Maternity Nursing: Intrapartum Q 40
A client is admitted to the L & D suite at 36 weeks’ gestation. She has a history of C-section and complains of severe abdominal pain that started less than 1 hour earlier. When the nurse palpates tetanic contractions, the client again complains of severe pain. After the client vomits, she states that the pain is better and then passes out. Which is the probable cause of her signs and symptoms?
A. Hysteria compounded by the flu
B. Placental abruption
C. Uterine rupture
D. Dysfunctional labor
Correct Answer: C. Uterine rupture.
Uterine rupture is a medical emergency that may occur before or during labor. Signs and symptoms typically include abdominal pain that may ease after uterine rupture, vomiting, vaginal bleeding, hypovolemic shock, and fetal distress. With placental abruption, the client typically complains of vaginal bleeding and constant abdominal pain.
Option A: The woman does not have hysteria. Uterine rupture in pregnancy is a rare and often catastrophic complication with a high incidence of fetal and maternal morbidity. Numerous factors are known to increase the risk of uterine rupture, but even in high-risk subgroups, the overall incidence of uterine rupture is low.
Option B: Placental abruption occurs when the maternal vessels tear away from the placenta and bleeding occurs between the uterine lining and the maternal side of the placenta. As the blood accumulates, it pushes the uterine wall and placenta apart. The placenta is the fetus’ source of oxygen and nutrients as well as the way the fetus excretes waste products. Diffusion to and from the maternal circulatory system is essential to maintaining these life-sustaining functions of the placenta. When accumulating blood causes separation of the placenta from the maternal vascular network, these vital functions of the placenta are interrupted. If the fetus does not receive enough oxygen and nutrients, it dies.
Option D: Dysfunctional or prolonged labor refers to prolongation in the duration of labor, typically in the first stage of labor. Diagnosis of delay in labor is dependent on careful monitoring of uterine contraction intensity, duration and frequency, cervical dilation, and descent of the fetus through the pelvis.