A nurse is assessing a client who is at 31 weeks of gestation.
Which of the following findings should the nurse identify as an indication of a potential prenatal complication?

Choice A rationale: Performing a vaginal exam to reassess effacement and dilation is not the immediate next action. At +2 station, the fetal head is already well-engaged in the birth canal, indicating adequate effacement and dilation. Further examination at this stage might not provide additional actionable information. Instead, the priority is to address the minimal progress observed during the prolonged second stage of labor.

Choice B rationale: Notifying the primary health care provider about minimal progress is the most appropriate next action. The client has been pushing for 2.5 hours with minimal progress, which raises concern for potential complications such as cephalopelvic disproportion or maternal exhaustion. Prompt notification allows the provider to evaluate the need for assisted delivery or other interventions to prevent prolonged labor-related complications.

Choice C rationale: Preparing the client for vacuum-assisted delivery might be considered if minimal progress persists and other factors are favorable. However, the decision for instrumental delivery requires the assessment and recommendation of the primary health care provider. Prematurely preparing for this procedure without consulting the provider may overlook other potential interventions or contraindications for assisted delivery.

Choice D rationale: Administering intravenous oxytocin is typically used to augment labor during the first stage, not the second stage where the client is actively pushing. In this scenario, uterine contractions are likely sufficient, given the prolonged pushing. The focus should be on evaluating the cause of minimal progress, which requires provider assessment before considering further interventions.

Choice A rationale: Low uterine tone with mild vaginal bleeding is more indicative of placenta previa rather than abruptio placenta. Placenta previa involves the placenta covering the cervix, leading to painless bleeding. Uterine tone remains soft as there is no detachment of the placenta from the uterine wall. Abruptio placenta, however, is characterized by uterine rigidity due to blood accumulation between the placenta and uterine wall.

Choice B rationale: Rigid uterine tone with dark vaginal bleeding is a hallmark of abruptio placenta. The rigidity arises from blood pooling behind the placenta, causing uterine muscle contraction. Dark vaginal bleeding occurs as the blood is often concealed and clotted before expulsion. This condition is a medical emergency due to the risk of maternal hemorrhage and fetal hypoxia. Prompt diagnosis and intervention are critical to prevent severe complications.

Choice C rationale: Soft uterine tone with painless vaginal bleeding is characteristic of placenta previa, not abruptio placenta. Placenta previa involves the placenta partially or completely covering the cervix, leading to painless bleeding as the placenta detaches from the lower uterine segment. The uterine tone remains soft because there is no significant blood accumulation or uterine muscle contraction, unlike in abruptio placenta.

Choice D rationale: Low uterine tone with absence of vaginal bleeding does not align with abruptio placenta. While concealed abruptio placenta can occur without visible bleeding, the uterine tone is typically rigid due to blood accumulation. Low uterine tone suggests a lack of uterine contraction or detachment, which is inconsistent with the pathophysiology of abruptio placenta. This finding may indicate other obstetric conditions rather than abruptio placenta.