A fetal weight is estimated at 4490 grams in a gravida 1 at 38 weeks' gestation. Counseling should occur before labor regarding the:
1. Mother's undiagnosed diabetes.
2. Likelihood of a cesarean delivery.
3. Effectiveness of epidural anesthesia with a large fetus.
4. Need for early delivery.
2
Rationale 1: There is a possibility of undiagnosed diabetes, but that is not the current concern, since the patient is close to delivery.
Rationale 2: The likelihood of a cesarean delivery with a fetus over 4000 grams is high, and this should be discussed with the patient before labor.
Rationale 3: The weight of the fetus has no bearing on the effectiveness of epidural anesthesia.
Rationale 4: The patient is already at term, so it is too late to discuss an early delivery.
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