A patient is being discharged from the hospital after the evacuation of a molar pregnancy. The nurse recognizes that additional discharge teaching is required when the patient makes which statement?

A. Maternal temperature of 101.4°F. A fever may indicate infection (chorioamnionitis), but it is not an immediate reason to stop oxytocin. The nurse should monitor for additional signs of infection and notify the provider, but the priority is fetal well-being.

B. Maternal blood pressure of 138/89. This blood pressure is not critically high and does not indicate a hypertensive crisis. Oxytocin can cause fluid retention and slight blood pressure changes, but this reading alone does not require stopping the infusion.

C. Change in fetal baseline heart rate from 125 to 90. A decrease in fetal heart rate (bradycardia) is a sign of fetal distress and requires immediate intervention. Oxytocin can cause uterine hyperstimulation, leading to decreased placental perfusion and fetal hypoxia. The priority is to stop oxytocin, reposition the mother, provide oxygen, and notify the provider.

D. Change in the maternal pulse from 80 to 93. A mild increase in heart rate is not uncommon during labor and may be due to pain, anxiety, or IV fluids. It does not indicate an emergency or the need to stop oxytocin.

A. Quantity of vaginal bleeding. While both placenta previa and abruptio placentae can cause vaginal bleeding, the amount alone does not differentiate between the two conditions. Placenta previa typically causes painless, bright red bleeding, whereas abruptio placentae often presents with concealed or variable bleeding, making quantity an unreliable distinguishing factor.

B. Presence of abdominal pain. Abdominal pain is a key differentiating factor. Placenta previa is characterized by painless vaginal bleeding, while abruptio placentae causes sudden, severe abdominal pain due to placental detachment and uterine muscle irritation. This makes the presence or absence of pain an important assessment finding.

C. Leopold's maneuver results. While Leopold’s maneuvers help determine fetal position and presentation, they do not provide definitive information about the location of the placenta or differentiate between placenta previa and abruptio placentae. Ultrasound is a more reliable diagnostic tool for this purpose.

D. Maternal blood pressure. Although abruptio placentae can lead to hypovolemic shock and blood pressure changes due to hemorrhage, maternal blood pressure alone is not a primary diagnostic criterion for differentiating between the two conditions. Other clinical findings such as pain and ultrasound results are more useful for diagnosis.