The nurse has been called to help with a 24-year-old G1P0 female with a viable intrauterine pregnancy at 42-weeks’ estimated gestational age. Patient is not in active labor, following an arrest of descent at the end of the first stage of labor. There was meconium detected in the amniotic fluid after PROM, and the fetus has had multiple episodes of bradycardia and late decelerations. Patient has a history of cocaine abuse. Which of the following statements is most correct regarding the management of this neonate when it is delivered?

Question

The nurse has been called to help with a 24-year-old G1P0 female with a viable intrauterine pregnancy at 42-weeks&rsquo; estimated gestational age.  Patient is not in active labor, following an arrest of descent at the end of the first stage of labor.  There was meconium detected in the amniotic fluid after PROM, and the fetus has had multiple episodes of bradycardia and late decelerations.  Patient has a history of cocaine abuse.  Which of the following statements is most correct regarding the management of this neonate when it is delivered?

Accepted Answer

The neonate should be suctioned, treated for respiratory distress, if present, and carefully assessed for persistent pulmonary hypertension.. A fetus in distress may pass meconium prior to birth, which places them at risk for meconium aspiration syndrome. Neonates born through meconium-stained fluid must be carefully assessed for signs of meconium aspiration, which manifests clinically as respiratory distress and pulmonary hypertension.  It is no longer recommended to intubate and deep suction (below the vocal cords) at the perineum (or abdomen) for any newborn with meconium; they are delivered and then assessed for respiratory distress. Meconium-stained fluid alone is not an indication for an emergency cesarean section; a vaginal delivery provides better squeeze to the neonate&rsquo;s chest to aid in clearing fluid in the lungs. Since post-term gestational age is a risk factor for passing meconium, these patients require close assessment for complications.

Want help? View the answer with rationale.

Rationale

Additional Physiological Adaptation Questions

Nursing Careers

Nursing Degrees

NCLEX