A nurse is assessing a client who is at 38 weeks of gestation.
Upon admission 2 hours ago, the client had irregular contractions, was dilated 2 cm, and was at -1 cm station. Which of the following findings indicates progression in labor?

Choice A rationale

Oxytocin use for labor induction or augmentation is a significant risk factor for uterine atony, the most common cause of postpartum hemorrhage (PPH). Prolonged or high-dose exposure can lead to receptor downregulation or overstimulation, resulting in a fatigued or poorly contracting uterus, which fails to clamp down on the blood vessels at the placental site after delivery.

Choice B rationale

A history of Human Papillomavirus (HPV), a sexually transmitted infection, is not recognized as an independent risk factor for increasing the likelihood of postpartum hemorrhage. The physiological mechanisms leading to PPH are primarily related to uterine function, trauma, or coagulation disorders, which HPV infection does not directly influence.

Choice C rationale

A history of uterine atony in a previous pregnancy significantly increases the risk for recurrence in subsequent deliveries because it suggests an underlying predisposition for the myometrium to fail its contractile function. Uterine atony prevents the spiral arteries from being compressed, leading to excessive blood loss, which defines postpartum hemorrhage.

Choice D rationale

The average newborn weight in Western populations is approximately 3.4 kg (7.5 lb), with a normal range generally considered between 2.5 kg and 4.0 kg. A newborn weight of 2.948 kg (6 lb 8 oz) is within the normal range and does not constitute a risk factor for PPH, unlike macrosomia (birth weight > 4000 g or 8 lb 13 oz) which overdistends the uterus.

Choice E rationale

Vacuum-assisted delivery, a form of operative vaginal delivery, increases the risk of PPH primarily due to associated genital tract trauma (e.g., cervical, vaginal, or perineal lacerations) and potentially compounding the risk of uterine atony from prolonged labor or necessary manual maneuvers. Trauma contributes to bleeding that is non-uterine in origin.

Choice A rationale: Uterine contractions occurring every 2 to 3 minutes at 30 weeks gestation are abnormal and indicate preterm labor. Normal uterine activity in the third trimester should not demonstrate such frequency or cervical change until term. The presence of cervical dilation (2 cm) and effacement (80%) confirms labor physiology. Preterm labor poses risks of neonatal respiratory distress, intraventricular hemorrhage, and sepsis. Therefore, this finding requires immediate follow-up to prevent complications associated with premature birth.

Choice B rationale: Abdominal assessment revealed a soft, nontender abdomen with no rebound tenderness. These findings are within normal limits and do not suggest acute abdominal pathology such as placental abruption, appendicitis, or peritonitis. In obstetrics, concerning abdominal findings would include rigidity, tenderness, or guarding. The absence of these signs indicates no emergent intra-abdominal complication. Thus, this assessment does not require follow-up, as it reflects a physiologically normal abdominal exam for a pregnant client.

Choice C rationale: Fundal height at 30 weeks gestation is expected to measure approximately 28 to 32 cm, correlating with gestational age ±2 cm. This client’s fundal height of 28 cm falls within the normal range. Deviations greater than 3 cm could indicate intrauterine growth restriction, oligohydramnios, or macrosomia. Since the measurement is consistent with gestational norms, it does not require follow-up. This finding is physiologically appropriate and does not suggest pathology or abnormal fetal growth at this stage of pregnancy.

Choice D rationale: Abdominal cramping in the third trimester, when associated with cervical dilation and effacement, is a hallmark of preterm labor. Unlike benign Braxton Hicks contractions, which are irregular and non-progressive, these cramps are accompanied by cervical change and regular contractions. This indicates true labor physiology before 37 weeks. Preterm labor increases risks of neonatal morbidity and mortality. Therefore, abdominal cramping in this context requires follow-up to initiate interventions such as tocolysis, corticosteroids, and infection evaluation.

Choice E rationale: Low back pain in pregnancy can be benign due to musculoskeletal strain, but in this case, it is associated with uterine contractions, cervical change, and rupture of membranes. Low back pain is a common presenting symptom of preterm labor due to referred pain from uterine activity. Additionally, fever (38.3°C) and elevated WBC count (22,000/mm³; normal 5,000–10,000/mm³) raise concern for intra-amniotic infection. Thus, low back pain here is pathologic and requires follow-up to rule out chorioamnionitis and manage preterm labor.