A nurse is caring for a female client who is gravida 1 para 0 at 32 weeks of gestation in the antepartum unit. Complete the following sentence by using the list of options. The nurse should identify that the client is at the greatest risk for _______ due to ________.

The nurse should identify that the client is at the greatest risk for preterm birth due to fetal fibronectin. Rationale for correct answers: Fetal fibronectin (fFN) is a glycoprotein found at the maternal-fetal interface, serving as a “biological glue” between the chorion and decidua. Normally, fFN is not detectable in cervicovaginal secretions between 22 and 34 weeks gestation. A level greater than 0.05 mcg/mL, such as this client’s 0.09 mcg/mL, signals disruption of the fetal membranes and an increased risk of preterm birth. It has a high negative predictive value, so a positive result strongly suggests premature labor risk, prompting interventions like tocolytics and corticosteroids to promote fetal lung maturity. Rationale for incorrect Response 1 options: Precipitous labor is rapid labor lasting under 3 hours from onset to delivery. Fetal fibronectin does not predict the speed of labor but the risk of preterm onset. This client’s labor is not precipitous based on exam and monitoring. Chorioamnionitis is an intra-amniotic infection usually accompanied by maternal fever, uterine tenderness, and fetal tachycardia. Fetal fibronectin does not indicate infection. Preeclampsia involves hypertension and proteinuria after 20 weeks and is unrelated to fetal fibronectin levels. Rationale for incorrect Response 2 options: Nitrazine and ferning tests assess membrane rupture. Both are negative here, indicating intact membranes, which does not exclude preterm labor but means premature rupture of membranes (PPROM) is unlikely. Blood pressure measurements evaluate maternal hemodynamics, not risk of preterm birth. Take-home points: Elevated fetal fibronectin (>0.05 mcg/mL) between 22-34 weeks indicates increased risk for preterm birth. Negative nitrazine and ferning tests suggest membranes are intact, helping differentiate preterm labor from PPROM. Preterm labor risk should be differentiated from precipitous labor, infection (chorioamnionitis), and hypertensive disorders like preeclampsia. Early identification of preterm labor risk allows timely administration of tocolytics and corticosteroids to improve neonatal outcomes.