A 20-year-old woman 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 patient's labor?
1. Cephalopelvic disproportion (CPD)
2. Prolapsed cord
3. Placenta accreta
4. Occiput anterior (OA) fetal position
Correct Answer: 1
Rationale 1: The nurse should suspect CPD when labor is prolonged, cervical dilatation and effacement are slow, and engagement of the presenting part is delayed.
Rationale 2: A prolapsed cord is an umbilical cord that precedes the fetal presenting part. Fetal bradycardia is a critical indicator of prolapsed cord. This patient is demsontrating prolonged labor, slow cervical dilatation and effacement, and delayed engagement of the presenting fetal part, which are consistent with cephalopelvic disproportion (CPD).
Rationale 3: Placenta accreta, in which the chorionic villi attach directly to the uterine myometrium, is associated with maternal hemorrhage and failed placental separation after birth. This patient is demonstrating prolonged labor, slow cervical dilatation and effacement, and delayed engagement of the presenting fetal part, which are consistent with cephalopelvic disproportion (CPD).
Rationale 4: The occiput anterior (OA) fetal position is amenable to delivery and would not represent a barrier to labor. This patient is demonstrating prolonged labor, slow cervical dilatation and effacement, and delayed engagement of the presenting fetal part, which are consistent with cephalopelvic disproportion (CPD).
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