Quote from PNS
I'm not an OB nurse, rather a student working on a case study, and I"m stuck on a question. Can someone help?
Would you do a vaginal check on a 33 weeker with confirmed amniotic fluid that is cloudy, mom has a slight temp, baby's heartbeat is 162-170 and has average variability. Patient has occasional contraction lasting 20 to 30 seconds.
I know you would need to know where she's at and if cord is compressed, but what throws me off is the infection... don't vaginal checks introduce more infection or risk of? Would she probably go C section anyways and since her contractions aren't that signficant would you bypass the vag check or do it?
Hi - I'm not going to answer your question outright as thinking this through is part of what you are learning, but will try to give you a couple of thoughts to lead you along.
First of all, look at your fetal heart rate - what does that tell you about the possibility of cord compression as an issue? Do you see any of the things you would expect to see in the FHR pattern if there was cord compression?
What do you know about the chance of infection being introduced by vaginal exam? If she is leaking amniotic fluid, what does that tell you about the natural barrier to infection? By what other method might the provider determine cervical dilation? (think visual) Did the doctor do a speculum exam to check for rupture of membranes? Are "occasional, 20-30 second contractions" likely to produce cervical change? And finally - what is the providers plan of care - induction,or postponing delivery with an eye to getting treatment to mature the lungs before delivery?
All these factors will influence the decision as to whether or not to do a vag. exam on this patient.
Good luck with your assignment!