A client in post-term labor is receiving oxytocin.

The health care provider orders the oxytocin infusion to infuse at 4 mU/min.

The oxytocin concentration available is 20 units in 1000 mL lactated ringers.

How many mL/hr will the infusion run? Record numerical answer only. Round to the nearest whole number.

Choice C rationale

Abruptio placentae is the premature separation of the placenta from the uterine wall. The classic signs include dark red vaginal bleeding (due to the pooling of blood behind the placenta), constant and intense abdominal pain, and a rigid, hypertonic uterus that does not relax between contractions. This rigidity is caused by the hemorrhage, clots, and resulting irritation and sustained contraction of the myometrium.

Choice A rationale

Preterm labor is characterized by regular uterine contractions causing cervical changes before 37 weeks' gestation. While contractions cause pain, the uterus typically relaxes completely between them, and the bleeding, if present, is usually bright red and less profuse than that seen with abruptio placentae, and it does not cause sustained uterine firmness.

Choice B rationale

Placenta previa is the implantation of the placenta over or near the cervical os. Its hallmark sign is painless, bright red vaginal bleeding that often occurs late in the second or third trimester. The uterus remains soft and relaxed, unlike the hard, board-like abdomen found with a severe placental abruption.

Choice D rationale

Placenta accreta involves abnormal adherence of the placenta to the uterine wall, typically becoming symptomatic at delivery when the placenta fails to separate. While it can cause bleeding, it does not typically present with the acute, severe abdominal pain and the sustained, board-like uterine rigidity seen before delivery, as it is a pathology of adherence, not separation.

Choice A rationale

This is an unscientific and dismissive response. There is a clear physiological reason for increased neonatal mucus following a cesarean birth. During a normal vaginal delivery, the thoracic squeeze exerted by the birth canal helps physically expel lung fluid and mucus, aiding the transition to extrauterine respiration.

Choice B rationale

While individual differences exist, this response fails to address the specific pathophysiology associated with the increased mucus observed in cesarean-born neonates. The lack of vaginal compression is a known factor that significantly impacts the clearance of fetal lung fluid and mucus, leading to transient tachypnea.

Choice C rationale

The lack of the "thoracic squeeze" during a cesarean birth means less fetal lung fluid and mucus are mechanically cleared compared to a vaginal birth. This remaining fluid can manifest as increased mucus-like secretions and often leads to conditions like Transient Tachypnea of the Newborn (TTN) as the lungs absorb the remaining fluid.

Choice D rationale

Pain medications like opioids, which may cross the placenta, primarily cause neonatal respiratory depression by acting on the central nervous system's respiratory centers, not by directly causing a physical build-up or inadequate clearance of mucus in the respiratory tract. Mucus clearance is a mechanical process.