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)

Newborn weight 2.948 kg (6 lb 8 oz)

History of uterine atony

Vacuum-assisted delivery

History of human papillomavirus

Labor induction with oxytocin

Answer and Explanation

Correct Answer : B,C,E

Choice A reason: A newborn weight of 2.948 kg is normal and not a risk factor for postpartum hemorrhage. Large-for-gestational-age infants (>4 kg) increase uterine overdistension, impairing contraction and causing bleeding. This weight does not strain uterine muscle tone, maintaining normal postpartum hemostasis, per obstetric physiology.

Choice B reason: Uterine atony, failure of the uterus to contract post-delivery, is a major cause of postpartum hemorrhage. Ineffective contractions prevent hemostasis at placental separation sites, leading to excessive bleeding. Myometrial fatigue or previous atony increases risk, as poor uterine tone disrupts clotting cascades, necessitating vigilant monitoring and oxytocic intervention.

Choice C reason: Vacuum-assisted delivery increases postpartum hemorrhage risk due to potential uterine or cervical trauma. Instrumentation can cause lacerations or hematomas, disrupting hemostasis. Tissue trauma triggers local bleeding, and prolonged labor may weaken uterine contractions, impairing clot formation at the placental site, per obstetric complication studies.

Choice D reason: History of human papillomavirus (HPV) does not increase postpartum hemorrhage risk, as it affects cervical epithelium, not uterine contractility or hemostasis. HPV is linked to cervical cancer, not obstetric complications. Postpartum bleeding stems from uterine or traumatic factors, making HPV irrelevant to hemorrhage pathophysiology in the postpartum period.

Choice E reason: Labor induction with oxytocin increases postpartum hemorrhage risk, as prolonged exposure may desensitize myometrial receptors, leading to uterine atony. Ineffective contractions post-delivery impair hemostasis at the placental site, causing bleeding. Oxytocin’s effect on uterine muscle tone requires careful monitoring to prevent excessive blood loss, per obstetric pharmacology.

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Correct Answer is C

Explanation

Choice A reason: Critical congenital heart disease (CCHD) screening uses pulse oximetry, not a heel blood sample. Blood sampling is for metabolic screening, not heart defects. Pulse oximetry measures oxygen saturation non-invasively, detecting shunting or cyanotic defects, aligning with CCHD screening’s focus on circulatory assessment.

Choice B reason: CCHD screening is typically performed at 24-48 hours of age, not 6-12 hours, to ensure stable postnatal circulation. Early testing may yield false positives due to transitional physiology. Pulse oximetry at the correct timing accurately detects critical heart defects, per neonatal screening protocols.

Choice C reason: CCHD screening compares oxygen saturation in the upper (right hand) and lower (foot) extremities using pulse oximetry to detect congenital heart defects causing differential cyanosis. A significant difference indicates potential shunting or ductal-dependent lesions, requiring further evaluation, aligning with the physiological basis of CCHD screening.

Choice D reason: CCHD screening results are immediate via pulse oximetry, not delayed 1-2 weeks. Real-time oxygen saturation readings identify potential heart defects, enabling prompt referral for echocardiography. Delayed results apply to metabolic screening, not CCHD, which relies on instant physiological data, per neonatal diagnostic protocols.

A. It can be helpful to talk about your loss with others who have experienced a pregnancy loss. B. I have found that it is best to avoid seeing the fetal remains after the procedure. C. It is okay to feel some grief now, even though it is so early in the pregnancy for a loss. D. Once the fetus is passed, the provider will likely be able to determine what caused the pregnancy loss.

Correct Answer is A

Explanation

Choice A reason: Discussing pregnancy loss with others who have experienced it provides emotional support, reducing feelings of isolation. Grief triggers stress hormones like cortisol, which can affect mental health. Peer support normalizes emotional responses, aiding psychological recovery by fostering shared understanding and coping strategies, validated by psychosocial research in miscarriage care.

Choice B reason: Advising against seeing fetal remains is inappropriate, as it may dismiss the client’s emotional needs. Grief processing varies, and viewing remains can aid closure for some. This statement imposes a personal bias, ignoring individual psychological responses to loss, which are influenced by complex neuroendocrine and emotional pathways.

Choice C reason: While acknowledging grief is valid, stating it is okay “even though” it is early minimizes the loss’s impact. Early pregnancy loss can trigger significant grief due to hormonal shifts and attachment. This statement risks invalidating the client’s emotional experience, which is shaped by psychological and neuroendocrine responses to miscarriage.

Choice D reason: Determining the cause of a missed abortion at 10 weeks is often not feasible, as fetal tissue may not yield specific findings. Chromosomal abnormalities, a common cause, require genetic testing, not routine post-procedure analysis. This statement risks false reassurance, as miscarriage etiology is frequently multifactorial and not always identifiable.

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