Question for L&D nurses about cervical effacement

newgrad2005 · Aug 28, 2004

Can a cervix ever reverse progress? I'm working on a case study for school, and in the scenario, at 1400 the client is 6cm dilated and 100% effaced. At 1900, the client is 8cm dilated and 90% effaced. Does this happen, or is it a typo? I've emailed my instructor, but thought I'd get a quicker response here. Thanks for your help!

Were the two exams done by the same person?

JMinCO · Aug 28, 2004

Amy B, There's two possibilities here: one is that someone different checked the pt and there's a difference of opinion, fairly commen esp with such a small discrepency or the pt had some swelling of the cervix for several possible reasons. This is sometimes a early sign of problems to come. Did the pt have a fetal malpresentation, small pelvic outlet, end up requiring an assisted delivery or c/s? Hope this helps, J.

QUOTE=AmyB]Can a cervix ever reverse progress? I'm working on a case study for school, and in the scenario, at 1400 the client is 6cm dilated and 100% effaced. At 1900, the client is 8cm dilated and 90% effaced. Does this happen, or is it a typo? I've emailed my instructor, but thought I'd get a quicker response here. Thanks for your help!

AmyB · Aug 28, 2004

Were the two exams done by the same person?

Nothing was noted about that. It's pretty brief and without much detail. This is the first part:

1400 The client's contractions are 4 minutes apart, last 45-60 seconds, and are of moderate intensity. lady partsl assessment is 6 cm dilated, +0 station, 100% effaced, RSA presentation. FHT's are 150,with average short term variability. She is more serious and focused on each contraction, feels helpless and apprehensive, and wants to "get this over with". She asks, "Can I have something to take the edge off this pain?" Her husband is supportive and attentive. She has been ambulating with him in the hallway but now wants to lie down. As she gets into bed, her membranes spontaneously rupture and a tinge of green is noted in the fluid color.

This is the second part:

1900 Her contractions are 2-3 minutes apart, last 70-80 seconds, and are of very strong intensity. lady partsl exam reveals 8 cm dilatation, 90% effacement. She shows frustration, loss of control, has nausea, and vomits small amounts. She tells her husband, "Get away, do not touch me!" As the nurse enters the room, she asks for a bedpan and says she feels like she has to have a bowel movement. She screams, "I have to push!"

SmilingBluEyes · Aug 28, 2004

Sure, it can happen. I can think of two cases right away; one is when a cervix swells up in dysfunctional labor....or when the water breaks and the pressure is off the cervix temporarily. In both cases, dilatation can "reverse" , even reported in checks by the same person. These are fairly common phenomena.

kmrmom42 · Aug 29, 2004

I don't have much to add to the replies posted here as I agree with all of them. But I am curious...what were you supposed to do with this case study? What was the question you were expected to answer?

AmyB · Aug 31, 2004

I don't have much to add to the replies posted here as I agree with all of them. But I am curious...what were you supposed to do with this case study? What was the question you were expected to answer?

After each scenario, we were suppossed to answer questions like, "What phase and stage of labor is the client in? What are the anticipated maternal responses during this phase?" Things like that. Pretty basic, now that I've started to get the hang of things.

Thank you to all who posted responses. I was finally able to speak to my instructor about the cervical progression. Apparently it was just a typo and nothing more.

Thanks again for all the help! :balloons:

kmrmom42 · Sep 3, 2004

Apparently it was just a typo and nothing more.
This is what I would have guessed because it did not seem intrinsic to the intent of the question.
Good for you for picking it up! You are developing good detecting skills which are essential for a good nurse!
Karen