# A nurse is caring for a client at 32 weeks gestation who presents to the labor and delivery unit with decreased fetal movement for the past 24 hours. Which assessment finding would be most indicative of intrauterine fetal demise? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543073 > language: ko > subject: Maternal Newborn Health ## 문제 A nurse is caring for a client at 32 weeks gestation who presents to the labor and delivery unit with decreased fetal movement for the past 24 hours. Which assessment finding would be most indicative of intrauterine fetal demise? ## 보기 1. Maternal temperature of 100.2°F (37.9°C) 2. Fetal heart rate of 110 beats per minute 3. Decreased amniotic fluid volume on ultrasound 4. Absence of fetal heart tones on Doppler assessment **✔ 정답** **정답: 4** ## 해설 Absence of fetal heart tones on Doppler is the definitive sign of IUFD, confirming fetal death. Other findings (maternal fever, normal FHR, decreased amniotic fluid) are not specific for demise. ## 심화 해설 Understanding the Clinical Scenario The client at 32 weeks gestation reports decreased fetal movement for 24 hours. This presentation raises immediate concern for fetal well-being. While several assessments can provide clues about the fetal environment, the diagnosis of intrauterine fetal demise (IUFD) requires a specific, definitive finding. The term IUFD, as referenced in the literature on high-risk pregnancies, describes the death of a fetus in utero at or after 20 weeks gestation [1]. Analysis of Assessment Findings To determine the most indicative sign, each option must be evaluated against the pathophysiological definition of fetal demise. **Option 1: Maternal temperature of 100.2°F (37.9°C)** A mildly elevated maternal temperature can indicate an infectious process, such as chorioamnionitis. While intrauterine infection is a known risk factor for adverse fetal outcomes and can potentially lead to fetal demise, a low-grade fever is a nonspecific maternal sign. It does not confirm that fetal death has occurred. Many conditions cause maternal fever with a live fetus. **Option 2: Fetal heart rate of 110 beats per minute** A baseline fetal heart rate of 110 bpm falls at the lower limit of the normal range (110-160 bpm). This finding warrants continued monitoring and further investigation, as it could represent fetal bradycardia, a sign of fetal distress. However, the presence of any fetal heart rate, even a bradycardic one, is definitive evidence of a live fetus. It rules out fetal demise. **Option 3: Decreased amniotic fluid volume on ultrasound** Oligohydramnios is a significant finding associated with uteroplacental insufficiency and fetal growth restriction (FGR), conditions that carry a high risk for adverse perinatal outcomes, including IUFD [4]. Research on early-onset small fetuses shows that abnormal fetal Doppler studies and angiogenic markers are used to predict composite adverse outcomes in this setting [4]. Nevertheless, oligohydramnios is a marker of a compromised fetal environment, not a direct indicator of death itself. A fetus can survive for a period with severely reduced fluid. **Option 4: Absence of fetal heart tones on Doppler assessment** The absence of a fetal heartbeat is the cardinal, confirmatory sign of fetal death. In the context of a pregnancy where fetal movement has ceased, the inability to detect cardiac activity via Doppler or ultrasound is the diagnostic standard for IUFD. The primary challenge in managing conditions with a high risk for IUFD, such as certain aneuploidies, is the lack of perfect surveillance tools to predict and prevent this outcome, making the final diagnosis reliant on the direct observation of cardiac activity or its absence [1]. This finding provides an immediate and unambiguous answer. Synthesis and Clinical Judgment The diagnostic process for suspected fetal demise moves from subjective reports (decreased fetal movement) to objective, confirmatory testing. While maternal symptoms and ultrasound findings of the fetal environment build a clinical picture of risk, the only finding that is pathognomonic for IUFD is the confirmed absence of a fetal heartbeat. A critical assessment of antenatal monitoring highlights that the endpoint of all fetal surveillance is the prediction and prevention of IUFD, which is ultimately defined by the cessation of cardiac activity [1]. Therefore, when the nurse is asked which finding is *most indicative* of the event having already occurred, the direct measure of cardiac function is the only correct choice.References (research sources) - [1]A Critical Assessment of Antenatal Monitoring for Fetal Well-Being in Down Syndrome Pregnancies.Research articleBishop JC, Jelin AC, Eke AC, Hertenstein CB, Jones A, Johnson CT, Blakemore K. (2025) · DOI: 10.3390/diagnostics16010039 - [4]Angiogenic factors and fetal Doppler for predicting adverse pregnancy outcome in early-onset small fetuses with and without pre-eclampsia.Research articleBonacina E, Armengol-Alsina M, Casellas A, Dalmau M, Diaz P, Roldán E, Temprado J, Duaso M, Ampurdanes Q, San José M, Armengol T, Lizarraga Z, Maiz N, Mendoza M. (2026) · DOI: 10.1002/uog.70188 ## 임상 시나리오 Clinical Confirmation of Intrauterine Fetal Demise When a patient presents with decreased fetal movement, the priority nursing action is to locate fetal heart tones (FHT) using a Doppler device. The **absence of FHT** on Doppler is the definitive clinical sign of intrauterine fetal demise (IUFD) and must be confirmed via ultrasound before breaking the news to the family. **Key Assessment:** Do not rely on maternal symptoms (fever, pain) or secondary ultrasound findings (oligohydramnios) to diagnose IUFD. Any detectable fetal heart rate, even bradycardia, means the fetus is alive and requires immediate intervention for distress, not a demise protocol. Nursing Responsibilities - Apply gel and use a 3-MHz Doppler on the maternal abdomen to auscultate for FHT for a full minute. - If no tones are heard, reposition the patient to a left lateral tilt and attempt again. Differentiate from maternal pulse by palpating the maternal radial artery simultaneously. - Notify the provider immediately for a stat ultrasound to confirm the absence of cardiac activity. - Prepare to support the patient emotionally; do not make the diagnosis independently. Use therapeutic communication and provide privacy. Differential to Rule Out **Maternal fever (100.2°F):** Evaluate for chorioamnionitis (foul-smelling discharge, uterine tenderness). This requires infection workup and fetal monitoring, not a demise workup. **FHR 110 bpm:** Initiate intrauterine resuscitation (left lateral position, IV fluid bolus, oxygen) and continuous monitoring. This is fetal bradycardia, a sign of potential hypoxia in a live fetus. **Decreased amniotic fluid:** Perform an amniotic fluid index (AFI) and biophysical profile (BPP). This guides management for a live fetus at risk for cord compression. ## 핵심 개념 - **Intrauterine Fetal Demise (IUFD)** — Fetal death occurring at or after 20 weeks gestation, confirmed by the absence of fetal heart activity. - **Fetal Heart Tones (FHT)** — Sounds of the fetal heartbeat auscultated via Doppler or fetoscope; absence is the primary diagnostic criterion for IUFD. - **Oligohydramnios** — Decreased amniotic fluid volume for gestational age, often associated with uteroplacental insufficiency but not a direct sign of demise. ## 같은 주제 문제 - [A nurse is caring for a client at 32 weeks gestation who presents with decreased fetal mov…](https://mymerci.kr/pages/nclex_q.php?qn_id=543072) - [A nurse is caring for a client at 28 weeks gestation who has just been diagnosed with intr…](https://mymerci.kr/pages/nclex_q.php?qn_id=543074) - [A nurse is caring for a 28-year-old gravida 2, para 1 client at 36 weeks gestation who pre…](https://mymerci.kr/pages/nclex_q.php?qn_id=543075) - [A nurse is caring for a client at 28 weeks gestation who has just been diagnosed with intr…](https://mymerci.kr/pages/nclex_q.php?qn_id=543076) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._