A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests:

Choice A rationale

Keeping the infant in the mother’s room without further evaluation increases the risk of missed complications like hypoglycemia. Monitoring and interventions are crucial for infants at risk due to macrosomia or difficult delivery.

Choice B rationale

Immediate nursery transfer without specific monitoring or intervention overlooks the infant’s risk for hypoglycemia and its symptoms, such as jitteriness or poor feeding. Further evaluation is more appropriate.

Choice C rationale

Macrosomic infants are at higher risk for hypoglycemia due to increased insulin levels post-birth. Frequent glucose monitoring and vigilance for signs like jitteriness or lethargy are crucial for timely intervention.

Choice D rationale

While gestational age assessment confirms LGA status, it does not address the immediate risk of hypoglycemia. Focus should remain on monitoring and stabilizing glucose levels in at-risk macrosomic infants.

Choice A rationale

Gastric problems later in life, such as gastrointestinal motility issues, may occur in infants with myelomeningocele but are not an immediate risk requiring urgent intervention.

Choice B rationale

Respiratory depression is not a direct consequence of myelomeningocele unless associated with other congenital anomalies or complications like Chiari malformation affecting brainstem function.

Choice C rationale

Decreased cardiac output is not a primary concern in myelomeningocele unless secondary to severe infection or other systemic complications, which are less immediate risks.

Choice D rationale

Infection is the greatest immediate risk due to the exposed neural tissue in myelomeningocele, which provides a direct pathway for pathogens, necessitating prompt surgical closure and sterile management.