Which of the following gravid clients is most appropriate for a charge nurse to assign to a new nurse with no obstetric (OB) experience?

Condition: Postpartum Hemorrhage (PPH)

Postpartum hemorrhage is defined as blood loss ≥ 500 mL after vaginal delivery or ≥ 1000 mL after cesarean delivery. In this case, the client has heavy bleeding, large clots, and lightheadedness, which are key indicators of excessive postpartum blood loss.

Risk Factors

1. Fetal Macrosomia: The baby weighs 9 lbs 4 oz (4196 grams), which is considered macrosomia (birth weight > 4000 g). Large fetal size increases the risk of uterine overdistension, which can impair uterine contractions and lead to uterine atony, the most common cause of postpartum hemorrhage.

2. Uterine Atony: The nurse initially noted a boggy uterus that required massage to become firm. Uterine atony occurs when the uterus fails to contract effectively after delivery, leading to excessive bleeding. This is the leading cause of PPH.

3. Prolonged Labor: A prolonged labor can cause uterine fatigue, reducing the uterus's ability to contract properly after delivery, thereby increasing the risk of uterine atony and PPH.

Assessment Findings

1. Heavy vaginal bleeding: The client has heavy bleeding with three quarter-sized clots, which is abnormal postpartum and indicates excessive blood loss.

2. Blood pressure: The client’s BP is 150/86 mmHg, which may indicate compensatory vasoconstriction due to ongoing blood loss. If hemorrhage continues, hypotension may develop.

3. Urine output: The client did not feel the urge to void, and catheterization drained 450 mL of urine. A full bladder can prevent proper uterine contraction, worsening uterine atony and bleeding.

A. "Placenta previa usually results in a higher risk of maternal hypertension, while abruptio placentae is commonly associated with a low-risk pregnancy.
This is incorrect because abruptio placentae, not placenta previa, is associated with maternal hypertension (e.g., preeclampsia, chronic hypertension). Placenta previa is not related to blood pressure issues.

B. "Placenta previa is characterized by sudden onset of severe abdominal pain and uterine tenderness, while abruptio placentae is associated with painless bleeding."
This is incorrect because placenta previa presents with painless, bright red vaginal bleeding, while abruptio placentae causes sudden, severe abdominal pain, uterine tenderness, and possibly dark red bleeding.

C. "Placenta previa typically presents with severe pain and contractions, whereas abruptio placentae involves painless bleeding without contractions."
This is incorrect because placenta previa does not cause pain or contractions. In contrast, abruptio placentae often presents with painful contractions and uterine hypertonicity.

D. "Placenta previa involves the placenta partially or completely covering the cervix, whereas abruptio placentae involves the premature separation of the placenta from the uterine wall."
Placenta previa occurs when the placenta covers the cervix (partial or complete), leading to bleeding. Abruptio placentae occurs when the placenta prematurely separates from the uterine wall, which can lead to hemorrhage and fetal distress.