A nurse is caring for a client who is at 36 weeks of gestation and has a confirmed intrauterine fetal demise. Which of the following treatment options should the nurse anticipate the provider to discuss with the client?

Choice A rationale Immediate cesarean birth is generally not indicated for intrauterine fetal demise unless there are maternal complications, such as hemorrhage or infection, or if the client has a prior uterine scar that contraindicates vaginal birth. Cesarean section carries higher risks for the mother compared to vaginal delivery and is usually reserved for specific obstetrical indications. Choice B rationale Methotrexate is an antimetabolite medication primarily used in the management of ectopic pregnancy or gestational trophoblastic disease due to its cytotoxic effects on rapidly dividing cells. It is not indicated for the induction of labor or expulsion of a fetus in cases of intrauterine fetal demise as it does not stimulate uterine contractions effectively for this purpose. Choice C rationale In cases of intrauterine fetal demise at 36 weeks of gestation, scheduled induction of labor is the most common and generally recommended treatment option. This approach allows for planned delivery, reduces the psychological burden of carrying a deceased fetus, and minimizes the risk of complications such as coagulopathy for the mother, typically occurring after prolonged retention. Choice D rationale Dilation with suction curettage is a procedure typically used for early pregnancy termination or management of miscarriage in the first or early second trimester. At 36 weeks of gestation, the size of the fetus and uterus makes this procedure unsafe and inappropriate for delivery of a deceased fetus, posing significant risks of uterine perforation or hemorrhage.