A nurse on a postpartum caring for a client.

Exhibits

For each potential client finding, click to specify if the finding is expected or unexpected.

A) Fetal baseline rate increasing at least 5 beats per minute:
An increase in the fetal baseline heart rate of 5 beats per minute is typically not associated with uteroplacental insufficiency. A baseline increase could indicate early signs of fetal stimulation, such as from fetal movement or excitement, but it does not align with the characteristic response to uteroplacental insufficiency, which usually causes signs of distress like late decelerations or fetal heart rate variability.

B) A shallow deceleration occurring with the beginning of contractions:
A shallow deceleration with the onset of contractions may suggest early decelerations, which are typically caused by fetal head compression during labor. Early decelerations are not typically associated with uteroplacental insufficiency, which generally leads to later decelerations. Early decelerations are generally considered benign and do not indicate oxygen deprivation or fetal distress.

C) Fetal heart rate declining late in contraction and remaining depressed:
Late decelerations, where the fetal heart rate drops after the peak of a contraction and stays depressed afterward, are a classic sign of uteroplacental insufficiency. This pattern occurs due to reduced blood flow and oxygen delivery to the fetus during contractions, leading to fetal hypoxia. Late decelerations suggest compromised placental function and require prompt attention to prevent further fetal distress.

D) Variable decelerations, too unpredictable to count:
Variable decelerations, characterized by abrupt drops in fetal heart rate with varying timing and duration, are usually caused by umbilical cord compression. While these decelerations can indicate fetal distress, they are not directly linked to uteroplacental insufficiency. Uteroplacental insufficiency typically leads to late decelerations, not variable decelerations.

Client Finding Assessment:

White blood cell count (18,000/mm³)

Expected: An elevated white blood cell count is common postpartum due to the body's inflammatory response to delivery, especially within the first few days after birth. This level is within the typical postpartum range of 5,000 to 30,000/mm³.

Blood clot size (pea-sized)

Expected: Small blood clots are common during the early postpartum period. It is normal to see some small clots in the lochia as the uterus contracts and expels blood from the uterine lining.

Uterine findings (firm and midline, 1–2 cm below the umbilicus)

Expected: A firm, midline uterus with a descent of about 1–2 cm below the umbilicus is a normal finding during the early postpartum period. This indicates appropriate uterine involution.

Lochia findings (moderate to light amount, no odor, with clots)

Expected: Lochia rubra (red blood flow) is expected during the first few days postpartum, with moderate bleeding and the presence of small clots. The absence of foul odor suggests no infection, which is a positive sign.

Calf findings (one varicose vein visible on left calf)

Expected: It is common for women to have visible varicose veins during pregnancy due to increased blood volume and pressure on the veins. These may persist postpartum, and unless associated with pain or swelling, they do not typically require intervention.

Blood pressure (145/98 mm Hg)

Unexpected: Elevated blood pressure postpartum is concerning and could indicate postpartum hypertension or preeclampsia. This needs to be addressed and monitored closely as it can be a sign of a serious condition that requires further evaluation.