor.

4. What are the nursing interventions for a prolapse cord? (5pts)

A prolapsed cord is always an emergency situation because the pressure
of the fetal head against the cord at the pelvic brim leads to cord compression
and decreased oxygenation to the fetus. Tocolytic to reduce uterine activity and
pressure on the fetus. Sterile saline compress to prevent drying. Surgical
management includes a Cesarean section.
1. Position pt. in Trendelenburg or knee-chest position.
Manually raise the presenting part aseptically
2. Administer Oxygen 10L/min via face mask
3. Strictly follow proper hand washing and aseptic techniques for all
healthcare providers.
4. Monitor pt’s. temp.
5. Maintain sterility of equipment
6. Administer tocolytic.
7. Cover exposed cord with gauze with sterile saline.
8. Do not push back the cord.
9. If the cervix is fully dilated, quick delivery should be done with the help of
forceps.
 Angelica Jane A. Suan Block CCC - NSG 124 March 12, 2024

10. Surgical management includes a cesarean section.

5. A pregnant client arrives in the emergency department and states, “My baby is
coming.” The nurse sees a portion of the umbilical cord protruding from the
vagina. Why should the nurse apply manual pressure to the baby’s head? (5pts)
This is to relieve pressure on the umbilical cord. The nurse should apply
manual pressure to the baby's head in this situation to prevent umbilical cord
prolapse. When a portion of the umbilical cord protrudes from the vagina before
the baby, it is at risk of compression between the presenting part of the fetus and
the maternal pelvis. This compression can compromise blood flow through the
umbilical cord, leading to fetal distress or even stillbirth due to hypoxia and
asphyxia. Applying manual pressure to the baby's head helps to alleviate
pressure on the umbilical cord and prevent cord compression. By pushing the
baby's head upwards towards the mother's pelvis, the nurse can reduce the risk
of cord prolapse and maintain adequate blood flow to the fetus until emergency
delivery can be facilitated. This intervention is crucial for optimizing fetal
outcomes and minimizing the risk of complications associated with umbilical cord
compression.

6. What is the best position for a woman with cord prolapse? (5pts)
The best position for a woman with cord prolapse is the knee-chest position/
trendelenburg position. This position helps relieve pressure on the umbilical cord
by reducing the gravitational pull of the fetus on the cord and promoting optimal
blood flow to the fetus. Placing the woman in the knee-chest position is a simple
and effective way to manage cord prolapse and minimize complications until
emergency interventions can be initiated.

7. What is the priority nursing diagnosis after artificial rupture of the membranes is
done? (5pts)
Potential Risk for Fetal injury related to prolapse cord/ Risk for Fetal Injury
related to Prolapsed Cord - AROM increases the risk of umbilical cord
prolapse, where the cord slips down alongside or ahead of the presenting part of
the fetus. This can lead to compression of the cord between the fetal presenting
part and the maternal pelvis, compromising blood flow to the fetus and resulting
in fetal distress or even stillbirth.

