A nurse in a clinic is caring for a client who is antepartum. The client expresses concern about preparing their preschooler for a new sibling.
Which of the following responses should the nurse make?

Choice A rationale

Oxytocin use for labor induction or augmentation is a significant risk factor for uterine atony, the most common cause of postpartum hemorrhage (PPH). Prolonged or high-dose exposure can lead to receptor downregulation or overstimulation, resulting in a fatigued or poorly contracting uterus, which fails to clamp down on the blood vessels at the placental site after delivery.

Choice B rationale

A history of Human Papillomavirus (HPV), a sexually transmitted infection, is not recognized as an independent risk factor for increasing the likelihood of postpartum hemorrhage. The physiological mechanisms leading to PPH are primarily related to uterine function, trauma, or coagulation disorders, which HPV infection does not directly influence.

Choice C rationale

A history of uterine atony in a previous pregnancy significantly increases the risk for recurrence in subsequent deliveries because it suggests an underlying predisposition for the myometrium to fail its contractile function. Uterine atony prevents the spiral arteries from being compressed, leading to excessive blood loss, which defines postpartum hemorrhage.

Choice D rationale

The average newborn weight in Western populations is approximately 3.4 kg (7.5 lb), with a normal range generally considered between 2.5 kg and 4.0 kg. A newborn weight of 2.948 kg (6 lb 8 oz) is within the normal range and does not constitute a risk factor for PPH, unlike macrosomia (birth weight > 4000 g or 8 lb 13 oz) which overdistends the uterus.

Choice E rationale

Vacuum-assisted delivery, a form of operative vaginal delivery, increases the risk of PPH primarily due to associated genital tract trauma (e.g., cervical, vaginal, or perineal lacerations) and potentially compounding the risk of uterine atony from prolonged labor or necessary manual maneuvers. Trauma contributes to bleeding that is non-uterine in origin.

Choice A rationale

Fundal massage is the primary intervention for uterine atony and postpartum hemorrhage to stimulate uterine contraction and tamponade bleeding. However, an amniotic fluid embolism (AFE) is characterized by sudden cardiopulmonary collapse, hypoxia, and coagulopathy, where fundal massage is irrelevant to the underlying pathology.

Choice B rationale

AFE involves the sudden entry of amniotic fluid into the maternal circulation, triggering a massive anaphylactoid reaction, acute respiratory distress, and severe refractory hypotension, leading to cardiac and respiratory arrest. Initiating cardiopulmonary resuscitation (CPR) is often immediately required to support life functions.

Choice C rationale

Assisting the client to empty their bladder may be beneficial during labor to allow the fetal head to descend, but it is not a priority intervention for the life-threatening, acute physiological crisis of an AFE. The immediate focus must be on optimizing oxygenation, circulation, and treating the underlying shock and coagulopathy.

Choice D rationale

AFE causes severe pulmonary vasoconstriction and acute respiratory distress, leading to profound hypoxemia. Applying oxygen at 2 L/min via nasal cannula is insufficient for this level of respiratory compromise; the client requires high-flow oxygen, often nonrebreather mask or mechanical ventilation, to maintain adequate arterial oxygen saturation.