A client at 28 weeks gestation asks about warning signs that should prompt her to call her provider immediately. Which of the following is a WARNING SIGN of preterm labor?

PRETERM LABOR is defined as regular uterine contractions resulting in cervical change before 37 weeks gestation. It is a major cause of neonatal morbidity and mortality. WARNING SIGNS of preterm labor (teach clients to report IMMEDIATELY if they experience before 37 weeks): (1) Regular uterine CONTRACTIONS — 4 or more in 1 hour, even if not very painful; (2) PELVIC PRESSURE — feeling that the baby is pushing down; (3) DULL LOW BACKACHE — constant or intermittent, may feel different from usual pregnancy back pain; (4) VAGINAL DISCHARGE — change in amount, color, consistency (watery, mucous, bloody); (5) VAGINAL BLEEDING — any amount is significant; (6) FLUID LEAKING — possible rupture of membranes (call immediately); (7) ABDOMINAL CRAMPING — with or without diarrhea.

Contrast with normal: Braxton-Hicks contractions are irregular, non-progressive, go away with rest and hydration, and do not cause cervical change — normal in the third trimester. RISK FACTORS for preterm birth: prior preterm birth, multiple gestation, cervical incompetence, uterine anomalies, infections (UTI, bacterial vaginosis), placenta previa, abruptio placentae, smoking, substance use, inadequate prenatal care. INTERVENTIONS if preterm labor confirmed: hospitalization; tocolytics (medications to slow or stop contractions: terbutaline, indomethacin, nifedipine); corticosteroids (betamethasone) to promote fetal lung maturity if delivery may occur; magnesium sulfate for fetal neuroprotection at <32 weeks; antibiotics for group B Strep prophylaxis.

Pn teaching: emphasize when to call (don't wait to see if it goes away); early intervention gives the best chance of continuing the pregnancy.