A client who is 32 weeks gestation and has gestational diabetes calls the provider’s office to report decreased fetal movement over the last several hours. The provider advises her to report to OB triage for further testing.
What test should you anticipate the provider will order?
Non-stress test.
Contraction stress test.
Biophysical profile.
Ultrasound.
The Correct Answer is A
Choice A rationale
A non-stress test (NST) is a common test used to evaluate fetal well-being, especially in cases of decreased fetal movement. It measures the fetal heart rate in response to its movements. A reactive NST, where the fetal heart rate increases with movement, indicates good oxygenation and neurological function.
Choice B rationale
A contraction stress test (CST) evaluates the fetal heart rate response to uterine contractions, which can be induced by oxytocin or nipple stimulation. It is typically used to assess placental function and fetal tolerance to labor, not for initial assessment of decreased fetal movement.
Choice C rationale
A biophysical profile (BPP) combines an NST with ultrasound to assess fetal breathing, movement, tone, and amniotic fluid volume. While comprehensive, it is more time-consuming and usually reserved for further evaluation if the NST is non-reactive.
Choice D rationale
An ultrasound can assess fetal growth, amniotic fluid volume, and anatomical structures. However, it does not provide real-time information on fetal heart rate reactivity, making it less suitable for immediate assessment of decreased fetal movement.
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Correct Answer is A
Explanation
Choice A rationale
The occiput anterior (OA) position is considered the optimal fetal position for vaginal birth. In this position, the baby’s head is down, and the back of the head (occiput) is facing the mother’s front. This position allows for the most efficient passage through the birth canal.
Choice B rationale
The occiput posterior (OP) position, where the baby’s head is down but facing the mother’s back, can lead to a longer and more painful labor. It is not considered optimal for vaginal birth.
Choice C rationale
Breech positions, where the baby’s buttocks or feet are positioned to come out first, are not optimal for vaginal birth and often require a cesarean section due to the increased risk of complications.
Choice D rationale
The transverse position, where the baby is lying sideways across the uterus, is not suitable for vaginal birth. This position typically requires a cesarean section to safely deliver the baby.
Correct Answer is A
Explanation
Choice A rationale
Late decelerations are a sign of uteroplacental insufficiency and fetal hypoxia. They occur after the peak of a contraction and indicate that the fetus is not receiving enough oxygen. This requires immediate intervention to improve fetal oxygenation and prevent fetal distress.
Choice B rationale
Variability in fetal heart rate of 12 bpm is considered moderate variability, which is a reassuring sign of fetal well-being. It indicates that the fetus has a healthy autonomic nervous system and is not in distress.
Choice C rationale
Accelerations in fetal heart rate are also a reassuring sign. They indicate that the fetus is well-oxygenated and responding appropriately to stimuli. No intervention is needed for accelerations.
Choice D rationale
A baseline fetal heart rate of 140 bpm is within the normal range (110-160 bpm) and does not indicate any immediate concern. It is a sign of a healthy, well-oxygenated fetus.