8. What are the predisposing factors of cord prolapse? (5pts)

Predisposing Factors Non-Modifiable Factors Obstetric Procedures

1. Premature Rupture of 1. Premature Rupture of 1. Amniotomy: Artificial

Membranes (PROM): PROM
increases the risk of cord prolapse
due to the sudden release of amniotic
fluid, which can allow the umbilical
cord to descend alongside or ahead
of the fetus, especially if the
presenting part is not well-engaged.
2. Fetal Presentation other than
Cephalic: Abnormal fetal
presentation, such as breech or
transverse lie, can predispose to cord
prolapse as the presenting part may
Membranes (PROM): PROM
increases the risk of cord prolapse
due to the sudden release of
amniotic fluid, which can allow the
umbilical cord to descend
alongside or ahead of the fetus,
especially if the presenting part is
not well-engaged.
2. Fetal Malpresentation:
Abnormal fetal presentation, such
as breech or transverse lie, can
predispose to cord prolapse as the
rupture of membranes
increases the risk of cord
prolapse if the presenting
part is not well-engaged or if
other risk factors are
present.
2. Intrauterine Pressure
Catheters: Insertion of
intrauterine pressure
catheters for monitoring can
dislodge the cord, leading to
prolapse.
 Angelica Jane A. Suan
not adequately seal off the cervix,
allowing the cord to descend.
3. Long Umbilical Cord: A
longer-than-average umbilical cord
may increase the risk of cord
prolapse due to increased mobility
and potential for cord descent
4. Placenta Previa: Placenta previa,
where the placenta partially or
completely covers the cervix, can
increase the risk of cord prolapse due
to the abnormal placental position
and increased likelihood of premature
rupture of membranes.
5. Intrauterine Tumors: Uterine or
pelvic tumors can distort uterine
anatomy, increasing the risk of cord
prolapse by altering fetal positioning
or causing premature rupture of
membranes.
6. Small/Premature Fetus: Small or
premature fetuses may have
insufficient fetal structures to
effectively block the cervix, increasing
the risk of cord prolapse.
7. Cephalopelvic Disproportion
(CPD): CPD, where the fetal head is
too large to pass through the
maternal pelvis, can increase the risk
of cord prolapse due to prolonged
labor and increased pressure on the
uterus.
8. Hydramnios: Excessive amniotic
fluid volume increases the risk of cord
prolapse by providing more space for
the umbilical cord to descend
alongside or ahead of the fetus.
9. Multiple Gestation: The presence
of multiple fetuses increases the risk
of cord prolapse due to increased
pressure on the uterus and higher
likelihood of abnormal fetal
presentations.
10. Amniotomy: Artificial rupture of
membranes increases the risk of cord
prolapse if the presenting part is not
well-engaged or if other risk factors
are present
9. Differentiate Monozygotic from dizygotic twins? (5pts)
Block CCC - NSG 124 March 12, 2024
presenting part may not 3. Manual Rotation of Fetal
adequately seal off the cervix, Head: Manipulation of the
allowing the cord to descend. fetal head during labor can
3. Prematurity: Premature infants dislodge the cord increasing
are at higher risk of cord prolapse the risk of prolapse.
due to their smaller size and 4. Forceps or Vacuum
underdeveloped fetal structures, Application: Traumatic use
which may not effectively block the of forceps or vacuum
cervix. extraction during delivery
4. Polyhydramnios: Excessive can dislodge the cord,
amniotic fluid volume increases leading to prolapse.
the risk of cord prolapse by 5. Vaginal Examination:
providing more space for the Excessive or traumatic
umbilical cord to descend vaginal examinations during
alongside or ahead of the fetus. labor can increase the risk of
5. Rupture of Membranes: Any cord prolapse by dislodging
rupture of the membranes, the cord or causing
whether spontaneous or artificial, premature rupture of
can increase the risk of cord membranes.
prolapse if the presenting part is
not well-engaged or if other risk
factors are present.
6. Multiparity: Women who have
had multiple pregnancies are at
higher risk due to possible
increased uterine laxity, which can
predispose to cord prolapse.
7. Multiple Gestations: The
presence of multiple fetuses
increases the risk of cord prolapse
due to increased pressure on the
uterus and higher likelihood of
abnormal fetal presentations.
8. Long Umbilical Cord: A
longer-than-average umbilical cord
may increase the risk of cord
prolapse due to increased mobility
and potential for cord descent.
9. Tumors: Uterine or pelvic
tumors can distort uterine
anatomy, increasing the risk of
cord prolapse by altering fetal
positioning or causing premature
rupture of membranes
 Angelica Jane A. Suan Block CCC - NSG 124 March 12, 2024

Monozygotic Twins (Identical Twins): Dizygotic Twins (Fraternal Twins):

Origin: Monozygotic twins occur when a single
fertilized egg (zygote) splits into two separate
embryos during early development, typically
within the first two weeks after conception. This
results in two genetically identical embryos.
Origin: Dizygotic twins result from the
simultaneous fertilization of two separate eggs
by two different sperm cells during the same
menstrual cycle. Each zygote develops
independently into a separate embryo.

Genetic Makeup: Monozygotic twins share the
same genetic material because they develop from
the same zygote. They are always of the same
sex and have nearly identical DNA sequences.
Placental and Amniotic Sac Arrangement:
Depending on the timing of the embryo split,
monozygotic twins may share the same placenta
and amniotic sac (monochorionicmonoamniotic),
have separate placentas but share the same
amniotic sac (monochorionic diamniotic), or have
separate placentas and amniotic sacs
(dichorionic-diamniotic).
Occurrence: Monozygotic twins occur randomly
in approximately 1 in every 250 pregnancies
worldwide.
Genetic Makeup: Dizygotic twins are
genetically similar to siblings born at different
times. They may be of the same sex or
different sexes and share approximately 50%
of their genetic material, like any siblings.
Placental and Amniotic Sac Arrangement:
Dizygotic twins always have separate
placentas and amniotic sacs
(dichorionic-diamniotic), as they are two
separate pregnancies
Occurrence: Dizygotic twins are more
common than monozygotic twins and occur
more frequently in certain populations,
particularly in women who have a family
history of multiple pregnancies or who undergo
fertility treatments. The occurrence rate varies
widely depending on factors such as ethnicity
and maternal age, but it is approximately 1 in
every 80 pregnancies worldwide.

