A client in active labor presents with dark red vaginal bleeding and a uterus tense between contractions. The nurse should prioritize which intervention?

• A. Monitor bleeding from IV sites
• B. Insert an internal fetal monitor
• C. Assess for cervical changes q1h
• D. Leopold's maneuvers

Answer: (A)

This scenario points to placental abruption, a situation in which the uterus can become tense and painful with ongoing vaginal bleeding. The immediate goal is maternal stabilization by assessing and controlling hemorrhage and preparing for potential delivery. Monitoring bleeding from IV sites is the most critical step because it gives real-time information about how much blood loss is occurring and guides urgent decisions about fluid resuscitation, need for blood products, and the speed of delivery if distress develops. It keeps you focused on the patient’s hemodynamic status at a moment when rapid changes can occur.

Internal fetal monitoring, while useful for fetal status, isn’t the top priority before stabilizing the mother in this emergency. Leopold’s maneuvers can help assess fetal position but won’t directly address the acute hemorrhage. Assessing cervical changes hourly is not aligned with the urgent need to manage ongoing bleeding and stabilization. In this context, tracking blood loss through IV sites aligns with the immediate life-saving priorities for the mother and fetus.