Which of the following findings place a client who had a vaginal delivery 3 hr ago at risk for postpartum hemorrhage? (Select all that apply)

Choice A reason: Not feeling fetal movement at 12 weeks is normal, as quickening typically begins at 16-20 weeks. Fetal movement is not expected this early due to small fetal size and limited neuromuscular development. This finding does not indicate an emergency, as it aligns with normal gestational physiology.

Choice B reason: 2+ deep tendon reflexes at 38 weeks are normal, reflecting intact neurological function. Hyperreflexia (3+ or 4+) may suggest preeclampsia, but 2+ is not concerning. Reflexes are influenced by magnesium levels and neurological status, but this finding does not prioritize immediate provider attention compared to urgent symptoms like blurred vision.

Choice C reason: Blurred vision at 36 weeks suggests preeclampsia, as cerebral edema or vasoconstriction affects visual pathways. This symptom indicates severe features, risking seizures or stroke. Preeclampsia’s endothelial dysfunction elevates blood pressure, impairing cerebral perfusion, making this a medical emergency requiring immediate provider evaluation to prevent maternal and fetal complications.

Choice D reason: A fetal heart rate of 160/min at 28 weeks is within the normal range (110-160/min), indicating fetal well-being. Doppler assessment reflects autonomic function and oxygenation, and this rate does not suggest distress. Unlike blurred vision, which signals maternal complications, this finding does not require urgent provider attention.

Choice A reason: Monitoring blood pressure every 30 minutes is inadequate for hypotension, which requires immediate intervention to restore placental perfusion. Epidural anesthesia can cause sympathetic blockade, reducing vascular tone and blood pressure. Frequent monitoring (every 5-10 minutes) is needed, but this action does not address the acute hypotension affecting fetal oxygenation.

Choice B reason: The knee-chest position is used for specific obstetric emergencies like cord prolapse, not hypotension from epidural anesthesia. It does not improve blood pressure or placental perfusion. Hypotension requires fluid or vasopressor support to restore circulation, as positional changes like knee-chest do not address the underlying sympathetic blockade causing reduced perfusion.

Choice C reason: Administering oxygen at 2 L/min via nasal cannula does not directly correct hypotension, the primary cause of decreased placental perfusion. While oxygen may support fetal oxygenation, it does not restore maternal blood pressure. Fluid boluses or vasopressors are needed to address the epidural-induced vasodilation and ensure adequate placental blood flow.

Choice D reason: A 500 mL lactated Ringer’s bolus corrects epidural-induced hypotension by expanding intravascular volume, restoring blood pressure, and improving placental perfusion. Epidurals cause sympathetic blockade, reducing vascular tone. Fluid administration counteracts this, enhancing cardiac output and uteroplacental blood flow, critical for fetal oxygenation and preventing hypoxia during labor.