One of the greatest dangers in giving morphine sulphate during labour is?

Appeared in: IGNOU Post B. SC. Nursing entrance-2019

Explanation

Morphine, an opioid, readily crosses the placental barrier and can enter the fetal circulation within minutes.
The primary and most life-threatening risk to the newborn is respiratory depression, as morphine suppresses the respiratory center in the fetal brain.
The newborn's blood-brain barrier is immature, leading to higher concentrations of the drug in the fetal brain compared to the mother's, amplifying its depressive effects.
This can result in a newborn with apnea (not breathing), weak or slow respirations, poor muscle tone, and a low Apgar score, requiring immediate resuscitation.
The risk is particularly high if morphine is administered close to the time of delivery (typically within 4 hours).

Option B: This is factually incorrect. Morphine typically causes vasodilation and can lead to a decrease in blood pressure (hypotension), not an increase.
Option C: While nausea and vomiting are common side effects of morphine due to stimulation of the chemoreceptor trigger zone, they are not the 'greatest danger'. Neonatal respiratory depression is a life-threatening emergency.
Option D: Morphine does not have a direct or significant effect on the coagulation cascade or platelet function. It does not prolong bleeding time.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Risks of Morphine Administration in Labor as background academic context rather than a clinical decision trigger.
A nurse's primary responsibility is to ensure patient safety for both mother and baby. This involves critically evaluating the timing of medication administration in labor.
Nurses must be prepared for neonatal resuscitation if an opioid has been given close to delivery. This includes having naloxone (Narcan), bag-mask equipment, and suction readily available.
Accurate documentation of the time and dose of morphine is crucial for the neonatal team to anticipate and manage potential respiratory depression.

How to Approach the Question

First, identify the core of the question: it asks for the 'greatest danger' of a specific drug (morphine) in a specific context (labor).
This requires you to prioritize potential adverse effects based on severity and life-threatening potential, not just frequency.
Evaluate each option: Consider the physiological effects of morphine on both the mother and the fetus.
Option A (newborn respiratory depression): This is a direct, well-known, and potentially fatal complication. It affects the baby's ability to breathe at birth.
Option B (increased BP): Recall that opioids typically cause hypotension, so this is factually incorrect.
Option C (nausea/vomiting): This is a common side effect but is not life-threatening compared to respiratory arrest.

Concept Tested & Keywords

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E6 Pharmacology KD Tripathi Essentials 9e Part 2 pp. 137-139, 136-138

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