A nurse is caring for a female client who is primigravida at 30 weeks of gestation in the antepartum unit.

For each potential intervention, click to specify if the intervention is anticipated or contraindicated for the client. There must be at least 1 selection in every row. There does not need to be a selection in every column.

The nurse should identify that the client is at the greatest risk for preterm birth due to fetal fibronectin.

Rationale for correct answers:
Fetal fibronectin (fFN) is a glycoprotein found at the maternal-fetal interface, serving as a “biological glue” between the chorion and decidua. Normally, fFN is not detectable in cervicovaginal secretions between 22 and 34 weeks gestation. A level greater than 0.05 mcg/mL, such as this client’s 0.09 mcg/mL, signals disruption of the fetal membranes and an increased risk of preterm birth. It has a high negative predictive value, so a positive result strongly suggests premature labor risk, prompting interventions like tocolytics and corticosteroids to promote fetal lung maturity.

Rationale for incorrect Response 1 options:
Precipitous labor is rapid labor lasting under 3 hours from onset to delivery. Fetal fibronectin does not predict the speed of labor but the risk of preterm onset. This client’s labor is not precipitous based on exam and monitoring.

Chorioamnionitis is an intra-amniotic infection usually accompanied by maternal fever, uterine tenderness, and fetal tachycardia. Fetal fibronectin does not indicate infection.

Preeclampsia involves hypertension and proteinuria after 20 weeks and is unrelated to fetal fibronectin levels.

Rationale for incorrect Response 2 options:
Nitrazine and ferning tests assess membrane rupture. Both are negative here, indicating intact membranes, which does not exclude preterm labor but means premature rupture of membranes (PPROM) is unlikely.

Blood pressure measurements evaluate maternal hemodynamics, not risk of preterm birth.

Take-home points:

• Elevated fetal fibronectin (>0.05 mcg/mL) between 22-34 weeks indicates increased risk for preterm birth.
• Negative nitrazine and ferning tests suggest membranes are intact, helping differentiate preterm labor from PPROM.
• Preterm labor risk should be differentiated from precipitous labor, infection (chorioamnionitis), and hypertensive disorders like preeclampsia.
• Early identification of preterm labor risk allows timely administration of tocolytics and corticosteroids to improve neonatal outcomes.

Choice A rationale

For clients prescribed methadone during pregnancy, breastfeeding is generally encouraged due to the benefits of breast milk for the infant. Methadone excretion into breast milk is minimal and not considered harmful, and it can help to reduce the severity of neonatal abstinence syndrome.

Choice B rationale

Methamphetamine use during pregnancy is associated with several adverse fetal outcomes, but fetal macrosomia (abnormally large baby) is not typically one of them. Instead, it is more commonly linked to intrauterine growth restriction, preterm birth, and small for gestational age infants due to vasoconstrictive effects.

Choice C rationale

For newborns experiencing neonatal abstinence syndrome due to prenatal substance exposure, environmental stimuli should be decreased, not increased. Reducing stimuli like bright lights, loud noises, and excessive handling helps to minimize agitation, irritability, and seizures in these vulnerable infants.

Choice D rationale

Increased head circumference is not an expected finding in a newborn with fetal alcohol syndrome (FAS). In fact, microcephaly (abnormally small head circumference) is a characteristic diagnostic criterion for FAS, reflecting the detrimental effects of alcohol on fetal brain development.