10. What are the complications of multifetal pregnancy? (5pts)

● Abortion/Vanishing Twin Syndrome: In multifetal pregnancies, one or more
fetuses may spontaneously abort or be reabsorbed by the mother's body, leading
to a condition known as vanishing twin syndrome.
● Preterm Labor: Multifetal pregnancies are at higher risk of preterm labor and
delivery due to increased uterine distension, which can trigger early contractions.
● Pregnancy-Induced Hypertension (PIH): Multifetal pregnancies place greater
demands on the mother's cardiovascular system, increasing the risk of
developing pregnancy-induced hypertension, which includes conditions like
preeclampsia and eclampsia.
● Anemia: Multifetal pregnancies may lead to maternal anemia due to increased
demands for nutrients and oxygen by multiple fetuses, as well as greater blood
volume expansion.
● Birth Defects: Multifetal pregnancies are associated with a higher risk of birth
defects, possibly due to genetic factors, placental abnormalities, or
environmental influences.
● Twin-to-Twin Transfusion Syndrome (TTTS): TTTS occurs in monochorionic
twin pregnancies where there is an imbalance in blood flow between the fetuses
sharing the same placenta, leading to severe complications for both twins.
● Caesarean Delivery: Multifetal pregnancies have an increased likelihood of
requiring caesarean delivery due to factors such as abnormal fetal presentation,
prolonged labor, or complications during delivery.
Angelica Jane A. Suan Block CCC - NSG 124 March 12, 2024

● Postpartum Hemorrhage: Multiple gestations are associated with a higher risk

of postpartum hemorrhage due to factors such as uterine overdistension,
placental abnormalities, or retained placental tissue.
● Hydramnios (Polyhydramnios): Multifetal pregnancies are more prone to
developing hydramnios, a condition characterized by excessive amniotic fluid
volume, which can lead to complications such as preterm labor or cord prolapse.
● Low Birth Weight: Multifetal pregnancies are at higher risk of delivering infants
with low birth weight due to factors such as prematurity, intrauterine growth
restriction, or competition for nutrients among the fetuses.
● Placenta Previa: Placenta previa, where the placenta partially or completely
covers the cervix, is more common in multifetal pregnancies and can lead to
complications such as bleeding during pregnancy or delivery.
● Intrauterine Growth Restriction (IUGR): Multifetal pregnancies are at
increased risk of IUGR, where one or more fetuses fail to grow at a normal rate,
potentially leading to complications such as preterm birth or low birth weight.
● Cord Entanglement, Prolapse, and Compression: In multifetal pregnancies,
there is a higher risk of complications involving the umbilical cord, such as
entanglement, prolapse (especially in cases of polyhydramnios), or compression
between fetuses, which can lead to fetal distress or stillbirth

11. During labor a client’s amniotic membranes rupture. Meconium is present in the
amniotic fluid is a normal finding of what fetal presentation? (5pts)
Meconium-stained amniotic fluid during labor is a common occurrence in
breech presentations due to the increased risk of fetal distress and umbilical
cord compression associated with this fetal presentation. The passage of
meconium into the amniotic fluid can result from the relaxation of the anal
sphincter in response to fetal distress, leading to the expulsion of the baby's first
bowel movement. While meconium staining indicates the need for close
monitoring of fetal wellbeing, it is considered a normal variant in breech
presentations. Prompt intervention may be required to address any signs of fetal
compromise and ensure a safe delivery for both the mother and the baby.

12. You assess that a fetus is in a breech presentation. Where would you auscultate
for the fetal heart sound? (5pts)
When a fetus is in a breech presentation, auscultating for the fetal heart
sounds high in the abdomen is crucial. This is because the positioning of the
fetus with the buttocks or legs downward and the head upward places the fetal
back and chest closer to the fundus. By listening for fetal heart tones at or above
the level of the umbilicus or closer to the fundus, healthcare providers increase
the likelihood of detecting the fetal heart sounds. This approach optimizes the
ability to monitor fetal well-being and ensure a safe delivery for both the mother
and the baby.

