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Question: josie is a 26yearold g2p1001 married white female her pregnancy...

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Josie is a 26-year-old, G2P1001, married, white female. Her pregnancy has been uneventful. She and her husband are very happy about this pregnancy. Their first child is three years old. Josie is a secondary school math teacher. She has remained employed throughout the pregnancy until last week when voiding frequency and urgency, and sho9rtness of breath became such problems that she decided to take a leave until after the baby is born. They plan to deliver at the birth center where their first child was born. Josie’s pregnancy is at 38 weeks’ gestation. She was just seen in the office this morning, and she and baby were doing well. The urine chemstrip was negative; BP and FHT were normal. The baby was at a -1 to -2 station, and her cervix was 80% effaced and 2 cm dilated. Josie had lost two pounds since last week. She had no edema and no headaches or vision changes. At that time, she was not experiencing any contractions. Currently: At 1am, Josie and her husband call the midwife to tell her that Josie’s waters have broken, and they are going to the birth center. When the midwife greets them, Josie is smiling and relaxed. She has been having contractions for about four hours at home, and they are just beginning to get strong. The baby is active. Immediately upon getting to the birth center, Josie asks to use the toilet. As soon as she sits down she tells the midwife that something is coming out of her vagina. The midwife recognizes a prolapse cord. Answer the following questions:

1. The midwife calls the nurse to assist in positioning Josie. What position will they place her in?

2. What are the risks associated with prolapsed cord?

3. What factors contributed to the cord prolapsing?

4. While the midwife does a vaginal exam, the nurse checks the fetal heart tones with a portable electronic fetal monitor. What patterns might the nurse expect to see?

5. What other immediate actions are needed at this time?

6. Should the cord be replaced into the vagina?

7. Josie is to be transported to the hospital. How should this transport be accomplished?

8. What problems might Josie experience postpartum?

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