A nurse is caring for a client who has a marginal placenta previa.
Which of the following should the nurse expect the client's ultrasound to reveal?

Choice A rationale

Following an eclamptic seizure, the priority for a preterm client at 26 weeks of gestation is to prepare for potential delivery while optimizing fetal outcomes. Antenatal steroids, such as betamethasone, are administered to accelerate fetal lung maturity by stimulating surfactant production in the alveolar cells. Since eclampsia often necessitates urgent delivery to resolve maternal hypertension and neurologic instability, providing steroids helps reduce the risk of neonatal respiratory distress syndrome and intraventricular hemorrhage.

Choice B rationale

Umbilical artery blood flow analysis is a Doppler ultrasound procedure used to assess placental perfusion and fetal well-being in chronic conditions like fetal growth restriction or preeclampsia. In the immediate wake of an eclamptic seizure, which is an acute obstetric emergency, this diagnostic test is not the primary intervention. The focus must remain on maternal stabilization, airway protection, and preparing for the likely termination of the pregnancy to prevent further life-threatening seizures or maternal organ failure.

Choice C rationale

Expectant management involves monitoring and delaying delivery to allow for further fetal growth; however, it is generally contraindicated once eclampsia has occurred. Eclampsia is a definitive indication for delivery regardless of gestational age because the maternal risks of stroke, hepatic rupture, or placental abruption are too high. Following a seizure, the clinical protocol shifts from expectant management to stabilization and delivery to ensure the safety of the mother, as the placenta is the underlying cause.

Choice D rationale

While monitoring the fetus is important, continuous fetal monitoring is often secondary to maternal stabilization immediately after an eclamptic event. During the seizure, the fetus often experiences transient bradycardia or late decelerations due to maternal hypoxia and uterine vasoconstriction. These usually resolve once maternal oxygenation is restored. The most critical intervention at 26 weeks, once the mother is stable, is the administration of corticosteroids to prepare the immature fetal lungs for an impending delivery.

Choice A rationale

A blood transfusion of packed red blood cells is not a direct treatment for a cerebral hemorrhage. While maintaining adequate oxygenation is important for all tissues, a cerebral hemorrhage is a localized bleeding event in the brain often related to severe hypertension in HELLP syndrome. Management for that specific complication would involve aggressive blood pressure control and neurosurgical consultation rather than relying on a red blood cell transfusion to fix the intracranial bleed.

Choice B rationale

While packed red blood cells improve the oxygen-carrying capacity of the blood, they do not directly repair damage to the kidneys caused by HELLP syndrome. Renal impairment in this syndrome occurs due to microangiopathic hemolytic anemia and fibrin deposition in the renal vasculature. Treating the underlying condition and managing blood pressure are the primary ways to mitigate kidney damage, although a transfusion may be part of overall supportive care for the systemic illness.

Choice C rationale

Transfusing packed red blood cells does not specifically target or improve blood flow to the liver. In HELLP syndrome, liver dysfunction occurs because of fibrin deposits in the hepatic sinusoids, leading to periportal necrosis and subcapsular hematomas. While a transfusion helps systemic oxygenation, it does not resolve the microvascular obstructions or the underlying inflammatory process affecting the liver. The primary treatment for HELLP syndrome remains the delivery of the fetus and the placenta.

Choice D rationale

The transfusion of packed red blood cells is specifically intended to correct anemia, which is a hallmark component of HELLP syndrome. The "H" in HELLP stands for hemolysis, where red blood cells are destroyed as they pass through damaged small blood vessels. This leads to a decrease in hemoglobin and hematocrit levels. Providing packed red blood cells restores the volume of functional erythrocytes, thereby improving oxygen delivery to maternal tissues and supporting physiological stability.