13. To widen the outlet in shoulder dystocia, what maneuver is indicated? (5pts)
McRobert’s maneuver is employed during shoulder dystocia to widen the
pelvic outlet by hyperflexing the mother's thighs onto her abdomen. This action
alters the pelvic angle, increasing the inclination and straightening the sacrum,
thus creating more space for the impacted shoulder to pass through. By
facilitating the delivery of the fetus, McRoberts maneuver minimizes the risk of
umbilical cord compression and associated fetal distress, ultimately improving
maternal and fetal outcomes.

III. Problems With the Passage

Angelica Jane A. Suan Block CCC - NSG 124 March 12, 2024

1. What are the risk factors of Cephalopelvic Disproportion (CPD)? (5pts)

● Increased Fetal Weight: Larger-than-average fetal size, also known as
macrosomia, is a significant risk factor for CPD. A fetus with excessive weight,
typically defined as weighing more than 4,000 grams (8 lbs 13 oz) at birth, may
have difficulty passing through the maternal pelvis during labor.
● Malpresentation/Malposition: Abnormal fetal presentation or position, such as
breech presentation (buttocks or feet first), transverse lie (sideways), or occiput
posterior position (back of the head facing the mother's back), can increase the
risk of CPD. These malpresentations can cause the fetal head to engage in the
pelvis in a less favorable orientation, making it more challenging for the baby to
descend through the birth canal.
● Problems with the Pelvis: Pelvic Anomalies: Abnormal pelvic shape or size,
such as a contracted or android pelvis, can limit the passage of the fetal head
during labor, leading to CPD

2. What are the different types of CPD? (5pts)

Inlet/ Internal Contraction: Outlet Contraction:

This type of CPD involves a narrowing of
the anteroposterior (AP) diameter of the
pelvic inlet. The AP diameter is the
distance between the pubic symphysis at
the front of the pelvis and the sacral
promontory at the back. When this
diameter is reduced, it can impede the
descent of the fetal head into the pelvis
during labor.
Outlet contraction refers to a narrowing of
the transverse diameter of the pelvic
outlet. The transverse diameter is the
distance between the ischial tuberosities,
which are the bony prominences on either
side of the pelvis. A reduced transverse
diameter can obstruct the passage of the
baby's head during the final stages of
labor and delivery.

3. What are the different maneuvers to assist labor and delivery of the baby? (5pts)
There are several maneuvers and techniques that healthcare providers may use
to assist labor and delivery of the baby, depending on the specific circumstances of
each birth. Some common maneuvers include:
1. McRoberts Maneuver:This maneuver involves hyperflexing the mother's thighs onto
her abdomen to increase the pelvic inclination angle and straighten the sacrum. It is
typically used to resolve shoulder dystocia by widening the pelvic outlet.
2. Suprapubic Pressure: Applying firm pressure to the mother's abdomen just above
the pubic symphysis can help dislodge a stuck shoulder or facilitate the descent of the
baby's head during delivery.
3. Episiotomy: In cases where the perineum is not stretching adequately to
accommodate the baby's head, an episiotomy may be performed. This involves making
a surgical incision in the perineum to enlarge the vaginal opening and facilitate delivery.
4. Manual Rotation: If the baby's head is not in the optimal position for delivery,
healthcare providers may manually rotate the baby's head to the desired position using
gentle, controlled maneuvers.
5. Hands-and-Knees Position: Having the mother assume a hands-and-knees position
can help alleviate pressure on the pelvic floor and facilitate rotation of the baby's
shoulders during delivery.
6. Forceps or Vacuum-Assisted Delivery: Forceps or vacuum extraction may be used
to assist with the delivery of the baby's head if prolonged or difficult labor is anticipated,
or if there are concerns about fetal distress.
7. Internal Rotation Maneuvers: Techniques such as the Ritgen maneuver or Rubin
maneuver can be used to facilitate internal rotation of the baby's head during delivery.
Angelica Jane A. Suan Block CCC - NSG 124 March 12, 2024

8. Directed Pushing: Providing guidance to the mother during the pushing phase of
labor, including coaching on when to push and how to push effectively, can help
expedite the delivery process.
9. External Cephalic Version (ECV): In cases of breech presentation, ECV may be
attempted to manually rotate the baby into a head-down position before delivery
10. Cesarean Section: If vaginal delivery is not progressing safely or if there are
concerns about maternal or fetal well-being, a cesarean section may be performed to
deliver the baby surgically.

