While assisting with a vacuum extraction birth, what should the nurse immediately report to the physician?

Choice A reason:

Uteroplacental insufficiency is a condition where the placenta cannot deliver enough oxygen and nutrients to the fetus. This can cause fetal hypoxia and distress, which can be detected by late decelerations on the fetal heart rate monitor. Late decelerations are defined as a decrease in the fetal heart rate that begins after the peak of the contraction and returns to baseline after the contraction ends. This indicates that the fetus is not tolerating the reduced blood flow during the contractions and needs immediate intervention. • Choice B reason:

Umbilical cord compression is a condition where the umbilical cord is squeezed or twisted, reducing the blood flow and oxygen to the fetus. This can cause variable decelerations on the fetal heart rate monitor. Variable decelerations are defined as a decrease in the fetal heart rate that varies in timing, shape, and duration, and may or may not be associated with contractions. This indicates that the fetus is experiencing intermittent or sustained cord compression and may need repositioning or other interventions. • Choice C reason:

Maternal bradycardia is a condition where the mother's heart rate is slower than normal, usually less than 60 beats per minute. This can cause reduced blood flow and oxygen to the placenta and the fetus, but it does not cause late decelerations on the fetal heart rate monitor. Maternal bradycardia can be caused by various factors, such as medications, hypothermia, hypothyroidism, or vagal stimulation. It may need treatment depending on the cause and severity. • Choice D reason:

Fetal head compression is a condition where the fetal head is pressed against the cervix or the pelvic floor during labor, stimulating the vagus nerve and slowing down the fetal heart rate. This can cause early decelerations on the fetal heart rate monitor. Early decelerations are defined as a decrease in the fetal heart rate that begins with the onset of the contraction and returns to baseline with the end of the contraction. This indicates that the fetus is descending in the birth canal and is usually a normal and benign finding.

Choice A reason:

Maternal exhaustion is a maternal indication for the use of vacuum extraction. Vacuum extraction is a technique that can assist the mother in delivering the baby when she is unable to push effectively or when pushing poses a risk to her health. Vacuum extraction can shorten the second stage of labor and reduce maternal fatigue and distress. According to the Cleveland Clinic, vacuum extraction might be indicated if "the mother can't push anymore, either due to exhaustion or a health condition.".

Choice B reason:

Failure to progress past 0 station is not a maternal indication for the use of vacuum extraction. The station refers to the position of the baby's head in relation to the mother's pelvis. 0 station means that the baby's head is at the level of the pelvic inlet, or the narrowest part of the pelvis. Vacuum extraction is usually not performed before the baby reaches +2 station, which means that the head is 2 cm below the pelvic inlet and visible at the vaginal opening. According to the American Academy of Family Physicians, vacuum extraction should not be attempted if "the fetal head is not engaged (above 0 station).".

Choice C reason:

A wide pelvic outlet is not a maternal indication for the use of vacuum extraction. The pelvic outlet is the lower part of the pelvis that forms the exit for the baby during delivery. A wide pelvic outlet means that there is more space for the baby to pass through, which can facilitate vaginal delivery and reduce the need for instrumental assistance. Vacuum extraction is more likely to be indicated when there is a narrow pelvic outlet, which can obstruct labor and cause fetal distress.

Choice D reason:

A history of rapid deliveries is not a maternal indication for the use of vacuum extraction. Rapid deliveries, also known as precipitous deliveries, are those that occur within 3 hours of the onset of labor. Rapid deliveries can pose risks to both the mother and the baby, such as excessive bleeding, umbilical cord prolapse, or birth trauma. However, vacuum extraction is not usually indicated in these cases, as it requires time and preparation to apply the device and monitor its effects. Vacuum extraction is more likely to be indicated when labor is prolonged or stalled in the second stage, and when there is a nonreassuring fetal heart rate.