A nurse in a provider’s office is caring for a client who is at 34 weeks of gestation and at risk for placental abruption. The nurse should recognize that which of the following is the most common risk factor for abruption?

Choice A reason:

Vernix in the folds and creases: Vernix caseosa is a white, cheese-like substance that covers the skin of the fetus. In post-term newborns, vernix is typically absent or only present in small amounts in the folds and creases of the skin.

Choice B reason:

Abundant lanugo: Lanugo is fine, soft hair that covers the body of the fetus. It is usually shed before birth, and post-term infants typically have little to no lanugo.

Choice C reason:

Positive Moro reflex: The Moro reflex, or startle reflex, is a normal reflex for an infant when they feel as if they are falling. This reflex is present at birth and usually disappears by 4 months of age.

Choice D reason:

Cracked peeling skin: Post-term infants often have dry, cracked, and peeling skin due to prolonged exposure to amniotic fluid.

Choice E reason:

Short soft fingernails: Post-term infants usually have long fingernails, not short and soft ones.

The correct answer is a) A client who is experiencing preterm labor at 26 weeks of gestation.

Choice A reason:

Tocolytic therapy is primarily used to delay preterm labor, which is defined as labor occurring before 37 weeks of gestation. The goal of tocolytic therapy is to prolong pregnancy, allowing more time for fetal development, particularly lung maturation. At 26 weeks of gestation, the fetus is significantly premature, and delaying labor can improve neonatal outcomes by reducing the risks associated with preterm birth, such as respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis. Tocolytics can help delay labor for 48 hours to 7 days, providing a critical window for administering corticosteroids to enhance fetal lung maturity.

Choice B reason:

Braxton-Hicks contractions, also known as “false labor,” are irregular and usually painless contractions that occur during pregnancy, typically starting in the second trimester. These contractions do not lead to cervical dilation and are not indicative of true labor. Therefore, administering tocolytic therapy to a client experiencing Braxton-Hicks contractions at 36 weeks of gestation is unnecessary and inappropriate. The primary purpose of tocolytics is to manage true preterm labor, not false labor.

Choice C reason:

A post-term pregnancy is defined as a pregnancy that extends beyond 42 weeks of gestation. In such cases, the primary concern is the potential for complications related to prolonged gestation, such as macrosomia, oligohydramnios, and placental insufficiency. Tocolytic therapy is not indicated for post-term pregnancies because the goal is not to delay labor but rather to manage the risks associated with prolonged pregnancy. Induction of labor or close monitoring is typically recommended for post-term pregnancies.

Choice D reason:

In the unfortunate event of fetal death at 32 weeks of gestation, the focus of care shifts to the safe and compassionate management of the mother’s health and well-being. Tocolytic therapy is not appropriate in this context, as there is no benefit to delaying labor. Instead, the healthcare team will discuss options for delivery and provide emotional support to the grieving parents. The priority is to ensure the mother’s physical and emotional health during this difficult time.