A client who has type 2 diabetes is pregnant with her second child. She was not diagnosed with diabetes until after her first pregnancy. Past obstetric history is unremarkable—spontaneous vaginal birth of a male weighing 7 pounds, 15 ounces
The client is now concerned over what will happen during this subsequent pregnancy as a result of her disease process. What impact could the disease process have on her upcoming birth?
a. Client will not be able to receive an epidural for pain management.
b. Client will not be able to have a vaginal birth.
c. A planned birth will be instituted by her health care provider.
d. It is likely that she will deliver a fetus who is small for gestational age (SGA).
ANS: C
Because of the presence of diabetes as a concurrent disease, the client will be closely monitored and a planned birth will be instituted to improve health outcomes for mother and fetus. Epidurals can be administered to obstetric clients who are diabetics. Although there is an increased risk for macrosomia and dystocia, the client will be prospectively managed and may still be able to have a vaginal birth. Because of the presence of diabetes as a concurrent disease, it is more likely that she will deliver a macrosomic infant who would be large for gestational age (LGA).
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