A nurse is caring for a client who is in labor.
 

Exhibits

After reviewing the information provided in the client's medical record, which of the following complications should the nurse identify that the client is at risk of developing?

Complete the following sentence by using the list of options.

The client is at great risk for developing

dropdown

as evidenced by the client's

dropdown

• PROM (Premature Rupture of Membranes): PROM refers to the rupture of membranes before the onset of labor and before 37 weeks of gestation. This client is at 28 weeks with confirmed membrane rupture and no contractions, making this the most accurate diagnosis.
• Preterm labor: Preterm labor is defined as regular uterine contractions with cervical change before 37 weeks. This client denies contractions, and the cervix is closed, so she does not meet the criteria for preterm labor at this time.
• Preeclampsia: Preeclampsia typically presents with new-onset hypertension (≥140/90 mm Hg) after 20 weeks of gestation, often with proteinuria or other signs of organ involvement. This client’s blood pressure is within normal limits, and there are no signs of proteinuria or significant symptoms of preeclampsia.
• Rupture of membranes at 28 weeks: The client reports 12 hours of clear vaginal leakage, and tests (positive nitrazine and ferning) confirm rupture of membranes. Since this occurred at 28 weeks, it represents preterm rupture and is directly linked to PROM.
• Uterine cramping at 28 weeks : The client specifically denies experiencing cramping or contractions. Without uterine activity or cervical change, there is no evidence to support uterine cramping or preterm labor.
• Blood pressure elevated at 140/90 mm Hg: The client’s recorded blood pressure is 108/84 mm Hg, which is within the normal range for pregnancy. There is no indication of elevated blood pressure or other signs that would suggest hypertensive complications.

A. Development of scoliosis in the spine: Scoliosis is a lateral curvature of the spine and is not a typical change during pregnancy. Pregnancy usually leads to lumbar lordosis, not scoliosis. This spinal shift affects posture but is not responsible for a waddling gait in pregnancy.

B. Increased blood volume leading to leg swelling: While increased blood volume can cause leg swelling and discomfort, it does not significantly alter the mechanics of walking. Edema may cause heaviness but not the joint instability seen with a waddling gait.

C. Relaxation of pelvic ligaments and joints: Pregnancy hormones like relaxin cause pelvic ligaments and joints to loosen in preparation for childbirth. This increased mobility alters pelvic alignment and stability, leading to the characteristic waddling gait.

D. Increased muscle strength in the lower extremities: Muscle strength typically does not increase during pregnancy; fatigue and reduced endurance are more common. Stronger muscles would improve balance, not cause a waddling gait, making this an unlikely factor.