A nurse is caring for a client who has consented to an amniocentesis for genetic cell analysis. The client asks why she can’t have the test before 14 weeks of gestation.
Which of the following responses should the nurse make?

Choice A:
Purpose of the Biophysical Profile (BPP): The BPP is a non-invasive test that combines ultrasound and fetal heart rate monitoring to assess fetal well-being, specifically in the third trimester of pregnancy. It evaluates five parameters: fetal breathing movements, fetal body movements, fetal tone, amniotic fluid volume, and fetal heart rate reactivity. Each parameter is assigned a score of 0 or 2, resulting in a total score of 0 to 10. A score of 8 or 10 is generally considered reassuring of fetal well-being, while a score of 6 or below may warrant further evaluation or intervention.
Timing of BPP: It's typically performed in the third trimester, often after 32 weeks of gestation, when the fetus has developed regular sleep-wake cycles and breathing movements.
Risk Assessment: It's often recommended for pregnancies considered high-risk, such as those with: Maternal diabetes
Preeclampsia
Decreased fetal movement Past stillbirth
Multiple gestation
Oligohydramnios (low amniotic fluid) Post-term pregnancy (over 42 weeks)

Choice B:
IV initiation is not a routine part of BPP: Intravenous (IV) access is not typically required for a BPP. The test involves external monitoring of fetal heart rate and ultrasound imaging, which do not necessitate IV access.

Choice C:
NPO status is not necessary: The client does not need to be NPO (nothing by mouth) for a BPP. There are no dietary restrictions or fasting requirements for this test.

Choice D:
BPP does not determine the estimated date of birth: The primary purpose of the BPP is to assess fetal well-being, not to determine the estimated date of delivery (EDD). The EDD is typically established based on the last menstrual period or early ultrasound measurements.

Choice A rationale:

Premature maturity is not a plausible cause of bleeding without contractions at 1 week of pregnancy. Premature maturity, or preterm labor, refers to labor that begins before 37 weeks of gestation. It is characterized by contractions and cervical changes, often accompanied by other symptoms such as lower back pain, pelvic pressure, or a change in vaginal discharge. At 1 week of pregnancy, the fetus is still in the very early stages of development, and premature labor is not possible.

Choice C rationale:

The location of the placenta can sometimes cause bleeding in pregnancy, but it is typically associated with later stages of gestation, such as the second or third trimester. Placental conditions like placenta previa, where the placenta lies low in the uterus and partially or completely covers the cervix, can lead to bleeding, but this is unlikely to occur at 1 week of pregnancy. Moreover, placenta previa is usually accompanied by pain or cramping, which is not present in the client's case.

Choice D rationale:

The frequency and duration of contractions are relevant in assessing labor progression, but they are not a primary cause of bleeding without contractions. Contractions are the rhythmic tightening and relaxing of the uterine muscles that help to dilate the cervix and move the baby through the birth canal. Bleeding without contractions at 1 week of pregnancy suggests a different underlying issue.

Choice B rationale:

Incompetency, also known as cervical insufficiency or cervical incompetence, is the most likely cause of bleeding without contractions at 1 week of pregnancy. It occurs when the cervix is weak and begins to open prematurely, even without the presence of contractions. This can lead to bleeding and potential miscarriage or preterm birth. The fact that the client can feel the baby moving does not rule out cervical insufficiency, as fetal movement can sometimes be felt as early as 13-16 weeks of pregnancy.