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A client has been admitted to the labor and delivery suite for induction of labor for post-term pregnancy. Misoprostol (Cytotec) has been inserted. Which of the following findings would warrant stopping the Cytotec treatment?

A.

Contraction frequency of 1 minute.

B.

Cervix is 50% effaced.

C.

Maternal respiratory rate of 24.

D.

Fetal heart baseline of 150.

Answer and Explanation

The Correct Answer is A

A. Contraction frequency of 1 minute. Misoprostol (Cytotec) is used for cervical ripening, but excessive uterine contractions (tachysystole), defined as more than five contractions in 10 minutes, can lead to fetal distress and uterine rupture. If contractions are occurring every minute, this indicates hyperstimulation, requiring immediate discontinuation of the medication and possible intervention with tocolytics to relax the uterus.

B. Cervix is 50% effaced. Cervical effacement is a normal part of labor progression and does not indicate a need to stop Cytotec treatment. Misoprostol is intended to help soften and ripen the cervix, and 50% effacement suggests the cervix is responding appropriately.

C. Maternal respiratory rate of 24. A respiratory rate of 24 breaths per minute is within the upper normal range for pregnancy due to increased metabolic demands. It does not indicate an adverse reaction to misoprostol or warrant discontinuation of treatment.

D. Fetal heart baseline of 150. A fetal heart rate of 150 beats per minute is within the normal range of 110-160 bpm and does not indicate fetal distress. There is no reason to stop Cytotec based on this finding.


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Related Questions

Correct Answer is D

Explanation

A. Maintaining euglycemia in labor reduces the need for insulin postpartum. While insulin requirements typically decrease after delivery due to the loss of placental hormones that cause insulin resistance, the primary reason for tight glucose control during labor is to prevent neonatal complications rather than reducing postpartum insulin needs.

B. A blood glucose level above 110 puts the client at risk for infection in labor. Poorly controlled diabetes can increase infection risk over time, but transient hyperglycemia in labor is not a direct cause of infection. The focus of glucose management during labor is to prevent neonatal hypoglycemia rather than maternal infection.

C. More insulin will be available for fetal use via placental transfer. Insulin does not cross the placenta, so maternal insulin therapy does not provide insulin to the fetus. However, maternal hyperglycemia leads to increased fetal insulin production, which can cause neonatal hypoglycemia after birth.

D. An elevated blood glucose in labor increases the risk of neonatal hypoglycemia. Maternal hyperglycemia causes the fetus to produce excessive insulin in utero. After birth, when the maternal glucose supply is suddenly cut off, the infant’s high insulin levels can cause a rapid drop in blood glucose, leading to neonatal hypoglycemia, which can be dangerous if not managed properly.

Correct Answer is B

Explanation

While many women are able to get pregnant again after an ectopic pregnancy, it is not guaranteed. The ability to conceive again depends on various factors, such as:

  • The extent of damage to the fallopian tube.

  • Whether one or both tubes are still functional.

  • The treatment used (e.g., methotrexate vs. surgery).

  • Any underlying fertility issues.

It is important to be honest but reassuring, explaining that many women do go on to have healthy pregnancies, but future fertility can be affected and should be discussed with a healthcare provider. Saying she "absolutely will" get pregnant again is inaccurate and potentially misleading.

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