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Abruptio placentae is the premature separation of a normally implanted placenta from the uterine wall. It typically presents with painful bleeding, uterine tenderness, and increased uterine resting tone. The blood is often dark red or concealed behind the placenta, causing a board-like abdomen. Unlike the painless nature of this client's bleeding, abruption is characterized by significant abdominal or back pain.

Uterine rupture is a catastrophic event involving a full-thickness tear of the uterine wall, most common in clients with previous scarring. Clinical signs include sudden, sharp abdominal pain, cessation of uterine contractions, and recession of the presenting part. While bleeding occurs, it is accompanied by profound maternal shock and fetal distress. The client's painless bleeding without a history of trauma or sudden abdominal pain makes this unlikely.

Vasa previa occurs when fetal vessels cross the internal os unprotected by the placenta or umbilical cord. While it presents with painless vaginal bleeding, it typically occurs immediately following the rupture of membranes. The bleeding is fetal in origin, leading to rapid fetal bradycardia and death even with minimal blood loss. Since this client is presenting with bleeding but no mention of membrane rupture or fetal distress, previa is more likely.

Monitoring the fetal heart rate is a mandatory assessment to evaluate fetal well-being and the impact of maternal blood loss on placental perfusion. Placenta previa increases the risk of fetal hypoxia if maternal hypotension occurs due to hemorrhage. Continuous or frequent intermittent monitoring provides essential data regarding the oxygenation status of the fetus. This action is non-invasive and does not pose a risk of mechanical trauma to the placental site.

Assessing maternal vital signs every 15 minutes is a critical component of hemodynamic monitoring in a client with active or suspected obstetric hemorrhage. Tachycardia and hypotension are late signs of hypovolemic shock in pregnant women due to their increased blood volume. Frequent assessment allows the nursing team to intervene early with fluid resuscitation or blood products. This is a standard safety protocol for any client presenting with third-trimester vaginal bleeding.

Quantifying vaginal bleeding by weighing peripads is the most accurate method for determining the volume of blood loss in an obstetric setting. One gram of pad weight is roughly equivalent to one milliliter of blood, providing an objective measurement of the severity of the hemorrhage. This assessment is essential for calculating the cumulative blood loss and guiding the intensity of the medical intervention. It is a non-invasive procedure that provides vital clinical information without disturbing the placenta.

Immediate cesarean section is indicated only if there is active hemorrhage, maternal instability, or signs of non-reassuring fetal status. At 32 weeks, an immediate delivery increases the risk of neonatal respiratory distress and other complications of prematurity. Since the bleeding is described as mild and no maternal or fetal distress is noted, conservative management is preferred over surgical intervention.

Encouraging ambulation is contraindicated in a client with active or suspected placenta previa. Physical activity can increase the risk of further placental separation and exacerbate vaginal bleeding due to gravity and cervical pressure. Clients are traditionally placed on modified bed rest to minimize uterine activity and prevent mechanical disruption of the low-lying placental site.

While tocolytics are sometimes used to stop preterm labor, they are not the initial intervention for placenta previa bleeding. The primary concern is potential hypovolemic shock from blood loss, which requires immediate venous access for fluid resuscitation. Tocolytics may mask signs of abruptio placentae or cause maternal tachycardia, which complicates the assessment of the client's hemodynamic status.

Marginal previa occurs when the edge of the placenta is located at the margin of the os, but does not actually cover it. The placental edge is typically within 2 cm of the internal cervical os but does not cross the cervical threshold. While it still carries a risk of bleeding during labor, it is not characterized by "completely covering" the opening. In some cases, a vaginal delivery may be attempted with marginal previa if the bleeding remains minimal.

Partial previa involves the placenta partially covering the internal cervical os, rather than a total occlusion. This means that a portion of the cervical opening is still free of placental tissue at the time of the ultrasound. While clinically similar to complete previa in terms of risk, it does not match the specific "completely covering" language used in the ultrasound report. The management remains high-risk, usually requiring a cesarean section as the cervix dilates.

A low-lying placenta is defined as a placenta implanted in the lower uterine segment but whose edge is more than 2 cm away from the internal os. This is the least severe form of abnormal placental positioning and often migrates upward as the uterus grows throughout the second and third trimesters. It does not cover the os at all, and therefore, it does not fit the description provided in the client's diagnostic report.