Which maternal condition always necessitates delivery by cesarean section?

Choice A) Monitor uterine contractions is incorrect because this is not the most urgent intervention for a pregnant woman who has experienced a bleeding episode in late pregnancy. Uterine contractions can indicate labor or placental abruption, which are possible causes of bleeding in late pregnancy. However, they are not the only or the most reliable indicators of these conditions, as some women may have painless bleeding or contractions without bleeding. Moreover, monitoring uterine contractions does not address the immediate needs of the mother and the fetus, such as oxygenation, circulation, and perfusion. Therefore, this intervention should be done after assessing and stabilizing the vital signs and FHR.

Choice B) Assess fetal heart rate (FHR) and maternal vital signs is correct because this is the most important and essential intervention for a pregnant woman who has experienced a bleeding episode in late pregnancy. Bleeding in late pregnancy can be caused by various conditions, such as placenta previa, placental abruption, uterine rupture, or vasa previa, which can compromise the blood supply and oxygen delivery to the mother and the fetus. Assessing FHR and maternal vital signs can help to determine the severity and cause of the bleeding, as well as guide further

interventions such as fluid resuscitation, oxygen therapy, blood transfusion, or emergency delivery. The normal FHR range for a fetus is 110 to 160 beats per minute, and it may vary with fetal activity or maternal position. The normal maternal vital signs are: blood pressure 120/80 mm Hg or lower, heart rate 60 to 100 beats per minute, respiratory rate 12 to 20 breaths per minute, and temperature 36.5°C to 37.5°C (97.7°F to 99.5°F). Any deviation from these ranges may indicate hypoxia, hypovolemia, shock, infection, or distress. Therefore, this intervention should be done as soon as possible for women who have bleeding in late pregnancy.

Choice c) Perform a venipuncture for hemoglobin and hematocrit levels is incorrect because this is not a priority intervention for a pregnant woman who has experienced a bleeding episode in late pregnancy. Hemoglobin and hematocrit are blood tests that measure the amount of red blood cells and their percentage in the blood volume.

They can help to evaluate the extent of blood loss and the need for blood transfusion. However, they are not

immediate or accurate indicators of bleeding in late pregnancy, as they may take time to reflect the changes in blood volume or be affected by other factors such as hydration or hemodilution. Moreover, performing a venipuncture does not address the immediate needs of the mother and the fetus, such as oxygenation, circulation, and perfusion.

Therefore, this intervention should be done after assessing and stabilizing the vital signs and FHR.

Choice d) Place clean disposable pads to collect any drainage is incorrect because this is not a priority intervention for a pregnant woman who has experienced a bleeding episode in late pregnancy. Placing clean disposable pads can help to keep the perineal area clean and dry, as well as to estimate the amount and type of bleeding. However, it does not address the immediate needs of the mother and the fetus, such as oxygenation, circulation, and perfusion. Moreover, it does not provide any information about the cause or severity of the bleeding, as it may be affected by factors such as gravity or pooling. Therefore, this intervention should be done after assessing and stabilizing the vital signs and FHR.

Choice a) They are born before 38 weeks of gestation is incorrect because this is not the definition of SGA. SGA refers to newborns who have a birth weight or length that is significantly lower than expected for their gestational age, regardless of when they are born. Therefore, a newborn can be SGA even if they are born at term or post-term.

Choice b) Placental malfunction is the only recognized cause of this condition is incorrect because this is not the only factor that can contribute to SGA. Placental malfunction can cause fetal growth restriction due to insufficient blood supply and nutrients to the fetus, but there are other possible causes such as maternal factors (e.g.,

hypertension, diabetes, smoking, malnutrition), fetal factors (e.g., chromosomal abnormalities, infections, congenital anomalies), and environmental factors (e.g., altitude, pollution, stress).

Choice c) They weigh less than 2500 g is incorrect because this is not the criterion for SGA. SGA is based on the comparison of the newborn's weight or length with the expected values for their gestational age, not on an absolute cutoff. Therefore, a newborn can be SGA even if they weigh more than 2500 g, as long as they are below the 10th percentile for their gestational age.

Choice d) They are below the 10th percentile on gestational growth charts is correct because this is the most commonly used definition of SGA. Gestational growth charts are tools that plot the expected weight or length of a fetus or newborn according to their gestational age and sex. They are based on population data and can vary

depending on the ethnicity and region of origin of the mother and the baby. A newborn who falls below the 10th percentile on these charts is considered SGA, meaning that they have grown less than 90% of their peers .