A client at 28 weeks gestation experiences blunt abdominal trauma. Which parameter should the nurse assess first for signs of internal hemorrhage?

• A. Vaginal bleeding.
• B. Complaints of abdominal pain.
• C. Changes in fetal heart rate patterns.
• D. Alteration in maternal blood pressure.

Answer: (C)

When a pregnant client experiences blunt abdominal trauma, the first clue to internal bleeding often comes from the fetus rather than the mother. The fetus relies entirely on placental blood flow for oxygen and nutrients, so any drop in placental perfusion from maternal hemorrhage or placental injury can quickly produce fetal distress. Changes in fetal heart rate patterns—such as tachycardia, bradycardia, reduced variability, or late decelerations—signal that the fetus may be not getting enough oxygen even before maternal vital signs show trouble. Monitoring fetal heart rate patterns provides the earliest indication that something is compromising circulation within the uterus or placenta, prompting urgent assessment and intervention. While vaginal bleeding, abdominal pain, or a drop in maternal blood pressure are important signs to monitor, they may not appear as promptly as fetal distress in the setting of internal hemorrhage. If abnormal FHR patterns are detected, escalate care promptly to address both fetal and maternal status.