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.

Choice A rationale

Meconium stools are a normal physiological finding in a newborn during the first 24-48 hours of life. This thick, tarry, dark-green stool is composed of intestinal epithelial cells, amniotic fluid, bile, and water, reflecting fetal gastrointestinal tract development and function. Its presence indicates typical bowel activity.

Choice B rationale

Depressed fontanels indicate dehydration in a newborn. The fontanels are soft spots on a baby's head where the skull bones have not yet fused. When a baby is dehydrated, the fluid volume in the brain decreases, causing the fontanel to appear sunken below the normal contour of the skull, which necessitates immediate medical attention due to potential complications.

Choice C rationale

Rust-stained urine, also known as "brick dust" urine, in a newborn can indicate dehydration. This discoloration is caused by the excretion of urate crystals, which are a normal metabolic byproduct. However, in concentrated urine, these crystals become more visible, suggesting insufficient fluid intake and requiring further assessment to prevent significant dehydration.

Choice D rationale

Overlapping suture lines, also known as molding, are a common and expected finding in newborns, especially after vaginal delivery. This temporary reshaping of the fetal skull allows it to pass more easily through the birth canal and typically resolves spontaneously within a few days as the brain grows and fills the cranial cavity.

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.