A nurse is caring for a client who is at 36 weeks of gestation and has suspected placenta previa. For which of the following findings should the nurse monitor the client?

Choice A rationale Intermittent abdominal pain associated with the passage of bloody mucus is typically characteristic of the onset of normal labor, often referred to as the bloody show. In placenta previa, the bleeding is usually spontaneous and not associated with uterine contractions or cervical changes that cause pain. Monitoring for this finding would lead the nurse to suspect labor rather than the specific vascular complications associated with an abnormally positioned placenta near the cervical os. Choice B rationale Placenta previa occurs when the placenta implants over or near the internal cervical os. As the cervix begins to thin or dilate in the third trimester, placental vessels tear, leading to painless, bright red vaginal bleeding. This is a classic diagnostic sign because the bleeding is external and does not cause uterine irritability or concealed hemorrhage. The lack of pain distinguishes it from placental abruption, where bleeding is often associated with significant uterine tenderness and constant pain. Choice C rationale Abdominal pain combined with minimal vaginal bleeding is more indicative of a concealed placental abruption. In abruption, the placenta prematurely separates from the uterine wall, causing retroplacental bleeding that can remain trapped, leading to increased uterine pressure and significant pain. Placenta previa involves bleeding from the lower segment where the blood can easily escape through the vagina, resulting in a larger volume of visible blood and a notable absence of abdominal or uterine tenderness. Choice D rationale Severe abdominal pain accompanied by an increasing fundal height is a hallmark sign of a concealed placental abruption or uterine rupture. Increasing fundal height occurs as blood accumulates behind the placenta, causing the uterus to expand and become board-like. In placenta previa, the fundal height usually remains consistent with gestational age because the blood is not trapped within the uterine cavity. Severe pain is not expected in previa unless the patient is also in active labor.