What complication should the nurse monitor for when a multigravida in early active labor admits to using crack cocaine?

Monitoring for abruptio placentae is essential in this scenario because the use of crack cocaine can lead to increased risk for this serious complication. Abruptio placentae, or placental abruption, occurs when the placenta detaches from the uterine wall before delivery, which can result in significant maternal and fetal morbidity.

Cocaine, including crack cocaine, is a potent vasoconstrictor that can cause changes in blood flow to the placenta. This can lead to ischemia, resulting in the placenta separating from the uterine wall. Symptoms of abruptio placentae can include severe abdominal pain, vaginal bleeding, and uterine contractions. Given the patient’s use of cocaine and being in active labor, the risk for this condition is heightened.

It's important to remain vigilant for signs of this complication, as it not only endangers the pregnancy but can also pose life-threatening risks to the mother due to hemorrhage and coagulopathy. Hence, monitoring for abruptio placentae in this context is critical for ensuring the safety and health of both the mother and the fetus.