Which of the following statements should a nurse include in vehicle safety education to the parents of a premature newborn?

Choice A reason: Assessing for abdominal tenderness does not address uterine atony or vaginal bleeding. Tenderness may indicate other issues, like infection, but atony requires immediate uterine contraction to control hemorrhage. Fundal massage directly stimulates myometrial contraction, addressing the primary cause of bleeding, per postpartum hemorrhage management protocols.

Choice B reason: Performing a fundal massage is the priority for uterine atony, as it stimulates myometrial contractions, promoting hemostasis at the placental site. Atony causes excessive bleeding due to poor uterine tone, and massage enhances oxytocin release, constricting blood vessels to reduce hemorrhage, aligning with obstetric emergency interventions.

Choice C reason: Avoiding sterile vaginal examinations does not address uterine atony or bleeding. Examinations assess cervical or vaginal trauma but do not correct myometrial failure. Atony requires active interventions like fundal massage to restore uterine tone and control hemorrhage, making this action irrelevant to the immediate physiological need.

Choice D reason: Obtaining a Kleihauer-Betke test assesses fetal-maternal hemorrhage, relevant for Rh-negative mothers, not uterine atony. Atony causes bleeding from poor uterine contraction, not fetal blood loss. This test does not address the immediate need to control hemorrhage through myometrial stimulation, per postpartum hemorrhage management principles.

Choice A reason: Palpation of the fetal presenting part in the cervical os indicates labor progression or malpresentation, not uterine rupture. Uterine rupture involves uterine wall tearing, causing hemorrhage or fetal extrusion, not cervical findings. This finding is unrelated to the catastrophic internal bleeding or placental disruption characteristic of rupture.

Choice B reason: Severe bradypnea (respiratory rate of 10/min) is not a primary sign of uterine rupture. Rupture causes hemorrhage, leading to hypovolemic shock with symptoms like hypotension or tachycardia. Respiratory changes may occur secondary to shock but are not specific. Uterine rupture primarily affects cardiovascular stability, not respiratory rate.

Choice C reason: A sudden gush of amniotic fluid indicates membrane rupture, a normal labor event, not uterine rupture. Uterine rupture involves uterine wall tearing, causing bleeding or fetal distress, not fluid release. Amniotic fluid loss is unrelated to the structural failure or hemorrhagic shock associated with uterine rupture in VBAC.

Choice D reason: Hypotension (85/40 mm Hg) indicates uterine rupture, as it suggests hypovolemic shock from internal hemorrhage due to uterine wall tearing. Blood loss reduces intravascular volume, impairing cardiac output and placental perfusion. This life-threatening sign in VBAC requires immediate intervention to address maternal and fetal compromise, aligning with rupture’s pathophysiology.