A nurse is caring for a 30-year-old female client who is at 20 weeks of gestation in the labor and delivery unit.

Exhibits

For each of the listed client findings, click to specify if the finding is consistent with ectopic pregnancy or molar pregnancy. Each finding may support more than 1 disease process.

Choice A rationale

Placenta previa is a condition where the placenta implants in the lower part of the uterus, potentially covering the cervix. It typically presents with painless vaginal bleeding, especially in the later trimesters, and is not directly associated with sudden, intense abdominal pain and cessation of contractions during labor.

Choice B rationale

Uterine rupture is a serious complication of vaginal birth after cesarean (VBAC), especially with strong, frequent contractions. The sudden onset of intense abdominal pain and the cessation of contractions, along with fetal distress indicated by the absent fetal heart rate tracing, are classic signs of uterine rupture. The prior cesarean scar weakens the uterine wall, making it susceptible to tearing under the stress of labor.

Choice C rationale

A prolapsed umbilical cord occurs when the cord descends into the vagina ahead of the presenting part, potentially compressing the fetal blood vessels and causing fetal distress. While fetal heart rate abnormalities would be present, it is not typically associated with sudden, intense maternal abdominal pain and cessation of contractions.

Choice D rationale

Abruptio placentae is the premature separation of the placenta from the uterine wall. It can cause sudden abdominal pain, vaginal bleeding (though not always), and fetal distress. However, the cessation of uterine contractions is not a typical finding in abruptio placentae. Contractions may continue, although they might be accompanied by increased uterine tone.

Rationale for Correct Condition

Preeclampsia is characterized by hypertension (≥140/90 mm Hg) and proteinuria (≥300 mg/24 hr) or signs of systemic involvement such as headache and edema. The client’s elevated BP, significant proteinuria, headache, hyperreflexia, and pitting edema strongly indicate preeclampsia. The absence of seizures rules out eclampsia, and the gestational age excludes chronic hypertension with superimposed preeclampsia.

Rationale for Correct Actions

Magnesium sulfate prevents seizures by stabilizing neuronal excitability and reducing cerebral vasospasm. It also lowers BP by promoting vascular relaxation. External fetal monitoring detects fetal distress from utero-placental insufficiency caused by preeclampsia-related hypertension and endothelial dysfunction.

Rationale for Correct Parameters

Blood pressure reflects disease progression and response to antihypertensives. Severe hypertension increases the risk of cerebral hemorrhage and placental abruption. Deep tendon reflexes indicate neurological impairment. Hyperreflexia signals worsening preeclampsia, while absent reflexes may indicate magnesium toxicity.

Rationale for Incorrect Conditions

Gestational hypertension lacks proteinuria and systemic symptoms. Chronic hypertension with superimposed preeclampsia requires a pre-existing hypertensive diagnosis. Eclampsia involves seizures, which the client has not reported.

Rationale for Incorrect Actions

Ampicillin is not indicated without infection. Rh immune globulin is unnecessary without Rh incompatibility. Anticoagulants are not first-line for preeclampsia.

Rationale for Incorrect Parameters

Temperature is not directly related to preeclampsia. Petechiae are signs of coagulopathy, not primary indicators. Pruritus is irrelevant unless liver dysfunction is suspected.

Take-Home Points

• Preeclampsia involves multisystem dysfunction with endothelial damage.
• Magnesium sulfate prevents seizures but must be monitored for toxicity.
• Differentiation from gestational hypertension is crucial for management.
• Fetal monitoring is key to detecting early signs of compromise.