Physiological Integrity Q 33
A client is admitted to the labor and delivery unit complaining of vaginal bleeding with very little discomfort. The nurse’s first action should be to:
A. Assess the fetal heart tones
B. Check for cervical dilation
C. Check for firmness of the uterus
D. Obtain a detailed history
Correct Answer: A. Assess the fetal heart tones
The symptoms of painless vaginal bleeding are consistent with placenta previa. Assess fetal heart sounds so the mother would be aware of the health of her baby. Assess any bleeding or spotting that might occur to give adequate measures. Most cases are diagnosed early on in pregnancy via sonography and others may present to the emergency room with painless vaginal bleeding in the second or third trimester of pregnancy.
Option B: Cervical check for dilation is contraindicated because this can increase the bleeding. A patient presenting with vaginal bleeding in the second or third trimester should receive a transabdominal sonogram before a digital examination. If there is a concern for placenta previa, then a transvaginal sonogram should be performed to confirm the location of the placenta.
Option C: Checking for firmness of the uterus can be done, but the first action should be to check the fetal heart tones. Painless vaginal bleeding during the second or third trimester of pregnancy is the usual presentation. The bleeding may be provoked from intercourse, vaginal examinations, labor, and at times there may be no identifiable cause. On speculum examination, there may be minimal bleeding to active bleeding.
Option D: A detailed history can be done later. The relationship between advanced maternal age and placenta previa may be confounded by higher parity and a higher probability of previous uterine procedures or fertility treatment. However, it may also represent an altered hormonal or implantation environment.