You are assuming the care of a patient admitted for a fetal demise at 30 weeks gestation. Which is the most therapeutic response to the patient? (Select onE.:

Choice A: Enter maneuvers (wood screw or rubin) by physician are interventions to relieve a dystocia, as they involve rotating the fetal shoulders to align them with the maternal pelvis and facilitate the delivery. The physician can perform these maneuvers by applying pressure on the fetal clavicles or scapulas through the vaginA.

Choice B: Put mother on all fours (gaskin) is an intervention to relieve a dystocia, as it involves changing the maternal position to widen the pelvic outlet and reduce the pressure on the fetal shoulders. The mother can assume this position by kneeling on the bed and resting on her elbows or hands.

Choice C: Suprapubic pressure by the nurse is an intervention to relieve a dystocia, as it involves applying firm and downward pressure on the mother's lower abdomen to dislodge the anterior fetal shoulder from behind the pubic symphysis and assist the delivery. The nurse can perform this intervention by using the heel of the hand or a fist.

Choice D: McRoberts by the nurse is an intervention to relieve a dystocia, as it involves flexing and abducting the mother's legs to her chest to increase the pelvic diameter and relax the pelvic floor muscles. The nurse can perform this intervention by holding the mother's legs or using stirrups.

Choice E: Delivery of the anterior arm by the physician is an intervention to relieve a dystocia, as it involves reaching into the vagina and sweeping the fetal arm across the chest and out of the birth canal to reduce the shoulder-to-shoulder diameter and assist the delivery. The physician can perform this intervention by using a finger or a forceps.

Choice F: Fundal pressure by the nurse is not an intervention to relieve a dystocia, as it involves pushing on the upper part of the uterus to expel the fetus. This intervention is contraindicated in shoulder dystocia, as it can worsen the impaction of the fetal shoulders and cause fetal injury or maternal traumA.

Choice A: Increasing IV fluid rate is a secondary action, as it helps restore the blood volume and improve the blood pressure and the fetal perfusion. The nurse should perform this action after taking the first action.

Choice B: Elevating the legs is a tertiary action, as it helps increase the venous return and the cardiac output and improve the blood pressure and the fetal perfusion. The nurse should perform this action after taking the first and second actions.

Choice C: Notifying the provider is a quaternary action, as it helps communicate the situation and obtain further orders and interventions. The nurse should perform this action after taking the first, second, and third actions.

Choice D: Placing the client in a lateral position to relieve pressure on the inferior vena cava is the first and most important action, as it helps prevent or correct the hypotension and the fetal bradycardia caused by the epidural anesthesia block. The epidural anesthesia block can block the sympathetic nerve fibers and cause vasodilation and pooling of blood in the lower extremities, which can reduce the blood pressure and the placental perfusion. The pressure of the gravid uterus on the inferior vena cava can also reduce the venous return and the cardiac output, which can worsen the hypotension and the fetal bradycardiA. By placing the client in a lateral position, the nurse can reduce the pressure on the inferior vena cava and improve the blood flow and the oxygen delivery to the fetus.