The measure to relieve fetal distress due to maternal supine hypotension is

When a pregnant woman lies on supine position, the weight of the gravid uterus would be compressing on the vena cava against the vertebrae obstructing blood flow from the lower extremities. This causes a decrease in blood return to the heart and consequently immediate decreased cardiac output and hypotension. Hence, putting the mother on side lying will relieve the pressure exerted by the gravid uterus on the vena cava.

Which of the following signs will distinguish threatened abortion from imminent abortion?

  • Severity of bleeding

  • Dilation of the cervix

  • Nature and location of pain

  • Presence of uterine contraction

  • Solution

    Dilation of the cervix

    In imminent abortion, the pregnancy will definitely be terminated because the cervix is already open unlike in threatened abortion where the cervix is still closed.

A pregnant mother is admitted to the hospital with the chief complaint of profuse vaginal bleeding, AOG 36 wks, not in labor. The nurse must always consider which of the following precautions:

  • The internal exam is done only at the delivery under strict asepsis with a double set-up

  • The preferred manner of delivering the baby is vaginal

  • An emergency delivery set for vaginal delivery must be made ready before examining the patient

  • Internal exam must be done following routine procedure

  • Solution

    The internal exam is done only at the delivery under strict asepsis with a double set-up

    Painless vaginal bleeding during the third trimester maybe a sign of placenta praevia.

    Option B: If the bleeding is due to soft tissue injury in the birth canal, immediate vaginal delivery may still be possible so the set up for vaginal delivery will be used.

    Option C: A double set-up means there is a set up for cesarean section and a set-up for vaginal delivery to accommodate immediately the necessary type of delivery needed. In both cases, strict asepsis must be observed.

    Option D: If an internal examination is done in this kind of condition, this can lead to even more bleeding and may require immediate delivery of the baby by cesarean section.

A gravidocardiac mother is advised to observe bed rest primarily to

  • Allow the fetus to achieve normal intrauterine growth

  • Minimize oxygen consumption which can aggravate the condition of the compromised heart of the mother

  • Prevent perinatal infection

  • Reduce incidence of premature labor

  • Solution

    Minimize oxygen consumption which can aggravate the condition of the compromised heart of the mother

    Activity of the mother will require more oxygen consumption. Since the heart of a gravido-cardiac is compromised, there is a need to put a mother on bedrest to reduce the need for oxygen.

When a pregnant woman goes into a convulsive seizure, the MOST immediate action of the nurse to ensure the safety of the patient is:

  • Apply restraint so that the patient will not fall out of bed

  • Put a mouth gag so that the patient will not bite her tongue and the tongue will not fall back

  • Position the mother on her side to allow the secretions to drain from her mouth and prevent aspiration

  • Check if the woman is also having a precipitate labor

  • Solution

    Position the mother on her side to allow the secretions to drain from her mouth and prevent aspiration

    Positioning the mother on her side will allow the secretions that may accumulate in her mouth to drain by gravity thus preventing aspiration pneumonia.

    Option B: Putting a mouth gag is not safe since during the convulsive seizure the jaw will immediately lock.

    Option C: The mother may go into labor also during the seizure, but the immediate concern of the nurse is the safety of the baby. After the seizure, check the perineum for signs of precipitate labor.

Upon assessment, the nurse found the following: fundus at 2 fingerbreadths above the umbilicus, last menstrual period (LMP) 5 months ago, fetal heart beat (FHB) not appreciated. Which of the following is the most possible diagnosis of this condition?

  • Hydatidiform mole

  • Missed abortion

  • Pelvic inflammatory disease

  • Ectopic pregnancy

  • Solution

    Hydatidiform mole

    Hydatidiform mole begins as a pregnancy but early in the development of the embryo degeneration occurs. The proliferation of the vesicle-like substances is rapid causing the uterus to enlarge bigger than the expected size based on ages of gestation (AOG). In the situation given, the pregnancy is only 5 months but the size of the uterus is already above the umbilicus which is compatible with 7 months AOG. Also, no fetal heart beat is appreciated because the pregnancy degenerated thus there is no appreciable fetal heart beat.

Which of the following signs and symptoms will most likely make the nurse suspect that the patient has hydatidiform mole?

  • Slight bleeding

  • Passage of clear vesicular mass per vagina

  • Absence of fetal heart beat

  • Enlargement of the uterus

  • Solution

    Passage of clear vesicular mass per vagina

    Hydatidiform mole (H-mole) is characterized by the degeneration of the chorionic villi wherein the villi becomes vesicle-like. These vesicle-like substances when expelled per vagina and is a definite sign that the woman has H-mole.

Which of the following is the most likely effect on the fetus if the woman is severely anemic during pregnancy?

  • Large for gestational age (LGA) fetus

  • Hemorrhage

  • Small for gestational age (SGA) baby

  • Erythroblastosis fetalis

  • Solution

    Small for gestational age (SGA) baby

    Anemia is a condition where there is a reduced amount of hemoglobin. Hemoglobin is needed to supply the fetus with adequate oxygen. Oxygen is needed for normal growth and development of the fetus.

Smoking is contraindicated in pregnancy because

  • Nicotine causes vasodilation of the mother’s blood vessels

  • Carbon monoxide binds with the hemoglobin of the mother reducing available hemoglobin for the fetus

  • The smoke will make the fetus, and the mother feel dizzy

  • Nicotine will cause vasoconstriction of the fetal blood vessels

  • Solution

    Carbon monoxide binds with the hemoglobin of the mother reducing available hemoglobin for the fetus

    Carbon monoxide is one of the substances found in cigarette smoke. This substance diminishes the ability of the hemoglobin to bind with oxygen thus reducing the amount of oxygenated blood reaching the fetus.

You are performing an abdominal exam on a 9th-month pregnant woman. While lying supine, she felt breathless, had pallor, tachycardia, and cold clammy skin. The correct assessment of the woman’s condition is that she is:

  • Experiencing the beginning of labor

  • Having supine hypotension

  • Having sudden elevation of BP

  • Going into shock

  • Solution

    Having supine hypotension

    Supine hypotension is characterized by breathlessness, pallor, tachycardia and cold, clammy skin. This is due to the compression of the abdominal aorta by the gravid uterus when the woman is in a supine position.