A nurse is caring for a client who is in labor and is receiving epidural analgesia.
Which of the following changes in the FHR should the nurse report to the provider?

Choice A rationale

Meconium aspiration syndrome is primarily associated with post-term gestation or fetal distress, where the fetus passes meconium in utero and subsequently aspirates it. While fetal distress can occur with PPROM, it is not the *most* direct or primary complication anticipated in the newborn due to preterm premature rupture of membranes itself.

Choice B rationale

Polycythemia, an abnormally high red blood cell count, is not a direct complication expected in a newborn specifically due to preterm premature rupture of membranes. It is more commonly associated with chronic hypoxia, maternal diabetes, or certain genetic conditions, and not a direct consequence of prolonged membrane rupture.

Choice C rationale

Sepsis is a significant and highly anticipated complication in a newborn following preterm premature rupture of the membranes (PPROM). The prolonged absence of the amniotic sac, which normally acts as a protective barrier, increases the risk of ascending infection from the maternal genital tract to the fetus, leading to neonatal sepsis.

Choice D rationale

Hyperbilirubinemia, or jaundice, is common in newborns, especially preterm infants, due to immature liver function. However, it is not a specific complication directly and primarily caused by preterm premature rupture of membranes. While prematurity itself is a risk factor for hyperbilirubinemia, PPROM does not directly induce elevated bilirubin levels. .

Fetal hypoxia occurs when oxygen delivery to the fetus is compromised. In this client, the contraction pattern of very frequent, prolonged contractions every 1–2 minutes lasting 90–120 seconds results in uterine tachysystole, which reduces uteroplacental blood flow during contractions. Normal contraction frequency is no more than 5 contractions in 10 minutes. Excessive contractions increase uterine tone, decrease relaxation time, and limit oxygen exchange, causing fetal heart rate changes like late decelerations and minimal variability. This leads to fetal hypoxia, a critical risk in labor complicated by these contraction abnormalities.

Rationale for incorrect Response 1 options:
Abruptio placentae is a sudden placental separation causing bleeding and pain, which is not directly indicated here, as there is no vaginal bleeding or sharp pain described.
Uterine tachysystole describes the contraction pattern itself rather than a complication; it is a cause, not the adverse outcome.
Chorioamnionitis is infection of fetal membranes, usually indicated by fever and uterine tenderness, neither present here.

Rationale for incorrect Response 2 options:
Gestational hypertension contributes to fetal risk but is not the immediate cause of the current fetal distress.
Fetal heart rate variability describes fetal condition but does not cause fetal hypoxia; rather, it signals it.
Intrauterine growth restriction indicates chronic fetal compromise but is not the direct cause of acute fetal hypoxia during labor contractions.

Take home points:

• Uterine tachysystole causes reduced oxygen delivery by limiting uterine relaxation time, risking fetal hypoxia.
• Fetal hypoxia manifests as late decelerations and minimal variability on fetal monitoring.
• Abruptio placentae and chorioamnionitis have distinct clinical signs, which differ from those caused by contraction abnormalities.
• Differentiating causes of fetal distress is vital for timely intervention during labor to prevent adverse outcomes.