A nurse is caring for a client in the second stage of labor who does not want any tools used to assist with the vaginal birth. Which of the following interventions should the nurse understand will help prevent an assisted vaginal birth? (Select All that Apply.)

A) Fetal baseline rate increasing at least 5 beats per minute:
An increase in the fetal baseline heart rate of 5 beats per minute is typically not associated with uteroplacental insufficiency. A baseline increase could indicate early signs of fetal stimulation, such as from fetal movement or excitement, but it does not align with the characteristic response to uteroplacental insufficiency, which usually causes signs of distress like late decelerations or fetal heart rate variability.

B) A shallow deceleration occurring with the beginning of contractions:
A shallow deceleration with the onset of contractions may suggest early decelerations, which are typically caused by fetal head compression during labor. Early decelerations are not typically associated with uteroplacental insufficiency, which generally leads to later decelerations. Early decelerations are generally considered benign and do not indicate oxygen deprivation or fetal distress.

C) Fetal heart rate declining late in contraction and remaining depressed:
Late decelerations, where the fetal heart rate drops after the peak of a contraction and stays depressed afterward, are a classic sign of uteroplacental insufficiency. This pattern occurs due to reduced blood flow and oxygen delivery to the fetus during contractions, leading to fetal hypoxia. Late decelerations suggest compromised placental function and require prompt attention to prevent further fetal distress.

D) Variable decelerations, too unpredictable to count:
Variable decelerations, characterized by abrupt drops in fetal heart rate with varying timing and duration, are usually caused by umbilical cord compression. While these decelerations can indicate fetal distress, they are not directly linked to uteroplacental insufficiency. Uteroplacental insufficiency typically leads to late decelerations, not variable decelerations.

The newborn's assessment findings that require follow-up:

Temperature 35.7°C (96.3°F) at 2200:

Hypothermia in newborns can lead to cold stress, which increases the risk of respiratory distress and hypoglycemia. The newborn’s temperature should be closely monitored, and warming measures should be initiated to prevent further complications.

Respiratory rate 68/min at 2200:

A respiratory rate above 60 breaths per minute in a newborn is considered tachypnea and can indicate respiratory distress or underlying conditions such as infection. The newborn should be further evaluated to determine the cause of the tachypnea and to ensure proper oxygenation.

Sternal retractions at 2200:

Sternal retractions suggest that the newborn is experiencing increased work of breathing, which is a key sign of respiratory distress. This requires immediate evaluation to assess the severity and identify potential causes, such as respiratory infections or inadequate ventilation.

Coarse rhonchi in bilateral lung fields at 2200:

The presence of coarse rhonchi indicates abnormal breath sounds, often related to fluid retention or infection in the lungs. This finding requires further assessment and possibly interventions to clear the airway and support respiratory function.