IV. Anomalies of the Placenta and Cord (1 pt each)

1. Has unusually deep attachment of the placenta to the uterine myometrium.
Placenta accreta

2. Umbilical vessels of a velamentous cord insertion cross the cervical os, so they
would deliver before the fetus. Vessel may tear with cervical dilatation, the same
as the placenta previa may tear. Vasa previa

3. Instead of entering the placenta directly, separates into small blood vessels that
reach the placenta by spreading across a fold of amnion. Frequently found in
multifetal pregnancy; assoc. with fetal anomalies. Velamentous Insertion of the
Cord

4. Cord inserted marginally rather than centrally; rare and has no known clinical
significance Battledore Placenta

5. The left side of the placenta is covered with chorion. Umbilical cord enters the
placenta at the usual midpoint, and larger vessels spread out from there. They
end abruptly at the point where the chorion folds back onto the surface, however.
(ordinarily the chorion membranes begins at the edge of the placenta and
spreads to envelop the fetus; no chorion covers the fetal side of the placenta).
Placenta Circumvallata

6. Has one or more accessory lobes connected to the main placenta by blood
vessels. Placenta Succenturiata

7. Long umbilical cord may lead to what conditions? (5pts)

a. Cord prolapse: A long umbilical cord increases the risk of cord prolapse,
where the cord slips through the cervix or protrudes into the birth canal ahead of
the presenting part of the fetus. Cord prolapse can compress the cord,
compromising blood flow to the baby and leading to fetal distress or even
stillbirth.
b. True knots of the cord: A long umbilical cord provides more opportunity for
the cord to form knots. True knots occur when the umbilical cord becomes
twisted upon itself, potentially leading to compression of blood vessels within the
cord. This compression can impair blood flow to the fetus, resulting in fetal
distress or stillbirth in severe cases.
c. Cord coil: A long umbilical cord may also lead to excessive coiling or looping
of the cord around the fetus. While some degree of cord coiling is normal,
excessive coiling can increase the risk of cord compression during labor or
delivery. Cord compression can interfere with blood flow and oxygen supply to
the fetus, potentially resulting in fetal distress or complications during delivery
Angelica Jane A. Suan Block CCC - NSG 124 March 12, 2024

V. Problems with the Psyche

1. Identify appropriate Nursing Diagnosis for a woman going through labor who knows
her child will be born dead. (5pts)
Grief related to loss of her infant and her liability to carry a pregnancy to term.
R: By identifying grief related to loss of her infant and her inability to carry a
pregnancy to term as a nursing diagnosis, nurses can address the woman's emotional
needs holistically, promoting healing, coping, and eventual adaptation to the loss.

VI. Nursing Care of a Family During a Surgical Intervention for Birth

1. Major indication for CS include: (4 points)
Dystocia or CPD
Fetal distress
Breech presentation
Previous cesarean birth
Rationale:
Dystocia or CPD (cephalopelvic disproportion): This occurs when the baby's
head is too large to fit through the mother's pelvis, leading to difficulties in labor
progress.
Fetal distress: When the fetus shows signs of distress, such as an abnormal
heart rate, CS may be necessary to expedite delivery and prevent potential
complications.
Breech presentation: This refers to a situation where the baby is positioned
bottom or feet first instead of head first, increasing the risk of complications
during vaginal delivery and making CS the safer option.
Previous cesarean birth: Women who have had a previous cesarean birth may
opt for a repeat cesarean delivery for various reasons, such as concerns about
the risk of uterine rupture during a trial of labor after cesarean (TOLAC).

2. Maternal risks of CS include: (6 points)

Aspiration
Hemorrhage
Infections
Injury to bowel or bladder
Thrombophlebitis
Pulmonary embolism
Rationale:
Aspiration: During the surgical procedure, there is a risk of inhaling stomach
contents, which can lead to lung infections or other pulmonary complications.
Hemorrhage: CS carries a higher risk of blood loss compared to vaginal delivery,
and excessive bleeding can occur during or after the procedure, potentially
necessitating blood transfusions or other interventions.
Infections: There is an increased risk of postoperative infections, such as wound
infections or infections of the uterus or surrounding tissues, following a cesarean
delivery.
Injury to bowel or bladder: There is a small risk of accidental injury to the bowel
or bladder during the surgical process, which may require additional treatment or
surgical repair.
Thrombophlebitis: This refers to the formation of blood clots in the veins, which
can lead to inflammation and potential complications if the clot dislodges and
travels to the lungs or other organs.
Pulmonary embolism: A serious complication that can arise from
thrombophlebitis, where a blood clot travels to the lungs, causing a blockage in
the pulmonary arteries.
 Angelica Jane A. Suan Block CCC - NSG 124 March 12, 2024

