A primigravida is pushing with contractions.

The nurse notes that the woman's perineum is beginning to bulge and that there is an increase in bloody show.

Which of the following actions by the nurse is appropriate at this time?

Choice A rationale

Supine hypotension, or aortocaval compression, is a risk typically associated with lying flat on the back during late pregnancy or labor, which compresses the vena cava and aorta. Rupture of membranes does not directly or significantly increase this risk; proper positioning, such as left lateral tilt, prevents this complication.

Choice B rationale

Precipitous labor is characterized by rapid labor and birth occurring within three hours of the onset of contractions. While rupture of membranes can occasionally precede or be associated with rapid progression, it is not an independent factor that substantially increases the underlying risk of a woman having a precipitous labor.

Choice C rationale

Intrauterine infection, or chorioamnionitis, is the primary risk that increases significantly after rupture of membranes, particularly if labor is prolonged. The amniotic sac provides a sterile barrier; its loss allows bacteria from the vagina to ascend into the uterus, which can infect the mother and the fetus.

Choice D rationale

Hemorrhage, or excessive bleeding, is most often associated with uterine atony, retained placental fragments, or trauma following birth. Rupture of membranes is not a direct or strong predictor of postpartum hemorrhage; this complication is primarily related to the third and fourth stages of labor.

Choice A rationale

A gravida 3, para 2 woman with a history of a very short previous labor (4 hours) is a grand multipara who has demonstrated rapid labor progression in the past. Multiparas, especially those with a history of precipitous labor (less than 3 hours), are at risk for rapid progression in subsequent labors. She should be advised to come to the hospital or birth center as soon as regular contractions begin to ensure a safe delivery in a controlled setting.

Choice B rationale

A gravida 1, para 0 (primigravida) generally has a longer labor duration, with the active phase often lasting many hours (normal range 6 to 18 hours). Even living 40 minutes away, she will likely have sufficient time to travel safely to the hospital once a clear pattern of regular, strong contractions has been established. This client is not the highest priority to leave immediately compared to others with a faster labor history.

Choice C rationale

A gravida 2, para 1 whose first labor lasted 16 hours has a history of a relatively long labor. Although her second labor is expected to be shorter than her first, the historical data suggests she will likely have many hours before delivery. Therefore, she does not need to rush to the hospital as soon as labor begins and can remain at home longer, following standard guidelines for hospital admission.

Choice D rationale

A gravida 2, para 1 who lives 10 minutes away has the advantage of close proximity to the hospital. While multiparas generally labor faster, her proximity allows for a slightly more relaxed approach to the initial phase of labor. She can wait until contractions are stronger, closer together (e.g., 5 minutes apart for 1 hour), or until her membranes rupture, before coming to the facility.