A multigravida client at 31 weeks gestation is admitted with confirmed pre-term labor.
As the nurse continues to monitor the client now receiving magnesium sulfate, which assessment findings will the nurse prioritize and report immediately to the RN or health care provider?

Choice A rationale

Puerperal infection, an infection of the reproductive tract after childbirth, is a risk factor for all postpartum women. However, a large newborn size (macrosomia) increases the risk of prolonged labor, increased instrumentation during delivery, and postpartum hemorrhage, which indirectly increases the risk of infection but is not the most direct immediate risk related to the newborn's weight.

Choice B rationale

Retained placental fragments are a risk factor when the placenta does not deliver intact. While a large newborn can sometimes be associated with difficulties during placental delivery, it is not the primary direct risk factor immediately following birth. Uterine atony is a more immediate and direct risk related to uterine overdistension.

Choice C rationale

Thrombophlebitis, the formation of blood clots in the veins, is a postpartum risk factor related to hormonal changes, immobility, and hypercoagulability. While factors like prolonged labor (more common with large babies) can contribute, it is not the most immediate and direct risk in the first few hours postpartum for a woman who delivered a large newborn.

Choice D rationale

A newborn weighing 9 lb 6 oz (4252 g) is considered macrosomic. This large size can lead to overdistension of the uterus during pregnancy and labor. Uterine overdistension impairs the ability of the uterine muscles to contract effectively after delivery, a condition known as uterine atony. Uterine atony is the primary and most immediate risk for postpartum hemorrhage in women who have delivered large newborns. .

Choice A rationale

In the immediate postpartum period, it is normal to observe lochia rubra, which is a dark red discharge, and the passage of small blood clots. A firm, midline fundus at the umbilicus indicates that the uterus is contracting effectively to control bleeding. Given these expected findings within the first hour postpartum, continued monitoring is the appropriate initial action.

Choice B rationale

Notifying the provider is usually indicated when there are deviations from the expected postpartum findings, such as excessive bleeding, a boggy uterus, or signs of infection. The current assessment does not indicate such complications.

Choice C rationale

Encouraging the client to empty her bladder is important in the postpartum period as a full bladder can interfere with uterine contraction and lead to increased bleeding. However, with a firm, midline fundus and expected lochia, this is not the priority action over continued monitoring.

Choice D rationale

Increasing the frequency of fundal massage is indicated when the uterus is boggy or not contracting effectively, leading to increased bleeding. The client's fundus is already firm, so increasing massage is not the immediate priority.