The multiparous client at term has arrived to the Labor and Delivery unit in active labor with intact membranes. Leopold's maneuver indicates the fetus is in a transverse lie with a shoulder presentation. What physician order is most important?
1. Artificially rupture membranes.
2. Apply internal fetal scalp electrode.
3. Monitor maternal blood pressure every 15 minutes.
4. Alert surgical team of urgent cesarean.
4
Rationale:
1. Artificial rupture of membranes is contraindicated with a transverse lie because of the high risk for prolapsed cord.
2. An internal fetal scalp electrode cannot be applied until membranes have ruptured. Artificial rupture of membranes is contraindicated with a transverse lie because of the high risk for prolapsed cord.
3. The fetus is at risk for hypoxia secondary to prolapsed cord if the membranes rupture. The maternal blood pressure is less important than getting the cesarean under way.
4. This is the highest priority because of the transverse lie and the risk of fetal hypoxia secondary to prolapsed cord if the membranes rupture.
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