A client at 34 weeks gestation arrives to OB triage and is concerned she may be in preterm labor.
Which of the following are signs and symptoms of preterm labor? (Select all that apply.)

Choice A rationale

Performing another vaginal exam does not directly influence labor progress. Labor can progress naturally without repeated exams, which can introduce unnecessary risk.

Choice B rationale

While vaginal exams can be uncomfortable, pain is not the primary reason to avoid multiple exams, especially when managing potential complications.

Choice C rationale

Vaginal exams might lead to minor bleeding due to irritation, but the risk of bleeding is not a primary concern in this context.

Choice D rationale

The most significant reason to avoid frequent vaginal exams after PPROM is the increased risk of infection. Each exam provides a potential pathway for bacteria to ascend, leading to complications like chorioamnionitis.

Choice A rationale

Placenta previa involves painless vaginal bleeding due to the placenta covering the cervical opening. It does not typically cause significant abdominal pain or the hemodynamic instability described in the scenario.

Choice B rationale

Abruptio placentae is the premature separation of the placenta from the uterine wall, causing severe abdominal pain, vaginal bleeding, and can lead to shock, consistent with the assessment findings.

Choice C rationale

Uterine rupture, often a complication in women with a previous cesarean section, involves the tearing of the uterine wall, causing sudden, severe abdominal pain and bleeding. However, it is less common than placental abruption.

Choice D rationale

Amniotic fluid embolism is a rare but life-threatening condition where amniotic fluid enters the mother's bloodstream, causing cardiovascular collapse and severe respiratory distress, which is less consistent with the described findings.