3. What are the fetal risks of C/S? (5pts)

Prematurity: Premature birth, defined as birth before 37 weeks of gestation,
poses significant risks to the fetus/neonate due to the immaturity of organ
systems. Premature infants may experience complications such as respiratory
distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing
enterocolitis (NEC), and developmental delays. These complications can lead to
long-term health issues and developmental disabilities.
Injury at Birth: During the birthing process, fetal/neonatal injury can occur due to
various factors such as mechanical trauma, birth trauma, or obstetric
interventions. Common injuries include brachial plexus injuries (such as Erb's
palsy), fractures, and intracranial hemorrhage. These injuries can result from
difficult deliveries, improper use of obstetric instruments (forceps or vacuum
extractors), or excessive force during delivery.
Respiratory Problems: Neonates may experience respiratory problems,
particularly if they are born prematurely or if there are complications during
delivery. Premature infants are at risk of respiratory distress syndrome (RDS),
which occurs due to insufficient surfactant production in the lungs. Additionally,
meconium aspiration syndrome (MAS) can occur if the fetus passes stool
(meconium) into the amniotic fluid and inhales it into the lungs during labor,
leading to respiratory distress and potential lung injury.

4. What are the different skin and uterine incisions in C/S? (5pts)

Skin Incisions: Uterine Incisions:

1. Vertical Incision: A vertical skin incision, also
known as a midline or classical incision, may be
used in certain situations where rapid access to the
uterus is required. This incision provides a straight
path to the uterus and allows for quick entry,
making it suitable for emergencies or when there
are concerns about the baby's well-being. However,
vertical incisions have a higher risk of complications
such as increased blood loss, wound infection, and
wound dehiscence compared to transverse
incisions.
1. Low Transverse Incisions: Low transverse
uterine incisions, also known as "bikini" or
"horizontal" incisions, are the most common type
of uterine incision during C-sections. These
incisions are made horizontally across the lower
segment of the uterus, parallel to the lower uterine
segment. Low transverse incisions are preferred
because they are associated with lower rates of
uterine rupture in future pregnancies, reduced
blood loss, and improved healing compared to
classical or vertical uterine incisions.

2. Pfannenstiel's Incision (Transverse Lower 2. Classical Incisions: Classical uterine incisions

Abdominal Incision): Pfannenstiel's incision is a
transverse skin incision made horizontally just
above the pubic hairline. This incision is the most
common approach for elective C Sections because
it offers better cosmetic outcomes, reduced
postoperative pain, and decreased risk of wound
complications compared to vertical incisions.
Additionally, Pfannenstiel's incision provides
adequate exposure for the surgical team to perform
the uterine incision and deliver the bab
involve a vertical incision on the upper segment of
the uterus. These incisions are rarely used today
due to their higher risk of complications, including
uterine rupture in subsequent pregnancies,
increased blood loss, and impaired wound healing.
However, classical incisions may be necessary in
specific situations such as extreme prematurity,
abnormal fetal presentation, or limited uterine
access.
3. Low Vertical Incisions: Low vertical uterine
incisions are less commonly used but may be
preferred in certain cases where the baby's
position or presentation necessitates a different
Angelica Jane A. Suan Block CCC - NSG 124 March 12, 2024

approach. These incisions provide adequate

exposure to deliver the baby safely while
minimizing the risk of uterine rupture compared to
classical incisions. However, low vertical incisions
may still carry a slightly higher risk of uterine
rupture than low transverse incisions

5. What should the nurse do immediately after episiotomy repair? (5pts)

● Palpate the Uterine Fundus for Size, Consistency, and Position. This helps
the nurse assess uterine tone and position to ensure that the uterus is
contracting appropriately to control postpartum bleeding. A firm, midline fundus
indicates good uterine contraction, which helps prevent excessive bleeding
(postpartum hemorrhage). Changes in the size, consistency, or position of the
uterine fundus may indicate complications such as uterine atony (lack of uterine
tone), which can lead to postpartum hemorrhage if not promptly addressed.
Palpating the fundus also helps identify any retained placental fragments or clots,
which can contribute to postpartum bleeding or infection if not expelled
● Take Vital Signs to Obtain Baseline Data. Vital signs such as blood pressure,
heart rate, respiratory rate, and temperature provide valuable information about
the mother's overall condition and help identify any signs of postpartum
complications such as hemorrhage, infection, or preeclampsia. Baseline vital
signs obtained immediately after episiotomy repair serve as a reference point for
monitoring the mother's vital signs throughout the postpartum period. Any
deviations from baseline values may indicate a need for further assessment and
intervention.

