A nurse is assisting in the care of a client who is in active labour. The nurse notes variable decelerations of the FHR. The nurse should identify which of the following is a cause of variable decelerations.

Choice A rationale :

Contractions every 3 to 4 minutes. Rationale: Contractions are a significant sign of labor. When the uterus contracts regularly and with increasing intensity, it indicates that the woman is in labor. However, contractions alone may not be enough to confirm active labor, as Braxton Hicks contractions can occur earlier in pregnancy, which are often irregular and less intense.

Choice B rationale

Pain just above the navel. Rationale: Pain above the navel is not a specific indicator of labor. In late pregnancy, the baby's head may engage in the pelvis, causing pressure and discomfort in the upper abdomen. However, this symptom alone does not confirm active labor and can be attributed to various other factors as well.

Choice C rationale

Amniotic fluid in the vaginal vault. Rationale: The presence of amniotic fluid in the vaginal vault, also known as rupture of membranes or "water breaking,”. is a significant sign that labor is likely to be in progress or imminent. When the amniotic sac ruptures, it releases the fluid that surrounds the baby in the uterus. This is a clear indication of active labor.

Choice D rationale

Cervical dilation. Rationale: Cervical dilation is one of the most reliable signs of active labor. As the uterus contracts, the cervix starts to dilate and efface (thin out) to allow the baby's passage through the birth canal. Measuring cervical dilation during a pelvic examination provides valuable information about the progress of labor.

Choice A rationale:

Abdominal pain with minimal red vaginal bleeding may not be as concerning as other options. While it could be a sign of placenta previa, it is not as specific or significant as the finding in Choice B.

Choice B rationale:

A large amount of bright red vaginal bleeding without pain is a significant finding that is highly suggestive of placenta previa. Placenta previa occurs when the placenta partially or completely covers the cervix, and vaginal bleeding is a common symptom. The bright red colour indicates active bleeding, and the absence of pain is noteworthy as placenta previa bleeding is typically painless.

Choice C rationale:

Severe abdominal pain with increasing fundal height is not a typical sign of placenta previa. While abdominal pain can be associated with various pregnancy complications, it is not a specific finding for this condition.

Choice D rationale:

Intermittent abdominal pain following the passage of bloody mucus could be related to other issues, such as preterm labor or cervical changes. While bleeding may be present in placenta previa, the pain and passage of mucus are not characteristic features of this condition.