An 82 beat per minute reading could be the mother's heart rate, indicating that the nurse does not have the doppler in the correct position. A normal fetal heart rate is between 120 and 160 beats per minute. The nurse must always remember to take the mother's pulse before assessing the fetal heart rate. Before calling the physician, it is important to determine that the data is accurate. To increase oxygen perfusion to the fetus, ask the mother to lay on her left side.

This is most likely the normal "bloody show" at the beginning of labor. There is no need to immediately arrive at the hospital, change position, or eat a bland diet. The patient should continue to monitor and call back or seek care when she experiences regular contractions that are becoming more intense and frequent.

Primary amenorrhea occurs when a female is fourteen years old and has not gotten her first period and has not developed secondary sex characteristics. Primary amenorrhea also occurs when a female sixteen or older has not gotten her first period but has developed secondary sex characteristics. Primary dysmenorrhea refers to painful menstruation not linked to a physiological disorder. Secondary dysmenorrhea refers to painful menstruation due to an underlying cause such as endometriosis. Oligomenorrhea refers to the absence of a period, typically for at least 35 days. 

Secondary dysmenorrhea refers to painful menstruation due to an underlying condition. Endometriosis, an example of a condition that frequently causes secondary dysmenorrhea, refers to the growth of uterine tissue in inappropriate places such as the ovary or rectum. High levels of prostaglandin are frequently found in women with primary dysmenorrhea which is painful menstruation without an underlying condition. Low levels of aldosterone would not likely cause painful menstruation. Turner syndrome is a chromosomal disorder that can frequently cause amenorrhea, or absence of a period.

Uterine conditions such as endometriosis and uterine fibroids increase the risk of ectopic pregnancy. Endometriosis is the inappropriate growth of uterine tissue outside the uterus. Uterine fibroids are benign tumors within the uterus. Sexually transmitted infections can cause a condition called pelvic inflammatory disease which can result in scarring. Scarring of the reproductive system greatly increases the risk of ectopic pregnancy and infertility. Yeast infections are common after antibiotic therapy and are treated with an over-the-counter medication. They generally do not cause permanent damage to the body.

This woman could be experiencing pre-term labor. A 20 week pregnancy is not considered viable. She should be seen immediately to determine if there is a cause such as cervical insufficiency (premature dilation of the cervix). 

Abruptio placentae is a serious condition where the placenta inappropriately and prematurely detaches from the uterus. Women with obstetric complications such as abruptio placentae can quickly develop disseminated intravascular coagulation (DIC). DIC is a clotting disorder in which the blood inappropriately clots. Severe bleeding can also occur as clotting proteins become scarce. Symptoms of DIC include blood clots, and bleeding into the tissues such as the skin and oral mucosa. A decreasing blood pressure is concerning due to the severe bleeding caused by the combination of DIC and abruptio placentae. Shortness of breath could indicate a the presence of a blood clot. Although uterine tenderness is of concern, it is common with abruptio placentae and does not indicate an immediately life-threatening condition.

The normal cervical canal is 2cm in length. Effacement is the thinning of the cervix as the body prepares for delivery. Thus, a 2cm cervix is 0% effaced and a 0cm cervix is 100% effaced.

If the placenta is not whole upon delivery, a piece may still be present in the uterus. This inhibits the ability of the uterus to shrink in size and may cause hemorrhage. The missing piece needs to be located immediately.

Marked fetal heart rate baseline variability of 25 beats per minute or more may be cause for concern. Similar findings may indicate that there is poor oxygenation of the fetus. Turn the mother to her left side (to increase perfusion) and notify the physician. Note that this is still in the normal range for fetal heart rate for a laboring patient (about 130 beats per minute), and that the low end of this spectrum is of slightly more concern.