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Expectant management at home is inappropriate at 36 weeks because the risk of sudden, profuse vaginal bleeding increases as the lower uterine segment thins. At this advanced gestational age, the benefits of continued fetal development are outweighed by the danger of maternal hemorrhage. Clients with complete previa often require hospitalization to ensure immediate access to surgical services and blood products if bleeding occurs.

Induction of labor with oxytocin is absolutely contraindicated in complete placenta previa because uterine contractions would cause the cervical os to dilate against the placenta. This would lead to immediate, massive placental detachment and maternal-fetal death. Oxytocin increases the frequency and intensity of myometrial activity, which would accelerate vascular shearing at the placental site. A vaginal birth cannot occur when the placenta blocks the passage.

Vaginal delivery with forceps is impossible and life-threatening in the presence of a complete previa. Forceps are used to assist a vaginal birth, which is physically blocked by the placental tissue covering the cervix. Any attempt to deliver the fetus through the vagina would require the fetus to pass through the placental mass, resulting in fetal exsanguination and maternal shock. Cesarean section remains the only viable delivery route.

Minimal vaginal spotting is a common finding in hospitalized clients with placenta previa and, while requiring documentation and assessment, does not typically necessitate immediate emergency intervention. Spotting often occurs as the lower segment undergoes minor physiologic changes without a full-scale vascular rupture. The nurse should continue to monitor the pad count and maternal vitals. However, it does not carry the same urgency as a profuse, sudden hemorrhage.

A fetal heart rate of 140 bpm with moderate variability is a reassuring finding indicating adequate fetal oxygenation and an intact autonomic nervous system. Moderate variability is the most important indicator of fetal well-being and the absence of metabolic acidosis. Since the fetus is currently stable, this finding does not trigger an emergency protocol. The nurse would continue routine electronic fetal monitoring as part of the standard plan of care.

Mild intermittent uterine contractions are common in the third trimester and, while they can lead to cervical changes, do not always require immediate intervention unless they become regular or increase in intensity. The nurse should assess for cervical effacement via ultrasound rather than a digital exam. While contractions are a risk factor for bleeding, they are managed with bed rest or tocolytics. They are a warning sign rather than an indicator of an active, catastrophic event.

Betamethasone 12 mg IM is an appropriate order for a client at 34 weeks gestation to promote fetal lung maturity. Corticosteroids stimulate the production of pulmonary surfactant in the fetal alveoli, which reduces the risk of respiratory distress syndrome (RDS) if the client requires a preterm delivery. This is a standard prophylactic intervention for any high-risk pregnancy where delivery is anticipated before 37 weeks. It does not negatively impact the placental site or maternal hemodynamics.

Magnesium sulfate IV is an appropriate order if the goal is to provide neuroprotection for the fetus or to manage preterm contractions (tocolysis) to allow for the completion of steroid therapy. In placenta previa, stopping contractions is vital to prevent cervical effacement and subsequent bleeding. While magnesium is a high-alert medication, its use to stabilize the uterus and protect the fetal brain from intraventricular hemorrhage is clinically indicated in preterm scenarios.

Iron supplementation for anemia is a standard and necessary order for clients with placenta previa, especially those experiencing intermittent bleeding. Chronic or acute blood loss depletes maternal iron stores, leading to a reduction in hemoglobin and maternal oxygen-carrying capacity. Optimizing the client’s hematologic status helps build a vascular reserve in case a major hemorrhagic event occurs during delivery. This is a supportive treatment that poses no risk to the placental attachment.