During the initial assessment of a woman admitted to the labor and delivery area, the nurse recognizes that the patient will be on bed rest. From the following assessment data, select the finding(s) that lead(s) her to this conclusion
(Select all that apply.)
a. Cervix dilated 5 cm
b. Cervical effacement 80%
c. Station –3
d. Uterine contraction frequency 3 to 5 minutes
e. Uterine contraction duration 45 to 60 seconds
f. SROM 1 hour before admission
ANS: A, C, F
A station of –3 indicates that the presenting part is not engaged (is above the ischial spines); an unengaged presenting part coupled with rupture of membranes increases the risk of umbilical cord prolapse. A cervix dilated to 5 cm, associated with a high presenting part and ruptured membranes, contributes to the risk of cord prolapse.
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