A client who is pregnant with her first child has been laboring for 14 hours with very minimal progress. Cervical dilatation and effacement are slow, and the nurse is unable to verify engagement of the presenting fetal part. What condition should the nurse suspect may be affecting the client's labor?
1. Prolapsed cord
2. Placenta accreta
3. Cephalopelvic disproportion (CPD)
4. Occiput anterior (OA) fetal position
3
Explanation:
1. A prolapsed cord is an umbilical cord that precedes the fetal presenting part. Fetal bradycardia is a critical indicator of prolapsed cord.
2. Placenta accreta, in which the chorionic villi attach directly to the uterine myometrium, is associated with maternal hemorrhage and failed placental separation after birth.
3. The nurse should suspect CPD when labor is prolonged, cervical dilatation and effacement are slow, and engagement of the presenting part is delayed.
4. The occiput anterior (OA) fetal position is amenable to delivery and would not represent a barrier to labor.
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