# A nurse is caring for a primigravida client at 40 weeks gestation who has been in active labor for 12 hours with minimal cervical dilation progress. The fetal heart rate shows late decelerations, and the client is experiencing strong, frequent contractions. What is the priority nursing intervention? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543056 > language: ko > subject: Maternal Newborn Health ## 문제 A nurse is caring for a primigravida client at 40 weeks gestation who has been in active labor for 12 hours with minimal cervical dilation progress. The fetal heart rate shows late decelerations, and the client is experiencing strong, frequent contractions. What is the priority nursing intervention? ## 보기 1. Administer oxygen via face mask at 8-10 L/min 2. Prepare the client for immediate cesarean delivery **✔ 정답** 3. Encourage position changes and ambulation 4. Increase the oxytocin infusion rate **정답: 2** ## 해설 Late decelerations indicate fetal hypoxia requiring immediate delivery. Other options are supportive but insufficient for this emergency. ## 심화 해설 Understanding the Clinical Scenario A primigravida at term with prolonged labor, minimal cervical change, and a fetal heart rate (FHR) tracing showing late decelerations in the setting of strong, frequent contractions presents a classic picture of uteroplacental insufficiency. The repetitive compression of the intervillous space during contractions, when already compromised, reduces fetal oxygenation. The FHR pattern is a direct reflection of this pathophysiology: late decelerations are a non-reassuring fetal heart rate (NRFHR) pattern that signals fetal hypoxemia and potential metabolic acidosis. Analyzing the Priority Intervention The priority nursing intervention is to prepare the client for immediate cesarean delivery. The rationale is rooted in the interpretation of the NRFHR pattern and the arrest of labor. Why Cesarean Delivery is the Priority The combination of findings indicates that vaginal delivery is not safely imminent and the fetus is physiologically compromised. A systematic review and meta-analysis of NRFHR status among laboring mothers in Ethiopia identifies NRFHR as a major contributor to perinatal mortality and morbidity, directly linked to insufficient fetal oxygenation [2]. In this scenario, the late decelerations are a critical indicator of fetal hypoxia [1]. When this pattern occurs alongside an arrest of labor progress (minimal cervical dilation after 12 hours of active labor), the clinical decision point has been reached where continuing to attempt a vaginal delivery poses an unacceptable risk of worsening fetal acidosis and injury. Expedited delivery via cesarean section is the definitive intervention to resolve the uteroplacental insufficiency and resuscitate the fetus. Critique of Alternative Options - Administer oxygen via face mask at 8-10 L/min: This is a supportive intrauterine resuscitation measure that can temporarily improve fetal oxygenation. However, it does not address the underlying mechanical cause of the late decelerations—repetitive cord or placental compression from strong contractions with no labor progress. It is a temporizing, not a definitive, action and should not delay preparation for surgical delivery. - Encourage position changes and ambulation: Position changes are a first-line intervention for variable decelerations or to promote labor progress. However, with a pattern of late decelerations indicating uteroplacental insufficiency, ambulation is contraindicated and position changes alone will not resolve the oxygenation deficit caused by a failure of labor to progress. - Increase the oxytocin infusion rate: This action is contraindicated. The client is already experiencing strong, frequent contractions, which are the physiological trigger for the late decelerations. Augmenting contractions would further reduce the already compromised fetal oxygen supply, exacerbating the NRFHR pattern and increasing the risk of fetal acidosis, a key factor associated with adverse perinatal outcomes . The recognition of NRFHR patterns and their associated factors, such as prolonged labor and uteroplacental insufficiency, is essential for timely intervention to prevent neonatal morbidity . In this case, the nurse's priority is to recognize the failure of conservative measures and advocate for immediate escalation to surgical delivery.References (research sources) - [1]Non-reassuring fetal heart rate and associated factors among laboring mothers at southern public hospitals in Ethiopia: a poisson regression model.Research articleAsnake AB, Desalew A, Meseret F, Mezmur H. (2026) · DOI: 10.1038/s41598-026-35575-6 - [2]Magnitude, associated factors, and immediate outcomes of nonreassuring fetal heart rate status among laboring mothers in Ethiopia: a systematic review and meta-analysis.Meta-analysis/systematic reviewYilak G, Molla B, Tilahun BD, Abate BB, Kitaw TA, Kassie A, Getie A, Erega BB, Ayele M, Lake ES. (2026) · DOI: 10.1016/j.xagr.2026.100620 ## 임상 시나리오 Clinical Practice Guide: Non-Reassuring Fetal Status with Labor Dystocia Identification and Immediate Actions When a laboring patient presents with a Category III fetal heart rate tracing (e.g., late decelerations) and arrest of dilation, the nurse must recognize this as an obstetric emergency. Immediate notification of the provider and preparation for emergent cesarean delivery are the priorities. Simultaneously, initiate intrauterine resuscitative measures as a bridge to delivery: administer oxygen via non-rebreather mask at 10 L/min, position the patient in left lateral position to maximize uteroplacental perfusion, discontinue oxytocin infusion, and administer a rapid intravenous fluid bolus as ordered. Pathophysiology and Clinical Reasoning Late decelerations result from uteroplacental insufficiency, where diminished blood flow and oxygen transfer during contractions lead to fetal myocardial hypoxia. Persistent late decelerations indicate fetal metabolic acidosis. When this occurs alongside labor dystocia (e.g., no cervical change for 4 hours with adequate contractions), the likelihood of a safe vaginal delivery diminishes rapidly. Continuing labor under these conditions risks worsening fetal acidemia, hypoxic-ischemic encephalopathy, or stillbirth. Nursing Responsibilities and Team Communication - Activate the chain of command and call for immediate obstetric and anesthesia provider presence. - Prepare the operating room and gather necessary supplies (e.g., surgical prep kit, indwelling catheter). - Ensure informed consent is obtained per facility protocol, explaining the urgency of the situation to the patient and support person. - Continuously monitor fetal heart rate and maternal vital signs until transfer to the operating room. - Document all interventions, communications, and the patient's response in the medical record. Postoperative and Debriefing Considerations Following delivery, anticipate the need for neonatal resuscitation due to potential acidosis. Participate in a team debriefing to review the event, communication effectiveness, and system improvements. Provide emotional support to the patient and family, addressing any concerns about the emergent nature of the delivery. ## 핵심 개념 - **Late Decelerations** — A non-reassuring fetal heart rate pattern characterized by a gradual decrease in heart rate with the nadir occurring after the peak of a contraction, indicating uteroplacental insufficiency and fetal hypoxemia. - **Uteroplacental Insufficiency** — A condition where the placenta cannot deliver adequate oxygen and nutrients to the fetus, often worsened by uterine contractions, leading to fetal distress. - **Arrest of Labor** — A diagnosis made when there is no cervical dilation for 4 hours despite adequate contractions or 6 hours with inadequate contractions, often necessitating cesarean delivery. - **Non-Reassuring Fetal Heart Rate (NRFHR)** — Abnormal FHR patterns such as late decelerations, severe variable decelerations, or prolonged bradycardia that suggest fetal compromise and potential metabolic acidosis. ## 같은 주제 문제 - [A nurse is assessing a multigravida client at 39 weeks gestation who has been in active la…](https://mymerci.kr/pages/nclex_q.php?qn_id=543051) - [A primigravida at 40 weeks gestation has been in active labor for 14 hours. 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