A patient with pregestational diabetes mellitus delivers a neonate who is diagnosed with macrosomia.
The nurse is aware that the neonate is at risk for additional long-term conditions related to maternal diabetes mellitus.
Which long-term effects may occur? Select all that apply.

Choice A rationale

Placental abruption involves the detachment of the placenta from the uterine wall before delivery, causing bleeding, abdominal pain, and uterine tenderness. It does not typically cause dyspnea, hypotension, frothy sputum, or loss of consciousness.

Choice B rationale

Uterine rupture is a tear in the uterine wall, often in a scarred uterus. Symptoms include severe abdominal pain, abnormal fetal heart rate, and vaginal bleeding. It can cause shock, but not frothy sputum or sudden dyspnea.

Choice C rationale

Uterine inversion occurs when the uterus turns inside out, often during placental delivery. It leads to pain, hemorrhage, and shock. Like uterine rupture, it does not cause frothy sputum or sudden dyspnea.

Choice D rationale

Anaphylactoid syndrome (amniotic fluid embolism) occurs when amniotic fluid enters the maternal circulation, causing an anaphylactic reaction. Symptoms include sudden dyspnea, hypotension, frothy sputum, and loss of consciousness, fitting the scenario described.

Choice A rationale

While it’s true that increased discomfort is expected with twins due to additional physical strain and space constraints, this alone is not sufficient reassurance. It is vital to assess for signs of preterm labor or other complications.

Choice B rationale

Performing a digital cervical examination is a valid approach to checking for dilation, but this action must be carefully considered based on other signs and symptoms presented by the patient. The focus here is on ensuring the absence or presence of labor, which might require hospital assessment.

Choice C rationale

Sending the patient to the hospital to be checked for possible signs of labor ensures that professional monitoring and interventions can occur if labor is confirmed. This action prioritizes safety, given the increased risk of complications with twin pregnancies and the advanced gestation of 37 weeks.

Choice D rationale

Assuring the patient of the absence of contractions after an examination might provide temporary relief, but it does not address the possibility of other signs of labor or complications that may require more comprehensive hospital assessment.