Maternity Nursing: Antepartum Q 47
A client in labor is transported to the delivery room and is prepared for cesarean delivery. The client is transferred to the delivery room table, and the nurse places the client in the:
A. Trendelenburg’s position with the legs in stirrups.
B. Semi-Fowler position with a pillow under the knees.
C. Prone position with the legs separated and elevated.
D. Supine position with a wedge under the right hip.
Correct Answer: D. Supine position with a wedge under the right hip.
Vena cava and descending aorta compression by the pregnant uterus impedes blood return from the lower trunk and extremities. This leads to decreasing cardiac return, cardiac output, and blood flow to the uterus and the fetus. The best position to prevent this would be side-lying with the uterus displaced off of abdominal vessels. Positioning for abdominal surgery necessitates a supine position; however, a wedge placed under the right hip provides displacement of the uterus.
Option A: Use of Trendelenburg position during prolonged active labor does not decrease the incidence of cesarean delivery and may be associated with poor fetal outcomes. Prospective, randomized data on the topic of maternal positioning in labor would further elucidate the role, if any, for Trendelenburg position in labor.
Option B: When maternal position in left lateral tilt was compared with the horizontal position, there was no influence on the incidence of hypotension, and there were no changes in systolic and diastolic blood pressure.
Option C: Prone position is inappropriate during cesarean delivery. When the full left lateral tilt was compared with left lateral tilt, maternal position did not increase the risk of hypotension and there were no changes in systolic and diastolic blood pressure.