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

Oligohydramnios refers to a condition characterized by a deficiency in amniotic fluid. It is not a common risk factor for hyperemesis gravidarum, which is more related to hormonal changes and genetic predisposition.

Choice B rationale

Twin gestations significantly increase the levels of human chorionic gonadotropin (hCG), leading to a higher incidence of hyperemesis gravidarum. Elevated hCG levels correlate directly with the severity of nausea and vomiting in pregnancy.

Choice C rationale

Anemia does not have a direct causal relationship with hyperemesis gravidarum. Hyperemesis may contribute to the development of anemia due to nutritional deficiencies, but it is not a predisposing risk factor.

Choice D rationale

Molar pregnancy, a gestational trophoblastic disease, causes significantly elevated levels of hCG, leading to an increased likelihood of hyperemesis gravidarum. This condition triggers extreme nausea and vomiting due to excessively high hormone levels.

Choice E rationale

A history of hyperemesis in previous pregnancies strongly predicts recurrence in subsequent pregnancies. This suggests a genetic or environmental predisposition to severe nausea and vomiting.

Choice A rationale

Intraamniotic infection (chorioamnionitis) is suspected due to the combination of prolonged rupture of membranes (25 hours), maternal fever (39.2°C), and fetal tachycardia (baseline of 175 bpm). These are key indicators of infection within the amniotic sac.

Choice B rationale

Pyelonephritis, an infection of the kidneys, is unlikely without the presence of symptoms such as flank pain, dysuria, and significant changes in urinalysis. The primary signs point towards intraamniotic infection.

Choice C rationale

Cholestasis of pregnancy primarily presents with intense itching, especially on the hands and feet, and does not typically involve fever or abnormal fetal heart rates. Thus, it is less likely in this scenario.

Choice D rationale

Placental abruption involves the separation of the placenta from the uterine wall before delivery, often presenting with abdominal pain, vaginal bleeding, and uterine contractions. The absence of these symptoms makes this diagnosis less likely.