A laboring client's membranes rupture spontaneously, and the nurse observes a loop of umbilical cord protruding from the vagina. What is the nurse's priority action?

A. Uterine inversion is a rare, life-threatening emergency in which the uterus turns inside out. It presents with sudden, severe abdominal pain, hemorrhage, shock, and the inability to palpate the uterine fundus abdominally. Although bleeding can be heavy, it is uncommon and not the most likely cause of profuse lochial bleeding 1 hour after a cesarean section.
B. Vaginal lacerations cause persistent bleeding despite a firm, well-contracted uterus and are more commonly associated with operative or traumatic vaginal deliveries. Since this client delivered by cesarean section, vaginal lacerations are less likely to be the source of heavy lochial bleeding.
C. Uterine atony is the most common cause of early postpartum hemorrhage, occurring within the first 24 hours after delivery. It results from failure of the uterus to contract and compress blood vessels at the placental site, leading to excessive lochial bleeding. Risk factors include prolonged labor, overdistended uterus, infection, and cesarean delivery.
D. Vaginal hematomas result from concealed bleeding into soft tissues and typically present with severe perineal or rectal pain, pressure, and signs of hypovolemia with minimal visible bleeding, making this an unlikely cause of profuse lochial bleeding.

A. Frequent urination is a normal physiologic change during pregnancy, especially as the uterus enlarges and places pressure on the bladder. While it may cause discomfort, it is not indicative of complications related to a cervical cerclage. Patients should be informed that urinary frequency is expected and does not require urgent medical attention unless accompanied by pain, burning, or signs of infection.

B. Mild leukorrhea is common in pregnancy due to increased estrogen and cervical gland activity. It is typically thin, white, and non-irritating. It does not signal a complication after cerclage placement. However, patients should be taught to monitor for changes such as foul odor, increased amount, or green/yellow color, which could indicate infection and require prompt evaluation.

C. After a cervical cerclage, the primary risks include preterm labor, cervical insufficiency recurrence, infection, or preterm rupture of membranes, all of which can threaten the pregnancy. Uterine contractions, sudden pelvic pressure, vaginal bleeding, or fluid leakage from the vagina are warning signs of complications that require immediate medical evaluation. Patients should be instructed to monitor for these symptoms closely, maintain limited activity as advised, and contact their provider immediately if any arise. Early recognition allows for timely interventions such as tocolytics, hospitalization, or cerclage reinforcement, which can help preserve the pregnancy.

D. Breast tenderness is a normal physiologic response to pregnancy hormones, particularly elevated estrogen and progesterone. It is not associated with cerclage placement and does not indicate a need for urgent intervention.