A nurse is caring for a newborn 4 hours after their birth.
Which of the following findings should the nurse report to the provider?

Choice A rationale

Acyclovir is an antiviral medication used primarily to treat herpes simplex virus (HSV) infections to prevent vertical transmission to the neonate. Group B Streptococcus (GBS) is a bacterium and is treated with antibiotics, specifically penicillin or ampicillin, administered intravenously during labor and delivery to prevent neonatal sepsis.

Choice B rationale

The Group B Streptococcus (GBS) culture is typically collected as a single screen between 36 weeks 0 days and 37 weeks 6 days of gestation from the lower vagina and perirectal area. This one-time positive result is sufficient to indicate the need for intrapartum antibiotic prophylaxis (IAP); repeat testing 24 hours later is not standard practice.

Choice C rationale

If the Group B Streptococcus (GBS) culture is positive, the client is considered colonized and requires intrapartum antibiotic prophylaxis (IAP), usually penicillin G, administered intravenously at the onset of labor or rupture of membranes. This reduces the risk of GBS transmission to the newborn, which can cause severe neonatal morbidity like sepsis or pneumonia.

Choice D rationale

The Group B Streptococcus (GBS) culture is a screening test obtained via a swab of the client's lower vagina and perirectal area, not a blood test. The GBS bacteria colonize these areas, and the swab is sent for culture and sensitivity to determine the need for prophylactic antibiotics during labor.

Vaginal bleeding

Bleeding occurs in placenta previa due to partial or total implantation of the placenta over the cervical os, leading to painless bright red bleeding from disrupted placental vessels. It also occurs in preterm labor when cervical effacement and dilation disrupt small cervical vessels, producing light bleeding or spotting. In abruptio placenta, bleeding is dark red and may be concealed or apparent, resulting from premature placental detachment and rupture of maternal vessels in the decidua basalis.

Uterine contractions

Regular uterine contractions every 2 to 3 minutes with cervical change are diagnostic of preterm labor, resulting from premature activation of uterine oxytocin receptors and prostaglandin release before 37 weeks. In abruptio placenta, contractions are often strong and sustained (hypertonic uterus) due to myometrial irritability from bleeding into the decidual layer. Placenta previa, however, typically presents with painless bleeding and a soft, relaxed uterus without contractions because the uterine muscle tone remains unaffected.

Cervical dilation

Cervical dilation indicates preterm labor, as biochemical changes in the cervix from increased prostaglandin and relaxin activity cause collagen breakdown and effacement before term. This process reflects uterine activation sequence initiation leading to potential preterm birth. In placenta previa, the cervix may remain closed despite bleeding because bleeding originates from placental implantation, not cervical change. Abruptio placenta rarely involves dilation unless labor progresses secondarily after placental separation, thus cervical dilation is not a key feature.

Abdominal tenderness

Abdominal tenderness is characteristic of abruptio placenta, caused by bleeding between the uterine wall and placenta leading to myometrial irritability, uterine rigidity, and ischemic pain. The trapped blood increases intrauterine pressure, stimulating pain receptors in the myometrium and stretching the uterine serosa. Placenta previa presents with a soft, nontender abdomen because bleeding is external and not associated with uterine muscle involvement. Preterm labor generally causes back discomfort or cramping, not localized abdominal tenderness.

Client report of low back pain

Low back pain is prominent in preterm labor, resulting from referred pain due to rhythmic uterine contractions transmitted through the lumbosacral plexus and pelvic nerves. It reflects early cervical change and uterine irritability. In abruptio placenta, the back pain may occur secondary to uteroplacental separation and posterior placental bleeding irritating the parietal peritoneum. Placenta previa typically lacks pain or back discomfort since bleeding occurs without uterine or peritoneal irritation.