What is a potential complication when the fetus is footling breech?

Correct Answer: A

Rationale: The correct answer is A: prolapsed cord. In a footling breech presentation, the feet or legs of the fetus are positioned to deliver first, increasing the risk of the umbilical cord slipping down before the fetus during labor, leading to a prolapsed cord. This is a serious emergency as it can compromise fetal blood flow and oxygen supply. Choice B: Oligohydramnios is a decreased level of amniotic fluid and is not directly related to a footling breech presentation. Choice C: Low biophysical profile score indicates fetal well-being based on specific parameters and is not a direct complication of a footling breech presentation. Choice D: Meconium-stained fluid can occur due to fetal distress but is not specific to a footling breech presentation.

Correct Answer: A

Rationale: The correct answer is A: cord prolapse. In multiple gestation, there is a higher chance of cord prolapse due to the presence of more than one fetus in the uterus. This can lead to fetal distress and necessitate an emergency cesarean delivery to prevent complications. The other choices are incorrect because increased pain in labor, inability to push, and twins in cephalic-cephalic presentation are not direct risk factors for cesarean delivery in the context of multiple gestation.

Correct Answer: B

Rationale: The correct answer is B: 30 minutes. When a Category III FHR tracing is diagnosed, it indicates severe fetal distress. Prompt delivery is crucial to prevent adverse outcomes. 30 minutes allows for timely intervention without risking further harm to the fetus. Option A (15 minutes) may be too rushed, potentially causing unnecessary stress during the delivery process. Options C (45 minutes) and D (60 minutes) delay delivery, increasing the risk of complications due to prolonged fetal distress. Timing is critical in ensuring the best possible outcome for both the mother and the baby.

Correct Answer: D

Rationale: The correct answer is D because using forceps or a vacuum to assist delivery can help manage failure to descend during labor by aiding in the descent of the baby through the birth canal. Forceps or vacuum extraction can provide the necessary assistance to safely deliver the baby when maternal pushing alone is insufficient. Explanation for why the other choices are incorrect: A: Administering pain medication does not address the underlying issue of failure to descend during labor. B: Allowing the patient to rest may not resolve the issue of failure to descend and could potentially delay necessary interventions. C: Continuing to push for an extended period of time without progress can lead to maternal exhaustion and fetal distress without addressing the root cause of failure to descend.

Correct Answer: D

Rationale: The correct answer is D: methylergonovine. Methylergonovine is a uterotonic medication used to treat uterine atony by causing the uterus to contract and prevent postpartum hemorrhage. Ampicillin (A) is an antibiotic, nitroglycerine (B) is a vasodilator, and magnesium sulfate (C) is a medication used for conditions like preeclampsia and eclampsia, but not specifically for uterine atony. Therefore, D is the correct choice for treating uterine atony.