A woman gives birth to a small infant with a malformed skull.

The infant grows abnormally slowly and shows signs of substantial cognitive and intellectual deficits.

The child also has facial abnormalities including a short nose and thin lip that become more striking as it develops.

The correct answer is choice B.

Choice A rationale:

Brownish vaginal discharge can be a sign of labor but it is not definitive.

Choice B rationale:

Cervical dilation is a definitive sign that labor has started.

Choice C rationale:

Presence of amniotic fluid in the vaginal vault can indicate rupture of membranes but it does not confirm labor.

Choice D rationale:

Pain above the umbilicus is not a typical sign of labor.

The correct answers are choices B, E, and F.

Choice A rationale:

Nausea with vomiting during the first trimester is a common symptom of pregnancy and does not need to be reported immediately to the health care provider.

Choice B rationale:

Sudden leakage of fluid during the second trimester could indicate premature rupture of membranes, which can lead to infection and preterm labor. This should be reported immediately.

Choice C rationale:

Urinary frequency in the third trimester is a common symptom of pregnancy due to the growing uterus putting pressure on the bladder.

Choice D rationale:

Backache during the second trimester is a common symptom of pregnancy as the body adjusts to the growing uterus.

Choice E rationale:

Lower abdominal pain with shoulder pain in the first trimester could indicate an ectopic pregnancy, which is a medical emergency and should be reported immediately.

Choice F rationale:

Headache with visual changes in the third trimester could indicate preeclampsia, a serious condition that can lead to seizures, stroke, and other complications. This should be reported immediately.