6. What common complication is possible with an episiotomy? (5pts)

Episiotomy, a common procedure during childbirth, may lead to prolonged
dyspareunia, causing pain during sexual intercourse. This complication arises
due to tissue trauma, delayed healing, scar tissue formation, muscle spasm, and
psychological factors. Addressing these issues promptly through appropriate
interventions and support is essential to ensure women's postpartum recovery
and sexual well-being.

7. What is Vaginal Birth After Cesarean (VBAC)? (5pts)

VBAC, or Vaginal Birth After Cesarean, is the process of attempting a vaginal
delivery for subsequent pregnancies following a previous cesarean section. It
offers potential benefits such as shorter recovery times and reduced maternal
morbidity but also carries risks, including the possibility of uterine rupture. The
decision to attempt VBAC is made in consultation with a healthcare provider,
considering the woman's medical history and obstetric factors. Close monitoring
during labor is essential to ensure the safety of both mother and baby

8. What are the contraindications to VBAC? (5pts)

● Previous Classical Incision of Uterus: A previous classical uterine incision
carries a higher risk of uterine rupture during a subsequent vaginal birth due to
the weaker uterine scar. The lower segment of the uterus, where the scar from a
low transverse incision is stronger, is preferred for VBAC to minimize the risk of
uterine rupture.
● Large Infant (>4000g): Macrosomia (birth weight >4000g) increases the risk of
shoulder dystocia and other birth complications during vaginal delivery. The
Angelica Jane A. Suan Block CCC - NSG 124 March 12, 2024

potential difficulty in delivering a large baby vaginally may increase the risk of
uterine rupture in women attempting VBAC.
● Malpresentation: Fetal malpresentation, such as breech presentation or
transverse lie, can increase the complexity of vaginal delivery and raise the risk
of uterine rupture. The optimal fetal position for VBAC is vertex presentation
(head down), as this reduces the risk of mechanical complications during
delivery.
● Inadequate Pelvimetry: Inadequate pelvimetry refers to a maternal pelvis that is
insufficiently spacious for the passage of the fetal head during vaginal birth.
Pelvimetry assessments may reveal cephalopelvic disproportion (CPD) or other
pelvic abnormalities that increase the risk of labor dystocia and uterine rupture
during VBAC.

9. What are the risks of VBAC? (5pts)

● Possible Uterine Rupture and Hemorrhage: The most serious risk associated
with VBAC is uterine rupture, where the scar from the previous cesarean section
tears open during labor. This can lead to severe hemorrhage for both the mother
and the baby, requiring emergency medical intervention to prevent
life-threatening complications. Uterine rupture is rare but can be catastrophic
when it occurs, necessitating close monitoring during VBAC attempts.
● Failure of Trial of Labor Requires Repeat Cesarean Section (C/S): In some
cases, labor may not progress as expected during a VBAC attempt, leading to
failure of the trial of labor. This may occur due to factors such as labor dystocia,
fetal distress, or maternal exhaustion. When a trial of labor fails, it often results in
the need for a repeat cesarean section to safely deliver the baby. This can
prolong the labor process and increase the risk of complications for both the
mother and the baby.

A WOMAN EXPERIENCING A MULTIPLE GESTATION

Molly Sandoval is a 25-year-old G2P1 at 37 weeks with a twin gestation admitted to a
birthing room in early labor. She states, if at all possible she wants to have a vaginal
rather than a cesarean birth.

