A nurse is reviewing the results of a biophysical profile for a client who is at 37 weeks of gestation.
Which of the following findings indicates fetal well-being?

Choice A rationale

Hydrotherapy, like immersion in a tub or shower, is a nonpharmacological comfort measure for labor pain management. The therapeutic temperature of the water should indeed be maintained between 36 to 37°C (about 96.8 to 98.6°F). This range ensures the water is comfortably warm, promoting muscle relaxation, reducing pain perception, and avoiding potential maternal hyperthermia or fetal distress due to extreme temperatures.

Choice B rationale

Counterpressure is a technique used to relieve back pain caused by pressure of the fetal occiput against the sacrum, commonly known as "back labor.”. It involves steady, strong pressure applied by a support person to the sacral area or lower back, not the upper abdomen. Applying pressure to the upper abdomen would be ineffective and potentially uncomfortable for the client.

Choice C rationale

Effleurage is a light, rhythmic, stroking massage, often applied to the abdomen, used primarily during contractions in the first stage of labor to promote relaxation and distract from pain. It is generally not used during the pushing phase (second stage), as the client's focus shifts to bearing down and expelling the fetus, making effleurage distracting and ineffective.

Choice D rationale

Transcutaneous Electrical Nerve Stimulation (TENS) involves applying mild electrical currents via electrodes to the skin. During labor, the electrodes are typically placed on the lower back (sacral area) to block pain signals related to contractions as they travel up the spinal cord. Applying the TENS unit to the lower abdomen is not the standard placement for optimal labor pain relief.

Choice A rationale

The Diphtheria-tetanus-acellular pertussis (Tdap) vaccine is recommended during each pregnancy, ideally between 27 and 36 weeks of gestation. This timing is crucial because it allows for the maternal production and optimal transplacental transfer of pertussis antibodies to the fetus. These antibodies provide crucial passive immunity to the newborn against pertussis (whooping cough), which is a severe and potentially fatal disease in infants before they can be directly immunized.

Choice B rationale

The Human papillomavirus (HPV) vaccine is not recommended during pregnancy because there is limited safety data regarding its use in pregnant women. While it is not known to cause adverse fetal effects, it is a recombinant vaccine and, as a precautionary measure, it should be delayed until the postpartum period. Routine HPV vaccination is typically administered to adolescents and young adults up to age 26.

Choice C rationale

The Varicella vaccine is a live attenuated virus vaccine and is contraindicated in pregnancy due to the theoretical risk of transmission of the live virus to the fetus, which could potentially cause congenital varicella syndrome. Women who are non-immune to varicella should receive this vaccine postpartum, before being discharged from the hospital, to protect future pregnancies.

Choice D rationale

The Measles, mumps, and rubella (MMR) vaccine is a live attenuated virus vaccine and is contraindicated in pregnancy due to the theoretical risk of fetal infection and subsequent congenital abnormalities, particularly from the rubella component. Women who are not immune to rubella should be vaccinated postpartum and advised to avoid conception for about one month following vaccination.

Choice E rationale

The inactivated influenza (flu shot) vaccine is recommended for all women who are pregnant during the flu season, regardless of their stage of gestation, including at 30 weeks. This is a killed virus vaccine and is considered safe in pregnancy. It protects the mother from severe influenza illness and also provides the newborn with passive immunity in the initial months of life.