A nurse is assisting with the monitoring of a client who is in labor.
Which of the following findings should the nurse report to the provider?

Choice A rationale:

Gestational hypertension is a condition characterized by elevated blood pressure during pregnancy. While it can increase the

risk of certain complications, it is not directly associated with an increased risk of postpartum hemorrhage. This is because

gestational hypertension primarily affects the vascular system, not the uterine muscle function, which is responsible for

controlling postpartum bleeding.

Choice B rationale:

A small for gestational age newborn (SGA) is a baby who is smaller than expected for their gestational age. While SGA can be

associated with some pregnancy complications, it is not a direct risk factor for postpartum hemorrhage. The size of the baby

does not have a significant impact on the ability of the uterus to contract and prevent excessive bleeding after delivery.

Choice C rationale:

Precipitous birth is defined as a labor that progresses very rapidly, with delivery occurring within three hours or less of the

onset of regular contractions. This rapid progression of labor can lead to postpartum hemorrhage for several reasons:

Uterine atony: The uterus may not have enough time to contract effectively after a rapid delivery, leading to increased

bleeding.

Lacerations and trauma: The rapid passage of the baby through the birth canal can increase the risk of tearing of the cervix,

vagina, or perineum, which can contribute to blood loss.

Retained placenta: The placenta may not separate from the uterine wall as easily after a precipitous birth, increasing the risk

of hemorrhage.

Choice D rationale:

A two-vessel umbilical cord is a variation in which the umbilical cord contains only two blood vessels (one vein and one

artery) instead of the usual three (one vein and two arteries). While this can be associated with certain fetal anomalies, it is not

a direct risk factor for postpartum hemorrhage. The number of blood vessels in the umbilical cord does not significantly

impact the ability of the uterus to contract and prevent bleeding after delivery.

Choice C rationale:

Endometritis is an inflammation of the inner lining of the uterus (endometrium). It is a common complication after childbirth,

affecting up to 1 in 10 women who deliver vaginally. Symptoms of endometritis typically develop within 1-3 days after

childbirth, but they can sometimes take up to a week to appear.

Swelling in the ankles is a common symptom of endometritis. This is because endometritis can cause inflammation and fluid

buildup in the pelvis, which can put pressure on the veins in the legs and cause them to swell.

Choice A rationale:

An increased heart rate can be a symptom of endometritis, but it is not a specific symptom. An increased heart rate can also be

caused by many other factors, such as fever, dehydration, and anxiety.

Choice B rationale:

Decreased appetite can be a symptom of endometritis, but it is not a specific symptom. Decreased appetite can also be caused

by many other factors, such as pain, fatigue, and nausea.

Choice D rationale:

Dry skin is not a typical symptom of endometritis. Dry skin can be caused by many other factors, such as dehydration,

medications, and underlying medical conditions.

Therefore, the most likely manifestation of endometritis in this patient is swelling in the ankles.