A nurse in a provider's office is caring for a client who is at 37 weeks of gestation and at risk for placental abruption.
The nurse should recognize that which of the following is a risk factor for abruption?

Choice A rationale

Abruptio placentae involves the premature separation of the placenta from the uterus, causing abdominal pain and bleeding. However, the severe left-sided pain and uncertain last menstrual period suggest another condition rather than abruption.

Choice B rationale

Gestational trophoblastic disease is characterized by abnormal growth of trophoblasts, the cells that normally develop into the placenta. It is usually identified by abnormal bleeding and unusually high hCG levels, not the acute symptoms described.

Choice C rationale

Complete abortion refers to the expulsion of all products of conception, typically accompanied by heavy bleeding and cramping. While it involves vaginal bleeding, the severe unilateral pain and low blood pressure suggest a different diagnosis.

Choice D rationale

Ectopic pregnancy, where a fertilized egg implants outside the uterus, typically causes severe unilateral pain and can lead to internal bleeding, resulting in low blood pressure and a high heart rate. These symptoms align with the client's presentation and are a medical emergency.

Choice A rationale

Performing another vaginal exam does not directly influence labor progress. Labor can progress naturally without repeated exams, which can introduce unnecessary risk.

Choice B rationale

While vaginal exams can be uncomfortable, pain is not the primary reason to avoid multiple exams, especially when managing potential complications.

Choice C rationale

Vaginal exams might lead to minor bleeding due to irritation, but the risk of bleeding is not a primary concern in this context.

Choice D rationale

The most significant reason to avoid frequent vaginal exams after PPROM is the increased risk of infection. Each exam provides a potential pathway for bacteria to ascend, leading to complications like chorioamnionitis.