What is the most common reason for late postpartum hemorrhage (PPH)?

A. Placing the client in a knee-chest position is not necessary for routine assessment of contractions. This position may be used for specific interventions, such as relieving cord compression, but it does not aid in safe palpation of contractions.

B. Pushing down forcefully before each contraction is unsafe. Forceful palpation can increase discomfort, alter contraction patterns, or compromise fetal oxygenation, especially if uterine tone is high or the fetus is compromised.

C. Avoiding palpation entirely would limit the nurse’s ability to assess contraction frequency, duration, and intensity, which are essential parameters for evaluating labor progress and fetal well-being. Complete avoidance is not recommended unless contraindicated for specific reasons.

D. Palpating gently between contractions to assess uterine tone is the safest and most effective method. It allows the nurse to evaluate baseline uterine tone, contraction frequency, and strength without interfering with fetal oxygenation or increasing maternal discomfort. Gentle palpation helps detect hypertonicity or tetanic contractions, which can lead to fetal distress or uterine rupture if unrecognized.

A. While preterm infants are at increased risk for hypoglycemia due to limited glycogen stores and immature metabolic regulation, dexamethasone does not directly prevent hypoglycemia. Its pharmacologic action is not related to neonatal blood sugar management.

B. Dexamethasone is a corticosteroid given to pregnant clients at risk of preterm birth, typically between 24 and 34 weeks gestation. The medication crosses the placenta and stimulates fetal lung epithelial cells to produce surfactant, a substance that reduces alveolar surface tension, enabling the lungs to remain open for effective gas exchange after birth. By accelerating lung development, dexamethasone significantly reduces the risk of respiratory distress syndrome (RDS), intraventricular hemorrhage, necrotizing enterocolitis, and neonatal mortality. The most benefit is observed when delivery occurs 24–48 hours after the first dose but within 7 days of administration.

C. While corticosteroid therapy can have secondary benefits, including a reduction in intraventricular hemorrhage, this is not the primary purpose of dexamethasone administration. The main goal remains enhancing fetal lung maturity.

D. Dexamethasone is not a tocolytic and does not suppress preterm labor contractions. Tocolytic medications, such as magnesium sulfate, nifedipine, or indomethacin, are used for short-term suppression of uterine activity to allow time for corticosteroids to enhance fetal lung maturity.