A patient has just spontaneously ruptured her membranes. Which of the following factors makes her especially high risk for having a prolapsed cord? Select all that apply.

Occiput anterior position.

Breech presentation.

Cervical dilation 5 cm.

Station-4.

Answer and Explanation

Correct Answer : B,D

A. Occiput anterior position. The occiput anterior (OA) position is the ideal fetal position for vaginal delivery, where the baby’s head is well-engaged in the pelvis. This positioning reduces the risk of a prolapsed cord since the presenting part (the fetal head) effectively blocks the cord from slipping through.

B. Breech presentation. In a breech presentation, the buttocks or feet are the presenting part, leaving more space in the birth canal. This increases the risk of cord prolapse, especially if the feet or buttocks do not fully block the cervix, allowing the umbilical cord to slip past and become compressed.

C. Cervical dilation 5 cm. While cervical dilation is important in labor progression, it does not directly increase the risk of cord prolapse. The risk is more dependent on fetal position and station rather than the degree of cervical dilation.

D. Station -4. A high fetal station (e.g., -4) means the baby’s presenting part has not yet descended into the pelvis, leaving more room for the umbilical cord to slip through once the membranes rupture. A well-engaged fetus at station 0 or lower helps prevent prolapse by blocking the cervix.

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Correct Answer is A

Explanation

A. The cervix is effacing and dilated to 2 cm. Cervical changes, including effacement and dilation, are the most definitive signs of preterm labor. Uterine contractions alone do not confirm preterm labor unless they result in cervical dilation, indicating that labor is progressing.

B. Irregular, mild uterine contractions are occurring every 15-30 minutes. Irregular contractions, known as Braxton Hicks contractions, can be common in pregnancy and do not necessarily indicate preterm labor. True preterm labor involves regular contractions that lead to cervical changes.

C. Estriol is not found in maternal saliva. The absence of estriol in maternal saliva does not confirm or rule out preterm labor. Salivary estriol testing is not a widely used or reliable diagnostic tool for determining the onset of preterm labor.

D. Fetal fibronectin is present in vaginal secretion. Fetal fibronectin (fFN) is a protein found in vaginal secretions between 22-34 weeks of pregnancy and can indicate a risk of preterm labor, but its presence alone does not confirm that labor is actively occurring. A positive fFN test means the patient may be at increased risk for preterm labor, but cervical changes remain the best indicator of actual labor.

A. Stay with the patient and call for help B. Suction the mouth to prevent aspiration C. Insert an oral airway D. Administer oxygen by tight face mask

Correct Answer is A

Explanation

A. Stay with the patient and call for help. The priority during a seizure is to ensure the patient’s safety and call for immediate assistance. The nurse should stay with the patient, protect her from injury, and note the seizure’s duration and characteristics. After the seizure ends, further interventions can be implemented.

B. Suction the mouth to prevent aspiration. Suctioning should only be performed after the seizure ends. Attempting to suction during an active seizure increases the risk of injury and airway obstruction.

C. Insert an oral airway. Inserting an oral airway during an active seizure is unsafe and contraindicated because it may cause trauma to the mouth or airway. An airway can be inserted after the seizure stops if necessary.

D. Administer oxygen by tight face mask. While oxygen is important, it should be provided after the seizure subsides and the airway is assessed. The primary focus during the seizure is safety, preventing injury, and calling for emergency assistance.

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A patient has just spontaneously ruptured her membranes. Which of the following factors makes her especially high risk for having a prolapsed cord? Select all that apply.

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