A nurse is performing a vaginal examination on a client who is in labor and has a prolapsed umbilical cord.
Which of the following actions should the nurse take to relieve cord compression?
Push the presenting part upward with gloved fingers
Pull the cord gently to reduce tension
Clamp the cord with sterile forceps
Cut the cord and tie it with sterile string
The Correct Answer is A
The correct answer is choice A. Push the presenting part upward with gloved fingers. This action can relieve cord compression and improve fetal oxygenation until an emergency cesarean section can be performed.
Choice B is wrong because pulling the cord gently to reduce tension can cause more damage to the umbilical vessels and increase the risk of fetal hemorrhage.
Choice C is wrong because clamping the cord with sterile forceps can cut off the blood supply to the fetus and cause fetal death.
Choice D is wrong because cutting the cord and tying it with sterile string can also cut off the blood supply to the fetus and cause fetal death.
Some additional information:
• A prolapsed umbilical cord is a rare but life-threatening obstetric emergency that occurs when the umbilical cord is abnormally positioned between the fetal presenting part and the cervix.
• The normal range of umbilical cord length is 40 to 60 cm. A longer cord can increase the risk of prolapse.
• The normal range of fetal heart rate is 110 to 160 beats per minute. A prolapsed cord can cause fetal bradycardia (slow heart rate) due to hypoxia.
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Related Questions
Correct Answer is D
Explanation
The correct answer is d. Call for assistance and prepare for an emergency cesarean delivery.
Rationale for Choice d:
- Emergency cesarean delivery is the definitive treatment for a prolapsed umbilical cord.It's crucial to expedite delivery to prevent fetal hypoxia and potential death.
- Any delay in delivery can have catastrophic consequences for the fetus.
- Calling for assistance immediately activates the necessary personnel and resources for a swift cesarean delivery.
- Prompt preparation ensures the operating room, anesthesia team, and surgical team are ready to proceed without delay.
Rationale for Choice a:
- Applying warm saline-soaked gauze to the exposed cord is a temporary measure to prevent cord compression and drying.
- It does not address the underlying issue of cord compression and compromised blood flow to the fetus.
- While this action is important, it should not take precedence over calling for assistance and preparing for emergency delivery.
Rationale for Choice b:
- Placing the client in Trendelenburg position (head down, feet up) was once thought to relieve pressure on the cord.
- However, current evidence does not support this practice.
- It can potentially worsen fetal distress by increasing venous return and cardiac output, leading to increased cord compression.
- It can also make it more difficult to monitor the fetal heart rate and perform a cesarean delivery.
Rationale for Choice c:
- Administering oxygen via face mask at 10 L/min may provide some benefit to the fetus by increasing maternal oxygen saturation.
- However, it does not address the primary issue of cord compression and compromised fetal blood flow.
- It should not be prioritized over calling for assistance and preparing for emergency delivery.
Correct Answer is B
Explanation
Terbutaline is a medication that can relax the uterine muscles and reduce contractions.This can help relieve pressure on the prolapsed umbilical cord and restore blood flow to the baby while preparing for an emergency cesarean delivery.
Choice A is wrong because magnesium sulfate is used to prevent seizures in women with preeclampsia or eclampsia, not to treat umbilical cord prolapse.
Choice C is wrong because oxytocin is used to induce or augment labor, not to stop it.Oxytocin can increase contractions and worsen cord compression.
Choice D is wrong because methylergonovine is used to prevent or treat postpartum hemorrhage, not to treat umbilical cord prolapse.Methylergonovine can also increase contractions and worsen cord compression.
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