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Bright red, painless vaginal bleeding is the hallmark diagnostic sign of placenta previa. While this requires careful monitoring and quantification of blood loss, it is an expected finding for the condition. In the absence of hemodynamic instability or fetal distress, it does not supersede the urgency of active shock. The nurse continues to assess the volume and color of the discharge.

A soft, non-tender uterus is an expected assessment finding that helps differentiate previa from abruptio placentae. This finding indicates a lack of myometrial irritability or intrauterine pressure elevation. Because it is a normal characteristic of the disease process, it does not require emergency intervention. It serves as a baseline for ongoing maternal assessment.

A fetal heart rate of 140 bpm with moderate variability indicates a reassuring fetus with adequate oxygenation. This finding suggests the fetoplacental unit is currently tolerating the maternal condition. Since the fetus is stable, this does not represent an immediate crisis. The nurse continues routine electronic fetal monitoring to detect future decelerations.

Encouraging ambulation is contraindicated because the force of gravity and the mechanical movement of the pelvis increase the risk of placental detachment. In complete placenta previa, any pressure on the lower uterine segment can initiate profuse bleeding. Nursing care focuses on reducing uterine irritability and preventing cervical changes, making activity restriction a cornerstone of the care plan. Ambulation would only be considered once the diagnosis of previa is ruled out by ultrasound.

Performing a digital cervical examination is an absolute contraindication in the presence of suspected or confirmed placenta previa. Inserting fingers into the cervix can cause direct trauma to the placental tissue, leading to immediate, massive maternal hemorrhage and hypovolemic shock. Any assessment of the cervix in a bleeding third-trimester client must be performed via transvaginal ultrasound only. This procedure represents one of the most dangerous iatrogenic risks in obstetric nursing.

Administering oxytocin to stimulate contractions is dangerous and strictly prohibited in clients with placenta previa. Uterine contractions cause the cervical os to dilate and the lower segment to efface, which would tear the placenta away from its attachment site. This results in maternal exsanguination and severing of the fetal oxygen supply. Furthermore, because the placenta blocks the birth canal, a vaginal delivery is physically impossible and should never be attempted.

Engaging in light jogging is contraindicated because the high-impact motion and repetitive jarring of the pelvic area can cause placental displacement and bleeding. While circulation is important, aerobic exercise in the context of placenta previa carries a high risk of triggering vascular shearing at the implantation site. The nurse should instead recommend non-stressful movements or gentle range-of-motion exercises that do not increase the risk of placental detachment. Jogging is never appropriate for a client requiring activity restriction.

Performing daily pelvic examinations at home is an extremely dangerous and incorrect instruction. Digital vaginal entry, whether performed by a clinician or the client, can puncture the placental mass and cause catastrophic, fatal hemorrhage. Clients are educated to avoid any insertion into the vagina, including tampons or fingers, to maintain the circulatory integrity of the placenta. The nurse must emphasize that any cervical assessment must only be performed by a physician using ultrasound in a hospital setting.

Increasing physical activity to reduce blood clots is inappropriate because the risk of hemorrhagic shock from placenta previa far outweighs the general risk of thromboembolism in a mobile client. While pregnancy is a hypercoagulable state, activity for a previa patient is strictly limited to prevent placental separation. To reduce the risk of clots without endangering the pregnancy, the nurse should suggest frequent position changes in bed and the use of anti-embolism stockings rather than increased physical exertion.

Magnesium sulfate is not used for labor induction; rather, it is used for tocolysis (suppressing labor) or fetal neuroprotection before 32 weeks. Inducing labor in a client with placenta previa is strictly contraindicated because the placenta obstructs the birth canal, making vaginal delivery impossible and life-threatening. Using magnesium to induce contractions would be a pharmacological error that contradicts the goal of maintaining uterine quiescence.

Oxytocin is used to stimulate uterine contractions, which is an absolute contraindication for placenta previa. Stimulating the uterus would cause the cervix to dilate and the lower segment to efface, leading to catastrophic placental detachment and maternal-fetal exsanguination. Any medication that promotes labor must be avoided to prevent the onset of a hemorrhagic crisis. Cesarean section is the only safe delivery route for this condition.

Methylergonovine is an oxytocic ergot alkaloid used to treat postpartum hemorrhage, but it is not administered before delivery. Giving this medication to a pregnant client could cause tetanic uterine contractions, leading to immediate placental separation and fetal hypoxia. While it helps "prevent bleeding" in the postpartum period by constricting uterine vessels, its antenatal use would precipitate the exact emergency the medical team is trying to avoid.

