A client is at 35 weeks of gestation calls the nurse at the clinic and reports a sudden discharge of fluid from the vagina. Based on the data provided, the nurse suspects which of the following conditions?

Appeared in: DHS 2018 shift 1st

Explanation

The client's report of a 'sudden discharge of fluid' from the vagina is the classic sign of Premature Rupture of Membranes (PROM).
Because this event occurred at 35 weeks (before 37 completed weeks of gestation), it is specifically termed Preterm Premature Rupture of Membranes (PPROM).
The primary symptom of PROM is a sudden gush or a continuous slow leak of watery amniotic fluid from the vagina, which directly matches the client's complaint.
Confirmation is typically done via a sterile speculum exam to visualize fluid pooling and tests like the Nitrazine or fern test.

Option A: Miscarriage, or spontaneous abortion, is defined as pregnancy loss before 20 weeks of gestation. This client is at 35 weeks, which is in the third trimester.
Option B: Preterm labor is defined by the presence of regular uterine contractions that cause cervical changes (effacement and dilation) before 37 weeks. The client's primary symptom is fluid discharge, not contractions.
Option C: Intrauterine fetal demise (IUFD) refers to the death of the fetus in utero. The most common symptom reported by the mother is a significant decrease or complete absence of fetal movement.

Clinical Relevance

Nursing practice connection: Use the key finding related to Assessment of complications in late pregnancy, specifically identifying Premature Rupture of Membranes (PROM) to guide bedside assessment, documentation, and the next nursing action.
Immediate assessment for PPROM is critical due to the high risk of complications such as chorioamnionitis (intra-amniotic infection), umbilical cord prolapse, placental abruption, and the onset of preterm labor.
Nursing priorities include confirming the rupture, assessing fetal well-being via heart rate monitoring, and closely monitoring the mother for signs of infection (fever, tachycardia, uterine tenderness, foul-smelling discharge).
Digital vaginal exams are contraindicated in suspected PPROM until active labor is established, as they can increase the risk of ascending infection.

How to Approach the Question

First, identify the key clinical details in the question: the gestational age (35 weeks, which is preterm) and the cardinal symptom ('sudden discharge of fluid from the vagina').
Next, evaluate each option by matching its classic definition to the client's presentation.
Recognize that a 'sudden discharge of fluid' is the hallmark sign of ruptured membranes.
Eliminate 'Miscarriage' because the gestational age (35 weeks) is far beyond the 20-week cutoff.
Differentiate from 'Preterm labor' by noting that the primary symptom reported is fluid loss, not the regular contractions that define labor.
Rule out 'Intrauterine fetal demise' as its key sign is absent fetal movement, not fluid discharge.

Concept Tested & Keywords

Concept Tested: Assessment of complications in late pregnancy, specifically identifying Premature Rupture of Membranes (PROM).
Stem keywords: 35 weeks of gestation, sudden discharge of fluid, vagina
Lead-in keywords: suspects
Clinical cues: Gestational age of 35 weeks indicates a preterm pregnancy.
Clinical cues: The symptom 'sudden discharge of fluid' is a cardinal sign in obstetrics.

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E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 33-41

E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 463-465

E6 Obstetrics Williams p. 23-42

Practise the full DHS 2018 shift 1st

Attempt every question from this paper in a timed mock, then review the full solution for each one.