A nurse is caring for a client who is a primigravida, at term, and having contractions but is stating that she is "not really sure if she is in labor or not.”. Which of the following is the BEST indicator of true labor that the nurse should recognize?

Choice A rationale

Goodell's sign is the softening of the cervix, usually occurring around the fourth to sixth week of pregnancy. It indicates early pregnancy but does not relate to the symptoms described by the client.

Choice B rationale

Lightening refers to the baby settling deeper into the pelvis, which often occurs a few weeks before labor in first-time pregnancies. This shift can make breathing easier and increase pressure on the bladder, causing frequent urination and increased swelling in the lower extremities.

Choice C rationale

Hegar's sign is the softening of the lower uterine segment, typically seen around the sixth to eighth week of pregnancy. It is an early sign of pregnancy and not related to the symptoms experienced by the client near term.

Choice D rationale

Quickening is the term used to describe the first movements of the fetus felt by the mother, usually occurring around 16 to 20 weeks of pregnancy. This does not correlate with the symptoms described by the client who is near term.

Rationale for correct condition: The client is likely experiencing PPROM, as evidenced by the sudden gush of clear fluid and continued light leakage, confirmed by fluid pooling in the vaginal vault that tested positive for ferning. PPROM can lead to preterm labor and increased risk of infection. The absence of contractions or bleeding, and the mild lower abdominal discomfort, further supports this diagnosis.

Rationale for actions: Administering prophylactic antibiotics helps prevent infection, which is a significant risk with PPROM. Educating the client on kick counts ensures monitoring of fetal well-being. Preparing for an emergent C-section is not immediately necessary as the cervix is closed. Providing IV fluids for hypotension is not applicable here as blood pressure is elevated. Discharging the client with follow-up in one week is inappropriate given the risk of infection and preterm labor.

Rationale for parameters: Monitoring signs of infection is crucial, as PPROM increases infection risk. Maternal blood pressure trends must be watched due to elevated readings, suggesting possible complications. Meconium-stained amniotic fluid, while concerning, is not present. Maternal platelet levels and fundal height measurements do not directly address the current risks associated with PPROM.

Rationale for incorrect conditions: Placental abruption typically involves abdominal pain and bleeding, which are absent. Preeclampsia involves hypertension and proteinuria, but no significant proteinuria is present. Oligohydramnios involves decreased amniotic fluid, but the client reports clear fluid leakage indicating rupture of membranes.