A woman who delivered a 9 pound (4082 gram) baby boy by cesarean section (C-section) under spinal anesthesia is recovering in the postanesthesia care unit (PACU). Her fundus is firm, at the umbilicus, and a continuous trickle of bright red blood with no clots from the vagina is observed by the nurse. Which action should the nurse implement?

Rationale:

A. Encourage the mother to increase frequency of breastfeeding: Encouraging more frequent feeds is important if weight loss exceeds the normal range or if feeding cues are not being met. In this case, the infant’s weight loss is within the expected 5–10% of birth weight during the first days of life.

B. Monitor the stool and urine output of the neonate for the last 24 hours: Monitoring elimination patterns helps assess hydration status and feeding effectiveness. However, since the weight loss is within the physiologic range, this step is not the most immediate action.

C. After verifying the accuracy of the weight, notify the healthcare provider: Notifying the provider is appropriate when weight loss is greater than 10% of birth weight or when the infant shows clinical signs of dehydration. In this case, the 6% loss is normal.

D. Inform and assure the mother that this is a normal weight loss: Normal neonatal physiology includes losing 5–10% of birth weight in the first 3–5 days due to fluid shifts, limited intake, and initial adaptation. The nurse should reassure the mother, explain that this is expected, and continue to encourage routine feeding and monitoring.

Rationale:

A. Ultrasound: Ultrasound provides the most accurate assessment of fetal position at 29 weeks, as it allows visualization of the fetus, placenta, and amniotic fluid. It is especially useful when Leopold’s maneuvers are inconclusive due to maternal obesity, uterine shape, or fetal movement.

B. Doppler: Doppler is primarily used to assess fetal heart rate and blood flow, not the position of the fetus. While it can confirm fetal presence, it does not provide reliable information about orientation or lie.

C. Leopold’s maneuvers: Leopold’s maneuvers can help estimate fetal position through abdominal palpation. However, at 29 weeks, the fetus is still relatively small and mobile, making this method less precise than ultrasound.

D. Vaginal examination: Vaginal examination can detect fetal presentation only when the fetus is low in the pelvis, usually near labor. At 29 weeks, the fetus is typically high in the uterus, so a vaginal exam would not accurately determine fetal position.