The nurse reviews results of a 28 week fetal ultrasound that reveals a small for gestational age fetus and a low implanted placenta.
The nurse will plan teaching for which pregnancy complication?

Choice A rationale

Placental abruption is the premature detachment of the normally implanted placenta from the uterine wall. The client's placenta is low-implanted, suggesting a placenta previa risk, not abruption. While the small for gestational age (SGA) fetus is associated with placental insufficiency, abruption is typically characterized by acute vaginal bleeding and pain, not exclusively by a low-implanted placenta on ultrasound.

Choice B rationale

Placenta accreta is an abnormal adherence of the placenta to the uterine wall, invading the myometrium. It is a major risk in clients with a history of previous cesarean births or uterine surgery. A low-implanted placenta (previa) on its own, without a history of uterine scarring, is not the primary indicator for accreta planning, which is focused on hemorrhage risk at delivery.

Choice C rationale

Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of gestation. While a small for gestational age (SGA) fetus and placental issues can increase the risk of preterm labor, the specific finding of a low-implanted placenta on a 28-week ultrasound points more directly to the risk of placenta previa, which is the priority teaching topic.

Choice D rationale

Placenta previa is the implantation of the placenta over or near the internal cervical os. A low-implanted placenta revealed at 28 weeks' gestation is a strong indicator of an increased risk for previa as the pregnancy progresses. The associated fetal growth restriction (SGA) is often related to the placenta's suboptimal location and functionality, requiring teaching on bleeding precautions and warning signs.

Choice A rationale

Appropriate for gestational age (AGA) refers to neonates whose weight falls between the 10th and 90th percentiles for their gestational age. The neonate is term (38 weeks), but weighs 4,017 grams, which is >4,000 grams and classified as macrosomic, thus >90th percentile and not AGA. The classification of AGA is based on a statistical growth curve and is distinct from being macrosomic.

Choice B rationale

Large for gestational age (LGA) describes neonates whose weight is above the 90th percentile for their gestational age, which includes those with macrosomia (birth weight >4,000 g). This neonate weighs 4,017 g, placing them in the LGA category. Term is defined as a birth occurring between 37 weeks 0 days and 41 weeks 6 days gestation, making 38 weeks a term birth.

Choice C rationale

Large for gestational age (LGA) is correct for this 4,017 g neonate, as their weight exceeds the 90th percentile for 38 weeks' gestation. However, preterm refers to births occurring before 37 weeks 0 days gestation. Since this neonate was born at 38 weeks' gestation, the "preterm" classification is incorrect because 38 weeks is within the term range.

Choice D rationale

Appropriate for gestational age (AGA) is incorrect because this neonate's weight of 4,017 g is greater than the 90th percentile for a 38-week gestation, classifying them as large for gestational age (LGA). Term is correct as the neonate was born at 38 weeks' gestation, which is within the 37 weeks 0 days to 41 weeks 6 days range, making the overall classification inaccurate.