A 26-week pregnant client has a Glucose challenge test (GCT) with 50 g of glucola, her results are 150mg/dl. What would be expected next step when caring for this client?

A. "It is possible that your baby experienced birth trauma that has caused some bleeding." While birth trauma can cause bleeding, it is not the most common cause of a small blood-tinged area in a newborn's diaper, particularly in female infants. Trauma-related bleeding would typically be more noticeable or involve more significant injury.

B. "Your baby has an infection that will need to be evaluated by the physician." This statement is unlikely, as the presence of a small amount of blood-tinged discharge in a newborn’s diaper is not typically a sign of infection. Infection would present with other symptoms, such as fever, irritability, or abnormal discharge.

C. "Breastfed babies often experience this type of bleeding problem due to lack of Vitamin K in the mother's milk." This is incorrect. Newborns are given a Vitamin K injection shortly after birth to prevent bleeding issues (such as Vitamin K deficiency bleeding). Lack of Vitamin K in the mother's milk is not a cause of blood-tinged discharge in female infants.

D. "Some female infants experience menstruation-like symptoms as a result of the mother's hormones." This is the correct response. A small amount of blood-tinged vaginal discharge (often described as pseudomenstruation) in female newborns is common and occurs due to the influence of the mother's hormones (mainly estrogen) passed to the baby in utero. It typically resolves within a few days to weeks and is considered a normal physiological response.

A. Polyhydramnios refers to an excessive amount of amniotic fluid and typically presents with maternal discomfort, dyspnea, and possibly preterm labor, but not with vaginal bleeding as a primary symptom.

B. Placenta previa is the most likely diagnosis based on the assessment findings. It typically presents with painless, bright red vaginal bleeding in the second or third trimester, a soft, nontender uterus, no contractions, and a normal fetal heart rate. The bleeding may start spontaneously and often recurs. This fits the client's clinical picture precisely.

C. Placental abruption usually involves painful vaginal bleeding, a firm or tender uterus, and may be associated with uterine contractions or abnormal fetal heart rate patterns. The absence of pain and uterine tenderness in this case makes placental abruption less likely.

D. Ruptured ectopic pregnancy would not be expected at 33 weeks’ gestation. Ectopic pregnancies typically present in the first trimester and are accompanied by severe abdominal pain, vaginal bleeding, and signs of hypovolemic shock if ruptured.