NORCET 2 - 2021 (shift-1)
Obstetrics & Gynaecology
Medium
A lady, G3A2P0L0, at 20 weeks gestation came to the antenatal clinic. Which action should be avoided by the nurse?
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).
Why Other Options Were Wrong
- 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.
Related Visual
- 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.
Question ID
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Practise the full NORCET 2 - 2021 (shift-1)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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