A nurse is reviewing the differences between placenta previa and abruptio placentae with a group of nursing students. Which of the following statements accurately differentiates placenta previa from abruptio placentae?

A. Fetal movement felt by provider
This is correct because fetal movement confirmed by a healthcare provider is a positive sign of pregnancy, as it directly confirms fetal presence.

B. Positive pregnancy test
This is incorrect because a positive pregnancy test is a probable sign, not a positive sign. It detects hCG, which can also be produced in conditions like gestational trophoblastic disease (molar pregnancy).

C. Hegar’s sign
This is incorrect because Hegar’s sign (softening of the lower uterus) is a probable sign, not a positive sign, as it can occur due to other physiological changes.

D. Breast tenderness and nausea
This is incorrect because breast tenderness and nausea are presumptive signs of pregnancy, meaning they are subjective symptoms that could be caused by other conditions (e.g., PMS, stress, illness).

A. Deep tendon reflexes (DTR) – Worsening

On 2/10, the client had hyperreflexia (DTRs 3+) and no clonus. By 2/11, the DTRs had increased to 4+ with positive clonus, indicating neuromuscular hyperexcitability, a hallmark of worsening preeclampsia with severe features. Clonus is a concerning sign that suggests progression toward eclampsia (seizures). This indicates neurological worsening.

B. Creatinine – Worsening

The client's creatinine level increased from 1.4 mg/dL (already elevated) to 2.0 mg/dL, which is indicative of worsening renal function. Normal pregnancy should not cause a creatinine rise above 1.1 mg/dL, so this elevation suggests renal impairment due to severe preeclampsia. The worsening creatinine level indicates deteriorating kidney function, possibly due to reduced renal perfusion.

C. Client denies pain – Unrelated

The absence of pain is not directly related to the client’s condition worsening or improving. While pain can be a symptom of severe preeclampsia (such as epigastric pain from liver involvement), the client currently has an epidural, which can explain the lack of pain perception. The denial of pain does not indicate improvement in the disease process but rather effective pain management.

D. Vaginal exam – Improvement

The vaginal exam findings indicate progress in labor. On 2/10, the client was not noted to be in active labor, but by 2/11, she was 7 cm dilated, 80% effaced, and at 0 station, with contractions increasing in frequency and intensity. This progression suggests that labor is advancing appropriately.

E. Blood pressure – Worsening

The client’s blood pressure was severely elevated on 2/10 (168/100 mmHg) and remained high on 2/11 (152/86 mmHg). While slightly lower, the diastolic remains elevated, and systolic pressures are still high. Given the worsening DTRs, renal function decline, and elevated liver enzymes, the blood pressure changes are not a sign of improvement but rather persistent hypertension despite possible interventions.

F. Decreased sensation in legs – Unrelated

The client received an epidural for pain relief, which normally causes decreased sensation in the lower extremities. This finding is not related to worsening preeclampsia or labor progression but is an expected effect of the epidural anesthesia. The client’s ability to slightly move her legs confirms that the block is working properly.