Complete previa is characterized by the placental mass entirely covering the internal cervical os. In this scenario, the center or a large portion of the placenta lies directly over the opening, creating a total obstruction of the birth canal. This is the most severe form and carries the highest risk for catastrophic hemorrhage and placenta accreta. Because the os is fully occluded, there is no possibility of the fetus passing through the cervix without causing total placental detachment.

Marginal previa occurs when the edge of the placenta is located at the margin of the internal os but does not cover it. In this classification, the placental edge touches the border of the opening without extending across the space. While it still poses a risk for bleeding during the effacement process, it is anatomically distinct from a partial previa where the tissue actually crosses over the os. Current clinical guidelines often group marginal and low-lying placentas together for management purposes.

A low-lying placenta is identified when the placental edge is implanted in the lower uterine segment but is not touching the internal os. Specifically, the edge is typically located between 1 mm and 20 mm from the cervical margin. Unlike partial or complete previa, a low-lying placenta may allow for a trial of labor if the distance is ≥ 20 mm. This condition is often monitored for "placental migration" as the uterus expands upward during the third trimester.

Lochia progressing from bright red to brown is an expected, normal finding during the puerperium. This transition from lochia rubra to lochia serosa typically occurs around the third or fourth day postpartum as the volume of blood decreases and the concentration of serous exudate and leukocytes increases. It indicates that the placental site is healing normally and that uterine involution is proceeding without complication. This finding does not require any clinical intervention.

A soft, contracted uterus is a contradictory description; however, a contracted uterus is the desired outcome after delivery. Effective myometrial contraction compresses the intrauterine vessels, which is the primary mechanism for preventing excessive blood loss. While a "soft" uterus (atony) is concerning, the term "contracted" implies hemostatic stability. If the fundus is firm and the patient is stable, this represents a reassuring assessment of the involution process.

A maternal temperature of 37°C (98.6°F) is a normal finding and indicates the absence of a febrile response or systemic infection. While the nurse monitors for postpartum endometritis, especially after a cesarean section for previa, a temperature within this range is not a cause for concern. It confirms that the patient's thermoregulation is intact and there is no immediate inflammatory crisis. No nursing intervention is required for this stable vital sign.

Resuming sexual activity as tolerated is an incorrect and dangerous instruction because clients with placenta previa or recent uterine surgery require a period of pelvic rest. Any vaginal penetration or orgasm can stimulate uterine contractions or cause mechanical trauma to the healing placental site in the lower uterine segment. Most providers recommend a minimum of 6 weeks of pelvic rest to ensure complete endometrial healing and closure of the cervix. Resuming activity too early increases the risk of both infection and hemorrhage.

Avoiding monitoring lochia unless instructed is inappropriate because lochia assessment is the primary method for the client to monitor their own recovery at home. The client should be taught to observe the color, amount, and odor of the discharge to detect signs of postpartum atony or endometritis. Failure to monitor lochia could lead to a delay in identifying a pathologic bleed. Standard nursing practice involves empowering the client to track their lochia progression from rubra to serosa as a marker of normal involution.

Engaging in strenuous exercise to prevent blood clots is contraindicated in the early postpartum period, especially after a high-risk delivery. While early ambulation (walking) is encouraged to prevent deep vein thrombosis, strenuous activity increases intra-abdominal pressure and can trigger primary or secondary uterine bleeding. Heavy exertion can disrupt the healing of the uterine vessels and the surgical incision if a cesarean was performed. The client should be advised to gradually increase activity based on their physical tolerance and provider guidance.

The supine position is contraindicated because it causes supine hypotensive syndrome due to the weight of the pregnant uterus compressing the great vessels against the vertebral column. This compression reduces venous return to the heart, leading to a drop in maternal blood pressure and a secondary decrease in uterine artery perfusion. In a client already compromised by the bleeding of a placenta previa, this position can rapidly lead to fetal bradycardia.

The Trendelenburg position, where the head is lower than the feet, is not typically used for uteroplacental perfusion and can actually impair maternal respiratory effort by pushing abdominal contents against the diaphragm. While it was historically used for cord prolapse, it does not specifically address the hemodynamic needs of a client with placenta previa. Furthermore, it can increase intracranial pressure and is uncomfortable for the laboring client.

High Fowler's position involves sitting the client upright at a 60–90 degree angle, which increases gravitational pressure on the lower uterine segment and cervix. In placenta previa, this increased pressure can exacerbate placental shearing and increase the volume of vaginal bleeding. While this position may assist with maternal breathing, it is not the optimal choice for maximizing blood flow to the placenta compared to a lateral tilt.