A client who is 4 weeks pregnant, is at the first prenatal visit and reports to the nurse the use of alcohol. Which of the following should the nurse educate the client about, to be a safe level of alcohol intake during pregnancy?

Explanation:

A. Preparation for cesarean birth:

This is the correct choice. Placenta previa is a condition where the placenta partially or completely covers the cervix, leading to vaginal bleeding. In cases of suspected placenta previa with significant bleeding, cesarean birth is the safest delivery option to minimize the risk of complications such as hemorrhage. Therefore, immediate preparation for cesarean birth is indicated to ensure the safety of both the mother and the baby.

B. Initiation of pushing:

Pushing or active pushing efforts are contraindicated in cases of suspected placenta previa with significant vaginal bleeding. Pushing can increase the risk of further placental detachment and exacerbate bleeding. It is crucial to avoid any actions that could worsen the bleeding or harm the mother and baby. Therefore, initiation of pushing is not appropriate in this situation.

C. Examination to determine cervical status:

While cervical examinations are important during labor to assess progress and determine readiness for delivery, they are not appropriate in cases of suspected placenta previa with active vaginal bleeding. Cervical examinations can potentially increase bleeding and should be avoided until the placental location and stability are assessed through ultrasound or other diagnostic methods. Therefore, examination to determine cervical status is not appropriate in this situation.

D. A magnesium sulfate infusion:

Magnesium sulfate infusion is not indicated for suspected placenta previa with significant vaginal bleeding. Magnesium sulfate is commonly used to prevent or manage preterm labor and certain hypertensive disorders during pregnancy but is not a treatment for placenta previa or its associated bleeding. Immediate preparation for cesarean birth is the priority in this situation to ensure the safety of the mother and baby. Therefore, a magnesium sulfate infusion is not appropriate in this situation.

Explanation:

A. The biparietal diameter

The biparietal diameter is a measurement of the fetal head's diameter, which is often assessed during routine prenatal ultrasounds to estimate gestational age and monitor fetal growth. However, in the scenario described, the client is experiencing heavy vaginal bleeding without contractions at 38 weeks of gestation. The focus is on the immediate concern of the fetus's well-being rather than assessing specific fetal measurements like the biparietal diameter.

B. Viability of the fetus

This choice is correct for the scenario described. Viability refers to the ability of the fetus to survive outside the uterus. Heavy vaginal bleeding near term raises concerns about potential harm to the fetus and its viability. An ultrasound would be performed to assess the fetal heart rate, movement, and overall condition to determine if the fetus is viable or if there are any immediate concerns that need to be addressed.

C. Fetal lung maturity

Fetal lung maturity is typically assessed closer to the end of pregnancy, usually around 36 to 39 weeks of gestation, to determine if the fetus's lungs are developed enough for birth. While important for planning deliveries, assessing fetal lung maturity is not the primary concern in a situation where the client is experiencing heavy vaginal bleeding without contractions at 38 weeks of gestation.

D. Location of the placenta

The location of the placenta is important for monitoring placental health and assessing potential complications such as placenta previa. However, in the context of heavy vaginal bleeding without contractions at 38 weeks of gestation, the immediate concern is the well-being and viability of the fetus rather than the placental location.