Which of the following findings indicates a client who is in a trial of labor for vaginal birth after cesarean (VBAC) may be experiencing a uterine rupture?

Choice A reason: Sternal retractions indicate respiratory distress, as the newborn uses accessory muscles to breathe, suggesting airway obstruction or lung immaturity. This requires immediate intervention to ensure oxygenation, as it may reflect transient tachypnea or pneumothorax, compromising alveolar gas exchange, per neonatal respiratory physiology.

Choice B reason: Molding, the temporary reshaping of the skull during vaginal birth, is normal due to cranial bone flexibility. It resolves spontaneously within days and does not affect neurological or respiratory function, requiring no intervention, as it aligns with the biomechanics of vaginal delivery and neonatal adaptation.

Choice C reason: Acrocyanosis, bluish discoloration of hands and feet, is normal in newborns due to immature peripheral circulation. It resolves as vascular tone stabilizes and does not indicate hypoxia, requiring no intervention. This physiological adaptation reflects normal thermoregulatory and circulatory adjustments in the immediate postnatal period.

Choice D reason: Vernix caseosa, a waxy skin coating, is a normal protective layer in newborns, aiding thermoregulation and skin hydration. It requires no intervention, as it naturally absorbs or is gently cleaned. Vernix supports skin barrier function and antimicrobial defense, aligning with neonatal dermatological physiology.

Choice A reason: Mitral valve stenosis at 28 weeks increases cardiac workload, risking heart failure or arrhythmias due to increased blood volume in pregnancy. However, it does not directly cause seizures. Seizure risk is linked to neurological or hypertensive conditions, not cardiac valvular issues, which primarily affect hemodynamic stability and not seizure thresholds.

Choice B reason: A positive Kleihauer-Betke test at 32 weeks indicates fetal-maternal hemorrhage, requiring Rho(D) immune globulin to prevent isoimmunization. It does not increase seizure risk, as it affects blood compatibility, not neurological stability. Seizures are unrelated to this hematological issue, which primarily impacts future pregnancies rather than maternal neurological function.

Choice C reason: Cystic fibrosis at 30 weeks affects respiratory and pancreatic function, leading to infections or malabsorption, but not seizures. Seizure risk requires neurological or hypertensive triggers, not pulmonary or metabolic issues. The condition’s impact on maternal oxygenation does not directly alter seizure thresholds or neurological excitability in pregnancy.

Choice D reason: Severe chronic hypertension at 36 weeks increases seizure risk due to preeclampsia or eclampsia, where elevated blood pressure disrupts cerebral autoregulation, causing neuronal irritability. Seizure precautions are critical, as hypertension-induced endothelial damage and cerebral edema can trigger convulsions, threatening maternal and fetal safety, necessitating magnesium sulfate prophylaxis.