Assessment of a woman in labor reveals cervical dilation of 3 cm, cervical effacement of 30%, and contractions occurring every 8 to 10 minutes, lasting about 30 seconds. The nurse determines that this client is in:
Select one:

Choice A Reason: Vascular spider veins. This is an incorrect answer that refers to a different skin change that occurs during pregnancy, which affects the blood vessels, not the pigment. Vascular spider veins are small red or purple clusters of blood vessels that appear on the skin, especially on the face, neck, chest, or legs. Vascular spider veins are caused by increased blood volume and hormonal changes, which dilate and rupture the capillaries. Vascular spider veins are harmless and usually disappear after delivery.

Choice B Reason: Linea nigra. This is because linea nigra is a term that refers to a darkened vertical line that appears on the abdomen during pregnancy, which runs from the umbilicus to the pubis. Linea nigra is caused by increased production of melanin, which is a pigment that gives color to the skin and hair. Linea nigra is more common and noticeable in women with darker skin tones, and it usually fades after delivery.

Choice C Reason: Melasma. This is an incorrect answer that refers to a different skin change that occurs during pregnancy, which affects the pigment, but not in a linear patern. Melasma is a term that refers to patches of brown or gray-brown discoloration that appear on the face, especially on the forehead, cheeks, nose, or upper lip. Melasma is also caused by increased production of melanin, but it is influenced by sun exposure and genetic factors. Melasma is also known as chloasma or the mask of pregnancy, and it may persist after delivery.

Choice D Reason: Striae gravidarum. This is an incorrect answer that refers to a different skin change that occurs during pregnancy, which affects the connective tissue, not the pigment. Striae gravidarum are stretch marks that appear on the skin, especially on the abdomen, breasts, hips, or thighs. Striae gravidarum are caused by rapid growth and stretching of the skin, which damage the collagen and elastin fibers. Striae gravidarum are initially red or purple, but they fade to white or silver after delivery.

Choice A Reason: Physiologic anemia due to maternal increased plasma volume. This is an incorrect answer that refers to a different condition that affects hemoglobin levels, not blood pressure. Physiologic anemia is a condition where the maternal plasma volume increases more than the red blood cell mass during pregnancy, which dilutes the hemoglobin concentration and lowers the hematocrit value. Physiologic anemia does not cause significant symptoms or complications in pregnant women, as it is an adaptive mechanism that enhances oxygen delivery and prevents fluid overload.

Choice B Reason: Pressure of the gravid uterus on the maternal inferior vena cava and aorta. This is because this statement explains the cause of supine hypotensive syndrome, which is a condition where lying flat on the back causes compression of the major blood vessels by the gravid uterus, which reduces venous return and cardiac output, which lowers blood pressure and perfusion to vital organs. Supine hypotensive syndrome can cause symptoms such as dizziness, lightheadedness, nausea, pallor, or syncope in pregnant women, especially in the third trimester.

Choice C Reason: Pressure of the presenting fetal part on the maternal diaphragm. This is an incorrect answer that indicates a different condition that affects respiratory function, not blood pressure. Pressure of the presenting fetal part on the maternal diaphragm is a result of cephalic engagement or lightening, which occurs when the fetal head descends into the pelvis and occupies more space in the abdominal cavity. Pressure of the presenting fetal part on the maternal diaphragm can cause symptoms such as dyspnea, heartburn, or rib pain in pregnant women.

Choice D Reason: A 50% increase in maternal blood volume during pregnancy. This is an incorrect answer that describes a normal physiological change that occurs during pregnancy, not a cause of supine hypotensive syndrome. A 50% increase in maternal blood volume during pregnancy is due to increased production of plasma and red blood cells, which helps meet the increased oxygen and nutrient demands of the fetus and placenta, and prepares the mother for blood loss during delivery. A 50% increase in maternal blood volume during pregnancy does not cause hypotension or dizziness in pregnant women.