A lady, G3A2P0L0, at 20 weeks gestation came to the antenatal clinic. Which action should be avoided by the n… - NORCET 2 - 2021 (shift-1)

NORCET 2 - 2021 (shift-1)

Obstetrics & Gynaecology

Medium

Appeared in: NORCET 2 - 2021 (shift-1)

Explanation

IV oxytocin is a uterotonic agent, meaning it stimulates the uterus to contract.
Administering oxytocin at 20 weeks gestation would induce labor or a second-trimester abortion.
This action is directly contrary to the primary goal of care, which is to maintain the pregnancy in a high-risk patient.
Uterine stimulants like oxytocin are contraindicated in early pregnancy when the goal is not termination (SRC_1).

Option A: Bed rest and follow-up is a conservative, non-harmful management strategy. While its efficacy is debated, it is not an action to be avoided; it's a potential part of the care plan to reduce physical strain.
Option B: Cervical cerclage is a primary surgical treatment for cervical incompetence, which is a strong possibility given the patient's history of recurrent mid-trimester losses. This is an indicated procedure, not one to be avoided.
Option C: Progesterone therapy is a common and effective medical treatment to help maintain pregnancy by relaxing the uterus and preventing preterm contractions. It is an indicated therapy, not one to be avoided.

Visual 1: Diagram: Illustration of a cervical cerclage procedure, showing the suture placed around the cervix to keep it closed.
Visual 2: Infographic: Explanation of the GTPAL (Gravida, Term, Preterm, Abortions, Living) system for documenting obstetric history, with this patient's G3P0A2L0 as an example.

Clinical Relevance

Nursing practice connection: Knowing Management of High-Risk Pregnancy helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Accurate interpretation of a patient's obstetric history (GTPAL/GPA) is crucial for identifying risks and planning appropriate antenatal care.
Nurses must understand the specific indications and contraindications for obstetric medications. Administering oxytocin inappropriately can have catastrophic consequences for the pregnancy.
What if the patient was at 41 weeks gestation with a favorable cervix but labor was not progressing? In that case, IV oxytocin would be an appropriate intervention to induce or augment labor.

How to Approach the Question

First, decode the patient's obstetric history: G3A2P0L0 means 3 pregnancies, 2 losses, 0 births past 20 weeks, 0 living children. This signifies a high-risk pregnancy with a history of loss.
Identify the gestational age: 20 weeks. This is pre-viable, so the primary goal is to maintain the pregnancy.
Analyze the question's lead-in: "Which action should be avoided?" This requires you to identify the contraindicated intervention.
Evaluate each option against the goal of maintaining the pregnancy.
Bed rest, cerclage, and progesterone are all interventions aimed at preserving the pregnancy.
IV oxytocin is an intervention aimed at ending the pregnancy by inducing labor. Therefore, it is the action to be avoided.

Concept Tested & Keywords

Concept Tested: Management of High-Risk Pregnancy
Stem keywords: G3A2P0L0, 20 weeks gestation, antenatal clinic
Lead-in keywords: avoided
Clinical cues: G3A2P0L0 history indicates recurrent pregnancy loss, suggesting high risk.
Clinical cues: 20 weeks gestation is a pre-viable stage, so the goal is pregnancy maintenance.

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