The patient has undergone an ultrasound, which estimated fetal weight at 4,500 g (9 pounds, 14 ounces). Which statement indicates that additional teaching is needed? "Because my baby is big:
1. "I am at risk for excessive bleeding after delivery."
2. "His blood sugars could be high after he is born."
3. "My perineum could experience trauma during the birth."
4. "His shoulders could get stuck and a collar bone broken."
Correct Answer: 2
Rationale 1: Because of the excessive size of the uterus with a macrosomic fetus, uterine atony leading to postpartum hemorrhage is a risk.
Rationale 2: Hypoglycemia, not hyperglycemia, is a potential complication experienced by a macrosomic fetus.
Rationale 3: Perineal trauma due to the large fetus is a possible complication of vaginal delivery of a macrosomic fetus.
Rationale 4: Shoulder dystocia is more common among large fetuses, and a broken clavicle could result.
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