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?

The nurse should monitor the client’s temperature due to the risk of chorioamnionitis.

Rationale for correct answers

Temperature monitoring is crucial for detecting chorioamnionitis, an infection of the amniotic sac, which is a major risk following preterm premature rupture of membranes (PPROM). PPROM increases susceptibility to ascending bacterial infection, leading to inflammation. Fever (>38°C or 100.4°F) is a primary diagnostic criterion.

Chorioamnionitis presents with maternal fever, fetal tachycardia (>160/min), uterine tenderness, and foul-smelling amniotic fluid. The client's normal temperature now (36.7°C) requires ongoing monitoring, as infection could develop rapidly.

Rationale for incorrect Response 1 options

• Magnesium levels: Magnesium sulfate is used for seizure prophylaxis in eclampsia or for neuroprotection in preterm labor. This client has no signs of either condition.
• Fundal height: Measurement assesses fetal growth and amniotic fluid levels; it is not a direct indicator of infection risk.
• Clotting factors: No evidence of coagulopathy or bleeding abnormalities; coagulation profile is normal.

Rationale for incorrect Response 2 options

• Concealed hemorrhage: No signs of placental abruption (painful bleeding, rigid abdomen). Normal hemoglobin (12.0 g/dL) supports this.
• Seizures: No hypertensive crisis or neurological symptoms suggestive of eclampsia.
• Disseminated intravascular coagulation (DIC): No abnormal coagulation markers or evidence of excessive bleeding.

Take-home points

• PPROM increases the risk of chorioamnionitis, a serious intrauterine infection. • Fever monitoring is essential, as maternal fever is an early indicator of infection. • Antibiotics are given prophylactically to reduce chorioamnionitis risk in PPROM. • Differentiation from placental abruption, eclampsia, and DIC is based on clinical and laboratory findings.

Choice A rationale

Accumulation of flatulence can cause abdominal discomfort after a cesarean birth, but it does not directly stimulate uterine contractions leading to afterpains. Afterpains are specifically related to the involution of the uterus, not gastrointestinal motility.

Choice B rationale

Breastfeeding stimulates the release of oxytocin from the posterior pituitary gland. Oxytocin is a powerful uterotonic hormone that causes the uterus to contract to its pre-pregnant size. These contractions are experienced as afterpains, especially in multiparous women whose uterine muscles may have less tone.

Choice C rationale

While some medications administered after birth can have side effects, severe cramps or afterpains are primarily a physiological response to uterine involution and the hormonal changes associated with breastfeeding, rather than a direct adverse effect of medication.

Choice D rationale

Healing of the abdominal incision after a C-section causes incisional pain, which is distinct from the cramping sensation of afterpains. Afterpains are specifically due to uterine contractions, not the healing process of the abdominal wall.