A laboring woman with no known risk factors suddenly experiences spontaneous rupture of membranes (ROM).The fluid consists of bright red blood.Her contractions are consistent with her current stage of labor.There is no change in uterine resting tone.The fetal heart rate begins to decline rapidly after the ROM.The nurse should suspect the possibility of:

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Vasa previa is the result of a velamentous insertion of the umbilical cord.The umbilical vessels are not surrounded by Wharton jelly and have no supportive tissue.They are at risk for laceration at any time,but laceration occurs most frequently during ROM.The sudden appearance of bright red blood at the time of ROM and a sudden change in the fetal heart rate without other known risk factors should immediately alert the nurse to the possibility of vasa previa.The presence of placenta previa most likely would be ascertained before labor and would be considered a risk factor for this pregnancy.In addition,if the woman had a placenta previa,it is unlikely that she would be allowed to pursue labor and a vaginal birth.With the presence of severe abruptio placentae,the uterine tonicity would typically be tetanus (i.e.,a board-like uterus).DIC is a pathologic form of diffuse clotting that consumes large amounts of clotting factors and causes widespread external bleeding,internal bleeding,or both.DIC is always a secondary diagnosis,often associated with obstetric risk factors such as HELLP syndrome.This woman did not have any prior risk factors.

A Laboring Woman with No Known Risk Factors Suddenly Experiences