In case of a pregnant mother with polyhydramnios labour is induced if:

IGNOU PB Bsc Entrance-2023

Obstetrics & Gynaecology

Easy

Appeared in: IGNOU PB Bsc Entrance-2023

Explanation

In pregnancies complicated by polyhydramnios (excess amniotic fluid), the presence of a major or lethal fetal anomaly is a primary indication for the induction of labor.
When a severe fetal anomaly is present, prolonging the pregnancy offers no benefit to the fetus and significantly increases maternal risks, such as respiratory compromise, placental abruption, and postpartum hemorrhage.
Therefore, labor is often induced to prioritize maternal safety, irrespective of the gestational age.
Common fetal anomalies associated with polyhydramnios include central nervous system defects (like anencephaly) and gastrointestinal obstructions, which impair fetal swallowing of amniotic fluid.

Option B: While labor induction is an option at term (more than 37 weeks), it is not an absolute requirement solely based on the presence of polyhydramnios. If the mother is asymptomatic and the fetus is stable, expectant management (awaiting spontaneous labor) is also a reasonable approach.
Option C: Inducing labor before 37 weeks (preterm) is generally contraindicated if the fetus is normal. The primary goal is to prolong the pregnancy to ensure fetal lung maturity and avoid the complications of prematurity.
Option D: Inducing labor at 28 weeks poses significant risks to the fetus due to extreme prematurity. This is strongly avoided unless there is a lethal fetal anomaly where fetal survival is not expected, or in cases of severe maternal compromise where continuing the pregnancy is life-threatening for the mother.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Indications for labor induction in pregnancies complicated by polyhydramnios as background academic context rather than a clinical decision trigger.
Nurses must closely monitor mothers with polyhydramnios for signs of respiratory distress, preterm labor contractions, and sudden gush of fluid (indicating membrane rupture).
Upon rupture of membranes, there is a high risk of umbilical cord prolapse due to the large volume of fluid. The nurse should be prepared for this emergency and immediately assess the fetal heart rate.
Postpartum, these mothers are at an increased risk for uterine atony and hemorrhage because the uterus was overdistended. Nurses should be vigilant in assessing fundal tone and lochia.

How to Approach the Question

First, understand the core of the question: it asks for a specific condition under which labor is induced for polyhydramnios. This implies looking for a definitive indication, not just a possible one.
Analyze the term 'polyhydramnios'. Recall that it means excess amniotic fluid and is associated with both maternal risks and potential underlying fetal problems.
Evaluate each option in the context of balancing maternal and fetal well-being.
Option A (fetal anomaly): Consider the implications of a lethal anomaly. Continuing the pregnancy offers no fetal benefit but increases maternal risk. This makes induction a logical step.
Option B (>37 weeks): This is 'term'. Induction is possible, but is it mandatory? No, expectant management is also an option. This is a 'may induce' situation, not an 'is induced' situation.
Options C and D (<37 weeks and 28 weeks): This is 'preterm'. The primary goal is to avoid prematurity if the fetus is viable. Induction is generally avoided. This makes these options incorrect unless a lethal anomaly is present.

Concept Tested & Keywords

Concept Tested: Indications for labor induction in pregnancies complicated by polyhydramnios.
Stem keywords: pregnant mother, polyhydramnios, labour is induced
Lead-in keywords: if
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: false