A 29-week gravid patient is admitted to the labor and delivery unit with vaginal bleeding. To differentiate between placenta previa and abruptio placentae, the nurse should assess which of the following?

Quantity of vaginal bleeding

Presence of abdominal pain

Leopold's maneuver results.

Maternal blood pressure

Answer and Explanation

The Correct Answer is B

A. Quantity of vaginal bleeding. While both placenta previa and abruptio placentae can cause vaginal bleeding, the amount alone does not differentiate between the two conditions. Placenta previa typically causes painless, bright red bleeding, whereas abruptio placentae often presents with concealed or variable bleeding, making quantity an unreliable distinguishing factor.

B. Presence of abdominal pain. Abdominal pain is a key differentiating factor. Placenta previa is characterized by painless vaginal bleeding, while abruptio placentae causes sudden, severe abdominal pain due to placental detachment and uterine muscle irritation. This makes the presence or absence of pain an important assessment finding.

C. Leopold's maneuver results. While Leopold’s maneuvers help determine fetal position and presentation, they do not provide definitive information about the location of the placenta or differentiate between placenta previa and abruptio placentae. Ultrasound is a more reliable diagnostic tool for this purpose.

D. Maternal blood pressure. Although abruptio placentae can lead to hypovolemic shock and blood pressure changes due to hemorrhage, maternal blood pressure alone is not a primary diagnostic criterion for differentiating between the two conditions. Other clinical findings such as pain and ultrasound results are more useful for diagnosis.

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Correct Answer is D

Explanation

A. Internal fetal monitoring. Internal fetal monitoring is contraindicated when placenta previa is suspected because it involves inserting a catheter or electrode into the uterus, which can increase the risk of hemorrhage if the placenta is covering the cervix.

B. Amniocentesis for fetal lung maturity. While fetal lung maturity assessment may be relevant if early delivery is being considered, it is not an immediate diagnostic procedure for evaluating the cause of vaginal bleeding. The priority is to determine placenta location and rule out placenta previa.

C. Contraction stress test. A contraction stress test evaluates fetal response to contractions but is not the appropriate initial diagnostic test in a patient with vaginal bleeding. Stimulating contractions could worsen bleeding if placenta previa or another placental abnormality is present.

D. Ultrasound for placenta location. The first-line diagnostic test for painless, bright red vaginal bleeding in the third trimester is an ultrasound. It helps determine whether the bleeding is due to placenta previa, a condition where the placenta partially or completely covers the cervix, which requires careful management to prevent complications.

A. The cervix is effacing and dilated to 2 cm B. Irregular, mild uterine contractions are occurring every 15-30 minutes C. Estriol is not found in maternal saliva D. Fetal fibronectin is present in vaginal secretions

Correct Answer is A

Explanation

A. The cervix is effacing and dilated to 2 cm. Cervical changes, including effacement and dilation, are the most definitive signs of preterm labor. Uterine contractions alone do not confirm preterm labor unless they result in cervical dilation, indicating that labor is progressing.

B. Irregular, mild uterine contractions are occurring every 15-30 minutes. Irregular contractions, known as Braxton Hicks contractions, can be common in pregnancy and do not necessarily indicate preterm labor. True preterm labor involves regular contractions that lead to cervical changes.

C. Estriol is not found in maternal saliva. The absence of estriol in maternal saliva does not confirm or rule out preterm labor. Salivary estriol testing is not a widely used or reliable diagnostic tool for determining the onset of preterm labor.

D. Fetal fibronectin is present in vaginal secretion. Fetal fibronectin (fFN) is a protein found in vaginal secretions between 22-34 weeks of pregnancy and can indicate a risk of preterm labor, but its presence alone does not confirm that labor is actively occurring. A positive fFN test means the patient may be at increased risk for preterm labor, but cervical changes remain the best indicator of actual labor.

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A 29-week gravid patient is admitted to the labor and delivery unit with vaginal bleeding. To differentiate between placenta previa and abruptio placentae, the nurse should assess which of the following?

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