1. What if Molly asks you if there is a way to “speed up” labor because her husband has
to leave for work. Would you ask her primary care provider if she could have oxytocin
administration? (5pts)
Enabling the natural progression of childbirth offers several benefits to the
mother, such as facilitating gradual cervical dilatation, and to the fetus, as it gradually
prepares the infant for the transition to the outside world. It is crucial for Molly’s primary
care provider to be informed about her concerns regarding the duration of labor, but the
elective use of oxytocin is a matter of controversy.
If Molly asks about speeding up her labor due to her husband needing to leave
for work, it would be important to discuss this with her primary care provider. Oxytocin
administration, which is a medication used to induce or augment labor, should only be
administered under the guidance of healthcare professionals. It's crucial to consider the
potential risks and benefits of using oxytocin in her specific situation, as well as to
ensure that it aligns with the overall management plan for her twin gestation. Molly's
primary care provider would be best positioned to evaluate whether oxytocin
administration is appropriate in her case and to discuss the potential implications for her
and her babies.
Angelica Jane A. Suan Block CCC - NSG 124 March 12, 2024

2. What if Molly’s primary care provider prescribes an amnioinfusion for her. How would
you prepare for this? (5pts)
If Molly's primary care provider prescribes an amnioinfusion, which involves
infusing saline or other fluids into the amniotic cavity, it would be essential to prepare for
this procedure by ensuring that the birthing room is equipped for the intervention. This
may involve coordinating with the healthcare team to gather the necessary equipment
and supplies for the amnioinfusion, ensuring that the room is set up to accommodate
the procedure, and providing Molly with information and support regarding what to
expect during the intervention. Additionally, the healthcare team would need to explain
the purpose of the amnioinfusion, address any questions or concerns Molly may have,
and ensure that she is comfortable and well-informed throughout the process.
The essential equipment required for preparation includes an amniohook if her
membranes are still intact, an infusion solution like normal saline or lactated Ringer’s
solution, a single- or double-lumen intrauterine pressure catheter, waterproof padding
for the bed, and a uterine and fetal heart rate monitor. Equally crucial is ensuring that
Molly and her husband comprehend the necessity of the procedure to safeguard the
well-being of her fetus and addressing any informational gaps she may have regarding
the procedure.

A WOMAN HAVING A CESAREAN BIRTH

Linda Okparo a 25-year-old, G2P1, 41-week pregnant woman is scheduled for an
elective cesarean birth in 2 days.
1. What if Linda insists she wants a general anesthesia for her cesarean birth rather
than an epidural. How would you approach this situation? (5pts)
If Linda insists on having general anesthesia for her cesarean birth instead of an
epidural, it's important to approach this situation with empathy and understanding while
also considering her safety and well-being. Engage in an open and respectful
conversation with Linda to understand her concerns and preferences regarding the type
of anesthesia. Provide her with information about the risks and benefits of both general
anesthesia and epidural anesthesia for cesarean birth, allowing her to make an
informed decision. Encourage Linda to discuss her preferences with her primary care
provider or an anesthesiologist, ensuring that she receives professional guidance and
has her questions addressed by a healthcare professional who can provide detailed
information about the implications of her choice. If Linda continues to express a strong
preference for general anesthesia, it's essential to ensure that she fully understands the
implications of her choice and provide her with the opportunity to give informed consent
after receiving comprehensive information from the healthcare team. While respecting
Linda's preferences, the healthcare team may explore other options to address her
concerns, such as providing additional support and reassurance for an epidural or
discussing strategies to enhance her comfort and experience during the cesarean birth.

2. What if Linda is prescribed PCEA after her cesarean birth for pain management. She
tells you, however, she is not interested in PCEA and would rather have injections for
pain. Would you advocate for use of PCEA or advocate with her primary care provider
for a changed method of pain control? (5pts)
If Linda is prescribed patient-controlled epidural analgesia (PCEA) for pain
management after her cesarean birth but expresses a preference for injections for pain
control instead, it's important to advocate for patient-centered care while ensuring that
her pain management needs are effectively addressed. Engage in a conversation with
Linda to understand her reasons for preferring injections over PCEA. Listen to her
perspective, address any concerns she may have, and provide information about the
benefits of PCEA for post-cesarean pain management. Advocate for Linda's
preferences and concerns by discussing them with her primary care provider or the
Angelica Jane A. Suan Block CCC - NSG 124 March 12, 2024

healthcare team. This may involve exploring alternative pain management methods that
align with her preferences while also ensuring that her pain is effectively controlled.
Provide Linda with information about the advantages of PCEA, including its ability to
provide personalized pain relief and the flexibility it offers in managing postoperative
discomfort. Additionally, offer support and guidance to help address any apprehensions
she may have about using PCEA. Collaborate with the healthcare team to advocate for
a pain management approach that takes into account Linda's preferences and ensures
that she receives appropriate care tailored to her individual needs and comfort. The goal
is to ensure that Linda's preferences are respected, her concerns are addressed, and
that she receives effective pain management in a manner that aligns with her medical
needs and personal comfort.