A client is attempting to deliver vaginally despite the fact that her previous delivery was by cesarean birth.
Her contractions are 2-3 minutes apart, lasting from 75 to 100 seconds.
Suddenly, the client complains of intense abdominal pain, and the fetal monitor stops picking up contractions.
The nurse recognizes that which of the following has occurred?

Choice A rationale

Completely saturating a perineal pad within 15 minutes indicates excessive postpartum bleeding, which is most commonly caused by uterine atony (failure of the uterus to contract effectively after delivery). Massaging the fundus stimulates uterine muscles to contract, helping to compress blood vessels at the placental site and control bleeding. This is the priority intervention to prevent further blood loss and potential hemorrhage.

Choice B rationale

Assessing vital signs is important to evaluate the extent of blood loss and the woman's hemodynamic stability. However, the immediate priority is to address the cause of the excessive bleeding by promoting uterine contraction. Vital sign assessment should follow fundal massage.

Choice C rationale

Calling the primary health care provider is necessary to report the excessive bleeding and implement further management if fundal massage is not effective. However, the nurse's immediate action should be to address the likely cause of the bleeding through fundal massage.

Choice D rationale

Initiating an intravenous (IV) infusion of Ringer's lactate solution may be necessary to restore fluid volume if significant blood loss has occurred or continues. However, the immediate priority is to stop the bleeding by promoting uterine contraction through fundal massage. IV fluids are a subsequent intervention to support hemodynamic stability.

Choice A rationale

Oral contraceptives primarily work by inhibiting ovulation through hormonal regulation. They do not inherently increase the risk of pelvic inflammatory disease (PID). In some cases, they may even offer a protective effect against PID by thickening cervical mucus, which can act as a barrier to ascending infections.

Choice B rationale

Frequent alcohol use can impair the immune system, potentially making an individual more susceptible to infections. However, it is not a direct cause of PID. PID is primarily caused by ascending infections, often sexually transmitted infections, rather than the direct effects of alcohol consumption.

Choice C rationale

Chlamydia trachomatis is a common sexually transmitted bacterium and a major cause of pelvic inflammatory disease. Untreated chlamydia infections can ascend from the cervix and uterus to the fallopian tubes and ovaries, leading to inflammation, scarring, and potentially long-term complications such as infertility and ectopic pregnancy.

Choice D rationale

Recurrent cystitis, an infection of the bladder, primarily affects the lower urinary tract. While urinary tract infections are common in women, they do not typically ascend to the reproductive organs and cause pelvic inflammatory disease. PID involves infection of the upper genital tract, including the uterus, fallopian tubes, and ovaries.