With arrest of dilation and severe back pain, fetal malposition (e.g., occiput posterior) is a likely cause of dystocia. The priority is to assess fetal position via Leopold's maneuvers and vaginal exam to guide interventions. Other assessments (maternal exhaustion, contraction adequacy, FHR) are important but secondary to identifying the underlying cause.
심화 해설
Clinical Judgment
This question assesses the nurse's priority in a dystocia situation called Secondary Arrest of Dilation. The key clues are "no progress from 6 cm for 4 hours despite adequate uterine contractions (every 2-3 minutes, lasting 60-90 seconds)" and "severe back pain". This strongly suggests a fetal malposition, specifically an Occiput Posterior Position. Malposition is the most common mechanical cause of arrested labor, and without checking it first, other interventions (fatigue management, contraction assessment) may be ineffective. Therefore, the highest priority assessment is to determine the exact fetal position and attitude.
Memory Tip
Before Anything Look at Position! (BALP)
When labor progress stops, before doing anything else (fatigue, contractions, fetal status), check the fetal Position first.
KR vs US
In Korea, when labor progress is delayed, it is common to report to the physician and then confirm fetal position via ultrasound. In the US NGN/CJMM, the emphasis is on the nurse independently assessing fetal position using Leopold's Maneuvers and a vaginal examination, and then, based on those findings, first attempting independent interventions such as position changes (hands-and-knees position). In other words, the core is the nurse's independent Clinical Judgment process of assessment-judgment-action.
임상 시나리오
Clinical Practice Guide
When secondary arrest of labor occurs (no progress for ≥4 hours at ≥6 cm dilation), the nurse systematically assesses the following:
1. Fetal position/presentation: Check for occiput posterior (OP) position, etc., using Leopold's maneuvers and vaginal examination.
2. Coping and fatigue: Evaluate the mother's energy level, anxiety, and pain control status.
3. Contraction quality: Assess effectiveness (ability to cause descent) in addition to frequency/duration. Consider IUPC if needed.
4. Fetal well-being: Monitor for signs of oxygen insufficiency through continuous FHR monitoring.
Caution
In SATA (Select All That Apply) questions asking for "Priority" or "First," choose the action that rules out risk or identifies the most likely cause. In this case, while all options are important, the assessment to find the root cause of dystocia (checking fetal position) should precede other supportive assessments (evaluating fatigue).
학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요.