A woman in labour present with transverse lie, cervix 4 cm dilated, membranes intact, fetal bradycardia, the… - IGNOU PB Bsc Nsg.Entrance-2026

IGNOU PB Bsc Nsg.Entrance-2026

Obstetrics & Gynaecology

Hard

Appeared in: IGNOU PB Bsc Nsg.Entrance-2026

Explanation

The clinical scenario presents two critical problems: a transverse lie and fetal bradycardia.
A transverse lie is an abnormal fetal presentation where the long axis of the fetus is perpendicular to the long axis of the mother, making vaginal delivery of a singleton impossible.
Fetal bradycardia (a heart rate below 110 bpm) is a non-reassuring sign of fetal distress, indicating fetal hypoxia and the need for immediate delivery.
The combination of an undeliverable presentation and acute fetal distress makes an emergency Caesarean section the only safe and appropriate treatment to prevent severe fetal morbidity or mortality.

Option A: External cephalic version (ECV) is a procedure to turn the fetus to a head-down position before labor begins. It is contraindicated in active labor (cervix 4 cm dilated) and in the presence of fetal distress (bradycardia) because the manipulation can worsen fetal compromise and there is no time for such a procedure in an emergency.
Option C: Internal podalic version is an intrauterine maneuver to convert the fetus to a breech presentation. It carries a very high risk of uterine rupture and fetal injury in a singleton pregnancy and is therefore not used.
Option D: Forceps delivery is a method of assisted vaginal delivery. It requires the fetal head to be in a deliverable position (vertex or sometimes face), engaged in the maternal pelvis, and the cervix to be fully dilated. None of these conditions are met with a transverse lie.

Clinical Relevance

Nursing practice connection: Use the key finding related to Management of Obstetric Emergencies: Transverse Lie with Fetal Distress to guide bedside assessment, documentation, and the next nursing action.
Recognizing the combination of a malpresentation like transverse lie and signs of fetal distress like bradycardia is a critical nursing skill. This situation requires immediate escalation and preparation for an emergency Caesarean section.
The nurse's role includes initiating intrauterine resuscitation measures (e.g., placing the mother in a left lateral position, administering oxygen and IV fluids) while simultaneously preparing the patient and the operating room for surgery.
What if? If the fetus was in a transverse lie but there were no signs of fetal distress and the membranes were intact before labor started (e.g., at 37 weeks), the treatment of choice would be External Cephalic Version (ECV), not Caesarean section.

How to Approach the Question

First, identify the key elements in the clinical scenario: a woman is in active labor (4 cm dilated), the fetus has a transverse lie, and there is fetal bradycardia.
Analyze the implications of each element. Transverse lie means vaginal delivery is impossible. Fetal bradycardia means the fetus is in distress and needs to be delivered immediately.
Evaluate the options based on these implications. The need for immediate delivery in an undeliverable presentation points directly to a surgical solution.
Rule out External Cephalic Version because it's contraindicated in active labor and fetal distress.
Rule out Internal Podalic Version as it's a high-risk procedure not used for singletons.
Rule out Forceps Delivery because the fetal head is not engaged in the pelvis.

Concept Tested & Keywords

Concept Tested: Management of Obstetric Emergencies: Transverse Lie with Fetal Distress
Stem keywords: transverse lie, labour, cervix 4 cm dilated, fetal bradycardia
Lead-in keywords: treatment of choice
Clinical cues: Transverse lie indicates an impossible vaginal delivery.
Clinical cues: Fetal bradycardia is a sign of fetal distress requiring immediate intervention.