A nurse in a prenatal clinic is reinforcing teaching with a group of women about the use of acupressure to relieve discomfort during labor.
Which of the following instructions should the nurse include in the teaching?

Choice A rationale

Monitoring urine output is important for assessing fluid balance and kidney function, especially in the context of significant blood loss, as decreased output can indicate hypovolemia. However, actively addressing the source of the bleeding takes precedence over monitoring a secondary effect, as the immediate threat to life is uncontrolled hemorrhage.

Choice B rationale

Performing fundal massage is the highest priority because uterine atony, a relaxed uterus, is the most common cause of postpartum hemorrhage. Massaging the fundus stimulates uterine contractions, which compress blood vessels in the myometrium, thereby reducing blood loss and preventing life-threatening hemorrhage by promoting hemostasis at the placental site.

Choice C rationale

Applying oxygen by face mask is a supportive measure for hypovolemia and shock, increasing oxygen delivery to tissues. While important in a deteriorating situation, it does not address the root cause of the bleeding. The primary focus must be on stopping the hemorrhage before addressing the systemic effects of blood loss.

Choice D rationale

Weighing the perineal pad quantifies blood loss, which is important for accurate assessment of the severity of hemorrhage. While useful for diagnosis and monitoring, this action does not directly intervene to stop the bleeding. The immediate priority is to control the hemorrhage to prevent further blood loss and stabilize the client's condition.

Choice A rationale

Multiple gestation, such as twins or triplets, typically results in elevated maternal serum alpha-fetoprotein (MSAFP) levels because there are multiple fetuses producing AFP. AFP is a protein produced by the fetal liver and yolk sac.

Choice B rationale

Neural tube defects, such as spina bifida or anencephaly, are associated with *elevated* levels of MSAFP due to the open defect allowing leakage of AFP into the amniotic fluid and then into the maternal circulation.

Choice C rationale

Intrauterine growth restriction (IUGR) can sometimes be associated with either normal or slightly elevated MSAFP levels, depending on the underlying cause, but it is not typically linked to *low* levels.

Choice D rationale

Low levels of maternal serum alpha-fetoprotein are associated with an increased risk of Down syndrome (Trisomy 21). This is thought to be due to altered placental function or fetal production of AFP in these pregnancies.