Which woman is the best candidate for a trial of labor after cesarean (TOLAC)?

Correct Answer: B

Rationale: Rationale for Choice B (Correct Answer): - A 21-year-old gravida 2, para 1 with one previous low-transverse cesarean section for CPD is the best candidate for TOLAC. - Low-transverse incisions have the lowest risk of uterine rupture during labor. - CPD is not a contraindication for TOLAC. - Young age and low parity are favorable factors for successful TOLAC. - Therefore, this candidate has the highest likelihood of a successful VBAC. Summary for Other Choices: - Choice A: Classical cesarean section carries a high risk of uterine rupture; prematurity increases this risk. - Choice C: Low-transverse incision is favorable, but the indication for the previous cesarean (late decelerations) may indicate an ongoing fetal concern. - Choice D: T-shaped incision increases the risk of uterine rupture; macrosomia is a risk factor for failed TOL

Correct Answer: A

Rationale: The active phase of labor according to ACOG begins at 6 cm dilation. At this point, contractions become stronger and more frequent, leading to faster cervical dilation. This stage signifies significant progress towards delivery. Choice B (3 cm) is incorrect as it falls within the early phase of labor. Choice C (5 cm) is also incorrect as it is near the beginning of the active phase but not the specific transition point. Choice D (10 cm) is incorrect as it marks full dilation and the transition to the second stage of labor.

Correct Answer: C

Rationale: The correct answer is C: 1 hour for a multiparous person, 2 hours for a nulliparous person. This is based on the typical duration of the third stage of labor, which involves the delivery of the placenta. In general, the third stage is expected to last around 5-30 minutes. However, for safety reasons and to allow for variations in individual cases, it is recommended to extend the time frame to 1 hour for multiparous individuals (those who have given birth before) and 2 hours for nulliparous individuals (those giving birth for the first time). This extended time frame ensures that healthcare providers have enough time to monitor and intervene if necessary without rushing the delivery of the placenta. Other choices are incorrect because they provide either too short (A and B) or too long (D) timeframes for the third stage of labor, which could lead to inadequate monitoring or unnecessary interventions.

Correct Answer: D

Rationale: The correct answer is D because decreased progesterone, increased estrogen, and the effects of oxytocin are the hormonal changes that initiate labor. Progesterone inhibits contractions, so its decrease allows labor to begin. Estrogen promotes uterine sensitivity to oxytocin, which stimulates contractions. Oxytocin is released in response to labor contractions and helps to strengthen contractions. A: Incorrect because decreased progesterone is needed for labor to start, estrogen needs to increase, and oxytocin is present during labor. B: Incorrect because increased progesterone inhibits labor, estrogen should increase, and oxytocin is present during labor. C: Incorrect because progesterone should decrease, estrogen should increase, and oxytocin is present during labor.

Correct Answer: E

Rationale: Based on the scenario, the decrease in blood pressure post-placenta delivery indicates potential hemorrhage, a common complication. The nurse should assess for signs of bleeding, such as excessive vaginal bleeding or tachycardia. Prompt intervention is crucial to prevent further complications. Other choices are less relevant - pain alone does not directly cause a decrease in blood pressure, skin-to-skin contact is important but not the priority in this situation, and a distended bladder can be addressed later. Assessing for possible hemorrhage is the most critical action to take in this scenario.