A primigravida is admitted to the birth setting in early labor. She is 3 cm dilated, -2 station, with intact membranes and FHR of 150 beats/min. Her membranes rupture spontaneously, and the FHR drops to 90 beats/min with variable decelerations

Question

The initial response from the nurse would be to: 1. Perform a vaginal exam.
2. Notify the physician.
3. Place the patient in a left lateral position.
4. Administer oxygen at 2 L per nasal cannula.

Answer 1

1
Rationale 1: A drop in fetal heart rate accompanied by variable decelerations is consistent with a prolapsed cord, and a vaginal exam is the best way to confirm this.
Rationale 2: The vaginal exam should be done before the physician is notified.
Rationale 3: Repositioning the patient will not relieve the decreased heart rate if the cord is compromised.
Rationale 4: Administering oxygen will not relieve the decreased heart rate if the cord is compromised.