Which patient would be at the highest risk for postpartum hemorrhage?

Choice A rationale

While lithotomy positioning can increase pressure on perineal tissues, it does not directly correlate with an elevated risk of postpartum hemorrhage. Other factors have stronger evidence for causing hemorrhage.

Choice B rationale

Uterine massage is a preventative measure against postpartum hemorrhage. It stimulates uterine contractions, promoting tone, and reducing atony, which is a primary cause of excessive postpartum bleeding.

Choice C rationale

A third stage lasting less than 10 minutes is within normal limits, reducing the likelihood of placental retention and subsequent bleeding. Prolonged stages, rather than shortened ones, increase risk.

Choice D rationale

Macrosomia, defined as infant birth weight over 4000 grams, increases uterine atony risk due to overdistension, impairing effective contractions post-delivery. Overdistension complicates placental separation, raising postpartum hemorrhage risk.

Choice A rationale

Gastric problems later in life are not an immediate concern for infants with myelomeningocele, as they often arise secondary to neurological impairments or medications but do not pose immediate life-threatening risks at birth.

Choice B rationale

Respiratory depression in infants with myelomeningocele is rare unless coexisting brainstem anomalies or complications from anesthesia are present, which are typically managed during medical interventions.

Choice C rationale

Decreased cardiac output is not a primary risk in infants with myelomeningocele unless there is a coexisting cardiac anomaly, which is not a routine feature of this congenital condition.

Choice D rationale

Infection is a critical immediate risk due to the open neural tube defect in myelomeningocele, which exposes the spinal cord and meninges to environmental pathogens, increasing the risk of meningitis or systemic infection.