Following a vaginal delivery, a postpartum client is troubled by severe cramping after breastfeeding her newborn.
Which explanation describes the most likely reason for the client's pain?

The correct answer is Choice D.

Choice A rationale: This choice incorrectly counts four pregnancies. Scientifically, gravida includes all confirmed pregnancies, but only those that actually occurred. The client has had one miscarriage, one fetal demise, and is currently pregnant—totaling three pregnancies. Counting four would imply an additional pregnancy that did not occur. Overestimating gravida can lead to inaccurate obstetric records and misinterpretation of reproductive history, which may affect clinical decision-making and risk assessment.

Choice B rationale: This choice undercounts the total number of pregnancies by only including two. It likely omits either the miscarriage or the current pregnancy. Scientifically, all pregnancies are counted in gravida, regardless of gestational age or outcome. Miscarriages and fetal demises are included. Underreporting gravida can lead to incomplete obstetric history, which may compromise prenatal care and risk evaluation during labor and delivery.

Choice C rationale: This choice significantly underestimates the gravida by counting only one pregnancy. It may reflect a misunderstanding that only the current or viable pregnancies are included. However, from a clinical standpoint, gravida includes all pregnancies, including those that ended in miscarriage or fetal demise. Accurate gravida documentation is essential for assessing maternal risk factors and planning appropriate obstetric care.

Choice D rationale: This is the correct interpretation. The client has had three pregnancies: one miscarriage at 16 weeks, one fetal demise at 31 weeks, and the current pregnancy at 39 weeks. Scientifically, gravida includes all pregnancies regardless of outcome. This total of three pregnancies makes her gravida 3. Accurate documentation of gravida is crucial for understanding reproductive history and guiding prenatal and intrapartum care.

Choice A rationale

Preterm birth can be a complication of gestational diabetes due to polyhydramnios or preeclampsia, but macrosomia carries a higher risk of birth trauma and neonatal complications. Prematurity can lead to respiratory distress syndrome and other developmental challenges.

Choice B rationale

Macrosomic newborn is the greatest risk to the fetus if euglycemia is not maintained. High maternal glucose levels lead to excessive fetal insulin production, resulting in increased fat deposition and growth. This can cause birth injuries, hypoglycemia, and respiratory distress in the neonate.

Choice C rationale

Low birth weight is typically associated with maternal malnutrition or placental insufficiency, not poorly controlled gestational diabetes. Uncontrolled gestational diabetes usually leads to fetal overgrowth (macrosomia) due to constant glucose supply.

Choice D rationale

Cleft palate is a congenital anomaly primarily linked to genetic and environmental factors during early fetal development, not directly or primarily to poorly controlled gestational diabetes. Metabolic imbalances of diabetes are not a primary cause of such structural malformations.