A nurse is caring for a client at a 10-week prenatal visit. The provider diagnoses the client with a missed spontaneous abortion confirmed by ultrasound and the nurse is discussing the plan of care with the client.
Which of the following statements should the nurse make?

Choice A rationale

Palpating contractions as mild indicates that the current oxytocin dose is likely insufficient to achieve an expected labor pattern. Oxytocin aims to induce moderate-to-strong uterine contractions, typically occurring every 2-3 minutes, lasting 40-90 seconds. Mild contractions suggest suboptimal uterine activity, justifying an increase in the infusion rate to stimulate more effective contractions.

Choice B rationale

Spontaneous rupture of membranes is a natural progression of labor and does not directly indicate the need to titrate oxytocin based on uterine contraction effectiveness. While rupture of membranes can accelerate labor, the oxytocin titration decisions are primarily based on the intensity and frequency of uterine contractions, not the status of the amniotic sac.

Choice C rationale

A decrease in the client's pain level is not an indicator for titrating oxytocin for labor induction. Pain is subjective and influenced by various factors, including analgesia. Oxytocin titration is guided by objective measures of uterine activity and cervical change, aiming for an adequate labor pattern rather than pain management.

Choice D rationale

Stabilization of the client's blood pressure, while desirable, is not a direct parameter for titrating oxytocin to achieve an expected labor pattern. Oxytocin's primary effect is on uterine contractility, and titration decisions are based on the frequency, duration, and intensity of contractions, and cervical dilation, not systemic blood pressure changes.

The client is at risk for developing HELLP syndrome as evidenced by Liver enzymes.

Rationale for correct answers:
HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe form of preeclampsia often presenting in the third trimester. This client has thrombocytopenia (platelets 100,000/mm³; normal 150,000–400,000/mm³), elevated blood urea nitrogen (25 mg/dL; normal 10–20 mg/dL), borderline elevated creatinine (1.1 mg/dL; normal 0.5–1.0 mg/dL), and elevated uric acid (9.8 mg/dL; normal 2.7–7.3 mg/dL), which suggests possible renal impairment and oxidative stress typical in HELLP. Mild epigastric discomfort also aligns with liver involvement. Although liver enzymes are not listed in the labs here, the question implies liver enzyme elevation as a hallmark finding to confirm HELLP, which is essential to monitor. Hemolysis would typically manifest as anemia, but hemoglobin and hematocrit are near normal. Prompt recognition and further testing of liver enzymes (AST, ALT) are critical for diagnosis and management.

Rationale for incorrect Response 1 options:
Chorioamnionitis is an infection of the amniotic sac, usually presenting with fever, uterine tenderness, and elevated WBC, which are not present here. Gestational diabetes is characterized by hyperglycemia, but the client’s blood glucose is only mildly elevated and not diagnostic. Pyelonephritis involves urinary tract infection with systemic symptoms like fever and flank pain, absent in this case.

Rationale for incorrect Response 2 options:
Amniotic membrane status is unrelated here, as there is no rupture or infection evidence. Ketonuria reflects starvation or diabetes, which is not indicated. Blood glucose is only mildly elevated and insufficient to diagnose gestational diabetes or explain current symptoms.

Take home points:

• HELLP syndrome involves low platelets, elevated liver enzymes, and hemolysis, often with epigastric pain.
• Early lab monitoring including liver enzymes is vital for timely diagnosis.
• Elevated BUN, creatinine, and uric acid can signal renal impairment in HELLP.
• Differentiate HELLP from infections or gestational diabetes by clinical presentation and specific labs.