A nurse is caring for a postpartum client following a vaginal birth of a newborn weighing 4252 g (9 lb 6 oz). The nurse should identify that this client is at risk for which of the following postpartum complications?
A.
Uterine atony
B.
Puerperal infection
C.
Retained placental fragments
D.
Thrombophlebitis.
The Correct Answer and Explanation is:
The correct answer is A. Uterine atony.
Explanation:
Uterine Atony is the most likely postpartum complication for this client. Uterine atony occurs when the uterus fails to contract effectively after delivery, leading to excessive bleeding. The primary risk factors for uterine atony include:
- Large Birth Weight: The newborn’s weight of 4252 grams (9 lb 6 oz) is considered macrosomic. Macrosomia increases the risk of uterine atony because the larger the fetus, the greater the uterine distension during pregnancy. This distension can impair the uterus’s ability to contract effectively after delivery.
- Prolonged Labor: Prolonged labor can contribute to uterine atony as the muscle fibers may become fatigued from prolonged contractions or stress during labor. Though the question does not specify the length of labor, the large fetal size alone is a significant factor.
- Multiple Pregnancies: Although not indicated in the scenario, multiple pregnancies or polyhydramnios (excess amniotic fluid) are other contributing factors. These can cause overstretching of the uterine muscles, affecting their ability to contract after delivery.
Puerperal Infection (B), Retained Placental Fragments (C), and Thrombophlebitis (D) are less directly related to the newborn’s weight.
- Puerperal Infection is an infection of the reproductive organs following childbirth, often related to poor hygiene or prolonged labor, but it’s not primarily connected to the baby’s birth weight.
- Retained Placental Fragments can lead to postpartum hemorrhage, but this condition is not as closely tied to the newborn’s size as uterine atony.
- Thrombophlebitis refers to inflammation of the veins with clot formation and is more related to immobilization or other risk factors rather than the baby’s weight.
Thus, in this case, the risk of uterine atony is the most relevant complication due to the baby’s large size, which affects the uterine muscle’s ability to contract and maintain hemostasis post-delivery.