NORCERT 8 Mains-2025
Obstetrics & Gynaecology
Medium
A G3P1 woman at 32 weeks of gestation is at risk for preterm labor. Which of the following is the best nursing intervention?
Appeared in: NORCERT 8 Mains-2025
Explanation
- The primary intervention for a woman at risk of preterm labor between 24 and 34 weeks is the administration of antenatal corticosteroids (e.g., Betamethasone, Dexamethasone).
- These medications accelerate fetal lung maturation by stimulating the production of surfactant, a substance that prevents the collapse of the alveoli (air sacs) in the lungs.
- This action significantly reduces the incidence and severity of major neonatal complications associated with prematurity, including Respiratory Distress Syndrome (RDS), intraventricular hemorrhage, and necrotizing enterocolitis.
- The patient's gestational age of 32 weeks falls directly within the established window of maximum benefit for this therapy.
Why Other Options Were Wrong
- Option A: Preparing for a caesarean section is a plan for delivery, not an intervention to improve fetal outcomes from prematurity. Preterm labor itself is not an indication for a C-section.
- Option B: Advising bed rest is an outdated practice that is not supported by current evidence to prevent preterm birth. It can also increase maternal risks like thromboembolism and deconditioning.
- Option C: Oxygen administration is not a routine treatment for preterm labor. It is only used to correct maternal or fetal hypoxia.
Related Visual
- Visual 1: Infographic - Illustrating the effect of corticosteroids on fetal lung surfactant production, showing how it helps alveoli stay open after birth.
- Visual 2: Flowchart - A management algorithm for a patient presenting with threatened preterm labor between 24-34 weeks, highlighting the central role of corticosteroid administration.
Clinical Relevance
- Nursing practice connection: Use the key finding related to Management of threatened preterm labor to guide bedside assessment, documentation, and the next nursing action.
- The nurse's primary role is to ensure the timely administration of the full course of corticosteroids, as the maximum benefit is achieved 24-48 hours after the first dose.
- Nurses must monitor for potential maternal side effects of corticosteroids, such as hyperglycemia (especially in diabetic patients) and signs of infection, as steroids can mask fever.
- Patient education is key; the nurse should explain the purpose of the medication is to help the baby's lungs develop, not to stop the labor itself.
How to Approach the Question
- Identify the core clinical scenario: A pregnant woman at 32 weeks is at risk for preterm labor.
- Determine the primary goal of intervention: The 'best' intervention is the one that most significantly improves neonatal outcomes if delivery occurs.
- Evaluate the gestational age: 32 weeks is a key time point. The fetus is viable but has immature lungs, making it highly susceptible to Respiratory Distress Syndrome (RDS).
- Analyze the options based on evidence-based practice: Caesarean section is a delivery method, not a treatment. Bed rest is an outdated and potentially harmful practice. Oxygen is for hypoxia, not a standard preterm labor treatment. Corticosteroids are known to accelerate fetal lung maturity.
- Conclude that administering corticosteroids directly addresses the main risk of prematurity at this gestational age (lung immaturity) and is the most beneficial intervention.
Concept Tested & Keywords
- Concept Tested: Management of threatened preterm labor
- Stem keywords: preterm labor, 32 weeks gestation, nursing intervention, G3P1
- Lead-in keywords: best
- Clinical cues: 32 weeks of gestation: This age is within the critical 24-34 week window where fetal lungs are immature and benefit most from corticosteroid administration.
Question ID
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