A woman at 38 weeks gestation calls the labor unit stating she has been having contractions for 2 hours.
To help determine if this is true labor, which query by the nurse would elicit the MOST useful information?

Choice A rationale

Unrepaired vaginal lacerations are a possible cause of postpartum hemorrhage, especially after a large baby. However, bleeding from a laceration is typically characterized by a firm uterus with bright red, continuous trickling of blood. In this scenario, the combination of a 9-pound infant and the use of Pitocin for augmentation points more strongly toward another physiological failure of the uterine muscle rather than a simple soft tissue tear in the birth canal.

Choice B rationale

Uterine atony is the most common cause of postpartum hemorrhage. It occurs when the uterine myometrium fails to contract effectively after delivery to compress the intramyometrial blood vessels. Risk factors in this patient include a large baby (9 pounds 7 ounces), which overstretches the muscle fibers, and the use of Pitocin, which can lead to muscle fatigue. Failure of the uterus to stay firm leads to rapid, heavy bleeding from the placental site.

Choice C rationale

Puerperal infection is a postpartum infection of the reproductive tract. While it is a serious complication, it typically manifests several days after delivery with symptoms like fever (greater than 100.4 F), foul-smelling lochia, and uterine tenderness. It is not the most likely cause of an acute, heavy bleeding episode occurring only 4 hours after birth. Hemorrhage from infection is usually a secondary, delayed event rather than an immediate primary cause of heavy lochia.

Choice D rationale

Vaginal or vulvar hematomas involve the collection of blood in the connective tissue of the pelvic soft tissues due to vessel damage. While they can be caused by the delivery of a large infant, the primary symptom is usually exquisite, deep pelvic pain or a feeling of rectal pressure rather than visible heavy external bleeding. Because the blood is trapped within the tissues, it does not typically present as the mother stating she is bleeding a lot.

Choice A rationale

Having only one breastmilk stool every 24 hours is generally considered insufficient for a 4-day-old infant. By the fourth day of life, as the mother’s milk transitions from colostrum to mature milk, the infant should ideally have multiple yellow, seedy stools daily. A single stool may indicate that the infant is not receiving an adequate volume of milk to stimulate the gastrointestinal tract and clear bilirubin, potentially leading to dehydration or neonatal jaundice in the first week.

Choice B rationale

A weight gain of 1 to 2 ounces per week is significantly below the expected growth parameters for a newborn. After the initial physiological weight loss in the first few days, a healthy, well-fed newborn is expected to gain approximately 0.5 to 1 ounce (15 to 30 grams) per day, or about 4 to 7 ounces per week. Slow weight gain can be a clinical sign of poor milk transfer, low milk supply, or an underlying medical issue requiring assessment.

Choice C rationale

The presence of at least 6 to 8 wet diapers per day is a reliable clinical indicator of adequate hydration and milk intake in a 4-day-old infant. Since breast milk is roughly 88 percent water, frequent voiding demonstrates that the infant is consuming enough volume to maintain renal output. In the clinical setting, fewer than 6 wet diapers by day four may suggest the infant is at risk for dehydration or is not latching effectively to transfer milk.

Choice D rationale

Sleeping for 6 hours at a time is generally inappropriate for a 4-day-old newborn, as they require frequent feedings to meet high metabolic demands and to establish the mother's milk supply. Newborns should typically be fed 8 to 12 times in a 24-hour period. Prolonged sleep intervals at this age can lead to hypoglycemia and a decrease in the stimulation of prolactin, which is necessary for continued milk production. Feeding should occur every 2 to 3 hours.