A nurse in the antepartum unit is caring for a client who is at 36 weeks of gestation and has gestational hypertension. Suddenly, the client reports continuous abdominal pain and vaginal bleeding. The nurse should suspect which of the following complications?

Choice A) Placenta previa is incorrect because this is not a likely complication for a client who has gestational hypertension and reports continuous abdominal pain and vaginal bleeding. Placenta previa is a condition where the placenta covers part or all of the cervix, preventing normal delivery. It can cause painless, bright red bleeding in the third trimester, especially after intercourse or a pelvic exam. However, it does not cause abdominal pain, as the bleeding is not associated with uterine contractions or separation. Moreover, it is not related to gestational hypertension, which is a condition that causes high blood pressure during pregnancy. Therefore, this response is irrelevant and inaccurate.

Choice B) Incompetent cervix is incorrect because this is not a possible complication for a client who is at 36 weeks of gestation and has gestational hypertension and reports continuous abdominal pain and vaginal bleeding.

Incompetent cervix is a condition where the cervix is weak and unable to hold the pregnancy, leading to premature dilation and delivery. It can cause painless, watery vaginal discharge or spotting in the second trimester, followed by rupture of membranes and labor. However, it does not cause abdominal pain or heavy bleeding, as the cervix does not tear or detach from the uterus. Moreover, it is not related to gestational hypertension, which is a condition that causes high blood pressure during pregnancy. Therefore, this response is irrelevant and inaccurate.

Choice C) Prolapsed cord is incorrect because this is not a common complication for a client who has gestational hypertension and reports continuous abdominal pain and vaginal bleeding. Prolapsed cord is a condition where the umbilical cord slips through the cervix and into the vagina before the baby, compressing the cord and cutting off the blood supply and oxygen to the baby. It can cause variable or prolonged fetal heart rate decelerations, visible or palpable cord in the vagina, or fetal distress. However, it does not cause abdominal pain or bleeding, as the cord does not rupture or bleed. Moreover, it is not related to gestational hypertension, which is a condition that causes high blood pressure during pregnancy. Therefore, this response is irrelevant and inaccurate.

Choice D) Abruptio placentae is correct because this is a probable complication for a client who has gestational hypertension and reports continuous abdominal pain and vaginal bleeding. Abruptio placentae is a condition where the placenta separates from the uterine wall before delivery, causing hemorrhage and hypoxia for the mother and the baby. It can cause severe, constant abdominal pain, dark red bleeding, uterine tenderness or rigidity, fetal distress or demise, or maternal shock or coagulopathy. It can be triggered by gestational hypertension, which is a condition that causes high blood pressure during pregnancy and increases the risk of placental abruption by 25%. Therefore, this response is relevant and accurate.

Choice a) Headaches is correct because this is a condition that can indicate a serious problem in the postpartum period and may require careful medical assessment. Headaches are common in the first few weeks after giving birth, but they can also be a sign of complications such as preeclampsia, eclampsia, cerebral venous thrombosis, meningitis, or aneurysm. Preeclampsia and eclampsia are conditions that cause high blood pressure, proteinuria, and seizures in pregnant or postpartum women. Cerebral venous thrombosis is a blood clot in the brain that can cause stroke-like symptoms. Meningitis is an infection of the membranes that cover the brain and spinal cord. Aneurysm is a bulge or rupture in a blood vessel that can cause bleeding in the brain. These conditions can be life-threatening and require immediate treatment. Therefore, women who experience severe, persistent, or unusual headaches in the postpartum period should seek medical attention as soon as possible.

Choice b) Varicosities of the legs is incorrect because this is not a condition that usually requires careful medical assessment in the postpartum period. Varicosities are enlarged or swollen veins that appear blue or purple under the skin. They are common in pregnancy due to increased blood volume, hormonal changes, and pressure from the growing uterus. They usually improve after delivery, but may persist or worsen in some women. Varicosities are usually harmless and do not cause any symptoms, but they may cause cosmetic concerns, discomfort, itching, or bleeding. They can also increase the risk of superficial thrombophlebitis, which is inflammation of a vein near the skin surface. However, these complications are rare and mild, and can be managed with conservative measures such as compression stockings, elevation of the legs, exercise, and painkillers. Therefore, women who have varicosities of the legs in the postpartum period do not need to worry too much, unless they have signs of infection or deep vein thrombosis, which is a more serious condition that involves a blood clot in a deep vein that can travel to the lungs and cause pulmonary embolism.

Choice c) Carpal tunnel syndrome is incorrect because this is not a condition that typically requires careful medical assessment in the postpartum period. Carpal tunnel syndrome is a condition that causes numbness, tingling, pain, or weakness in the hand and wrist due to compression of the median nerve that runs through a narrow passage called the carpal tunnel. It can occur in pregnancy due to fluid retention, hormonal changes, or repetitive movements. It usually resolves after delivery, but may persist or recur in some women. Carpal tunnel syndrome is usually mild and does not cause any serious complications, but it may interfere with daily activities or quality of life. It can be treated with conservative measures such as splinting, icing, massage, stretching, or painkillers. In severe cases, surgery may be needed to release the pressure on the nerve. Therefore, women who have carpal tunnel syndrome in the postpartum period do not need to seek medical attention urgently, unless they have signs of nerve damage or infection.

Choice d) Periodic numbness and tingling of the fingers is incorrect because this is not a condition that generally requires careful medical assessment in the postpartum period. Periodic numbness and tingling of the fingers can be caused by various factors such as cold exposure, poor circulation, nerve compression, vitamin deficiency, or anxiety.

It can also occur in pregnancy due to fluid retention or hormonal changes. It usually goes away after delivery, but may linger or come back in some women. Periodic numbness and tingling of the fingers is usually harmless and does not indicate any serious problem, but it may cause discomfort or annoyance. It can be relieved with simple measures such as warming up, moving around, shaking out the hands, taking supplements, or relaxing. Therefore, women who experience periodic numbness and tingling of the fingers in the postpartum period do not need to worry too much, unless they have signs of infection or neurological disorder.