A charge nurse is discussing risk factors for postpartum hemorrhage with a newly licensed nurse. Which of the following conditions should the nurse include as a risk factor?

(A) Maternal temperature 36.3°C (101°F):
While maternal temperature elevation can indicate infection, in this scenario, the sudden gush of vaginal fluid takes precedence as it could be indicative of premature rupture of membranes. However, assessing maternal temperature is important for ruling out maternal infection, but it is not the priority manifestation compared to assessing fetal well-being.

(B) Amniotic fluid with meconium noted:
While the presence of meconium in the amniotic fluid is concerning, assessing fetal heart tones is the priority. Meconium-stained amniotic fluid can indicate fetal distress, but the immediate concern is to determine if the fetus is experiencing any compromise or distress by assessing the fetal heart rate.

(C) Fetal heart tones 98/min:
In this scenario, the priority is to assess the well-being of the fetus. Fetal heart tones provide critical information about fetal status, indicating whether the baby is experiencing any distress or compromise. A fetal heart rate of 98 beats per minute (bpm) is within the normal range for a fetus at 34 weeks of gestation. However, any abnormalities or significant deviations from the normal fetal heart rate range may indicate fetal distress, requiring immediate intervention.

(D) Foul-smelling vaginal discharge:
Foul-smelling vaginal discharge can indicate infection, such as chorioamnionitis, which is a concern during pregnancy. However, in this scenario, assessing fetal well-being takes precedence as it is essential to ensure timely interventions to assess and manage any fetal distress.

(a) "You will need to receive a medroxyprogesterone acetate injection once per month."
Medroxyprogesterone acetate injections (Depo-Provera) are administered every three months (every 12 weeks), not monthly. This statement is incorrect and could lead to confusion about the correct usage of this contraceptive method.

(b) "Combined estrogen-progestin contraceptive pills cause longer periods."
Combined estrogen-progestin contraceptive pills typically result in shorter, lighter, and more regular periods, rather than longer ones. This statement is incorrect and misrepresents the effects of combined oral contraceptives on menstrual cycles.

(c) "Oral contraceptives decrease the risk for endometrial cancer."
This statement is correct. Oral contraceptives, particularly those containing both estrogen and progestin, are known to decrease the risk of endometrial cancer. This is an important benefit of using oral contraceptives and is a factual statement that should be included in the teaching.

(d) "You will need to have your diaphragm replaced every 4 years."
A diaphragm typically needs to be replaced every 2 years, not every 4 years. Additionally, a diaphragm should be refitted if there are significant changes in weight, childbirth, or abdominal/pelvic surgery. This statement is incorrect regarding the replacement timeline.