Which of the following risk factors should a nurse include when planning a class on postpartum depression for a group of clients who are pregnant?

Choice A reason: Polycythemia, an excess of red blood cells, is associated with conditions like chronic hypoxia or twin-to-twin transfusion, not preterm premature rupture of membranes (PPROM). PPROM increases infection risk, not hematocrit levels. Neonatal physiology in PPROM is more likely to involve inflammatory responses than erythrocytosis, making polycythemia an unlikely complication in this context.

Choice B reason: Fractured clavicle typically occurs during difficult vaginal deliveries, particularly with shoulder dystocia, not PPROM. PPROM predisposes to infection due to prolonged amniotic fluid exposure, not mechanical trauma. The newborn’s skeletal system faces no increased fracture risk from PPROM, as it is unrelated to delivery mechanics or bone integrity.

Choice C reason: Meconium aspiration occurs when a newborn inhales meconium-stained amniotic fluid, typically in term or post-term infants under stress. PPROM at 35 weeks increases infection risk, not meconium passage, as preterm infants rarely produce meconium. The complication is unrelated to PPROM’s primary pathophysiological concern of infection due to membrane rupture.

Choice D reason: Sepsis is a significant risk in PPROM, as ruptured membranes allow bacterial ascent from the vagina, leading to intra-amniotic infection. Preterm newborns have immature immune systems, increasing susceptibility to pathogens like group B streptococcus. Monitoring for sepsis is critical, as it can cause systemic inflammation, organ dysfunction, and high mortality if untreated.

Choice A reason: A newborn weight of 2.948 kg is normal and not a risk factor for postpartum hemorrhage. Large-for-gestational-age infants (>4 kg) increase uterine overdistension, impairing contraction and causing bleeding. This weight does not strain uterine muscle tone, maintaining normal postpartum hemostasis, per obstetric physiology.

Choice B reason: Uterine atony, failure of the uterus to contract post-delivery, is a major cause of postpartum hemorrhage. Ineffective contractions prevent hemostasis at placental separation sites, leading to excessive bleeding. Myometrial fatigue or previous atony increases risk, as poor uterine tone disrupts clotting cascades, necessitating vigilant monitoring and oxytocic intervention.

Choice C reason: Vacuum-assisted delivery increases postpartum hemorrhage risk due to potential uterine or cervical trauma. Instrumentation can cause lacerations or hematomas, disrupting hemostasis. Tissue trauma triggers local bleeding, and prolonged labor may weaken uterine contractions, impairing clot formation at the placental site, per obstetric complication studies.

Choice D reason: History of human papillomavirus (HPV) does not increase postpartum hemorrhage risk, as it affects cervical epithelium, not uterine contractility or hemostasis. HPV is linked to cervical cancer, not obstetric complications. Postpartum bleeding stems from uterine or traumatic factors, making HPV irrelevant to hemorrhage pathophysiology in the postpartum period.

Choice E reason: Labor induction with oxytocin increases postpartum hemorrhage risk, as prolonged exposure may desensitize myometrial receptors, leading to uterine atony. Ineffective contractions post-delivery impair hemostasis at the placental site, causing bleeding. Oxytocin’s effect on uterine muscle tone requires careful monitoring to prevent excessive blood loss, per obstetric pharmacology.