What are the contraindications for a patient wanting to have a TOLAC?

Choice A rationale

Decrease proteinuria is not the primary goal for magnesium sulfate therapy. It's an indicator of kidney function and hypertension severity. Therapy focuses on neuroprotection and seizure prevention. Proteinuria reflects preeclampsia's renal impact, not neuroprotection.

Choice B rationale

Prevent maternal seizures is magnesium sulfate's primary goal. It stabilizes neuronal membranes, reducing seizure risk in severe preeclampsia. By inhibiting NMDA receptors and calcium channels, it prevents seizures, critical for maternal-fetal safety.

Choice C rationale

Reduce deep tendon reflexes is not magnesium sulfate's primary goal, but a side effect. It signifies therapeutic levels, indicating potential toxicity. Reflex reduction helps assess magnesium toxicity risk, ensuring safe neuroprotective dosing.

Choice A rationale

A boggy uterus indicates uterine atony, a leading cause of postpartum hemorrhage, as the uterus fails to contract effectively to compress blood vessels.

Choice B rationale

Moderate lochia rubra is expected postpartum vaginal bleeding, representing normal shedding of the uterine lining, not specifically indicating hemorrhage risk.

Choice C rationale

A first-degree perineal laceration is a minor tear that does not significantly increase the risk for postpartum hemorrhage as it usually involves limited bleeding.

Choice D rationale

Hypotension alone does not increase the risk for postpartum hemorrhage; however, it could be a result of ongoing hemorrhage rather than a cause.