A nurse is assisting with the admission of a client who is at 10 weeks of gestation and reports abdominal pain and moderate vaginal bleeding.

Incomplete abortion is the initial diagnosis.

Which of the following actions should the nurse contribute to the client’s plan of care?

Choice A rationale:

Placenta previa is a condition in which the placenta covers all or part of the cervix. It's a serious complication that can cause heavy bleeding during pregnancy and childbirth. However, it's not a direct complication of maternal gestational diabetes.

Choice B rationale:

Newborn hypoglycemia is a condition in which a newborn's blood sugar levels are too low. It can occur in infants of mothers with gestational diabetes, but it's not the most common or significant complication associated with the condition.

Choice C rationale:

Oligohydramnios is a condition characterized by a low amount of amniotic fluid around the baby. It can be associated with maternal gestational diabetes, but it's not as common as other complications, such as macrosomia (large for gestational age baby).

Choice D rationale:

Small for gestational age (SGA) newborn refers to a baby who is smaller than expected for their gestational age. It can be caused by several factors, including restricted intrauterine growth, which can be associated with maternal gestational diabetes. However, it's not the most direct or common complication of the condition.

Choice E rationale:

Maternal gestational diabetes is a condition in which a woman develops high blood sugar levels during pregnancy. It's the most common metabolic complication of pregnancy and can lead to several serious health risks for both the mother and baby. These risks include:

Macrosomia (large for gestational age baby): High blood sugar levels in the mother can cause the baby to grow excessively large, leading to complications during labor and delivery, such as shoulder dystocia, birth injuries, and cesarean delivery. Preeclampsia: Gestational diabetes increases the risk of preeclampsia, a serious condition characterized by high blood pressure and protein in the urine. It can affect multiple organs, including the liver and kidneys, and can be life-threatening for both mother and baby.

Premature birth: Women with gestational diabetes are more likely to deliver their babies prematurely, which can lead to health problems for the baby, such as respiratory distress syndrome, feeding difficulties, and developmental delays.

Neonatal hypoglycemia: Newborns of mothers with gestational diabetes are at increased risk of hypoglycemia (low blood sugar) after birth due to the sudden withdrawal of maternal glucose supply. This can cause seizures, brain damage, and even death if not promptly treated.

Type 2 diabetes later in life: Both mother and child are at increased risk of developing type 2 diabetes later in life.

The correct answer is choice b. Placenta previa.

Choice A rationale:

Threatened abortion typically occurs in the first trimester and involves vaginal bleeding with or without abdominal pain. It is not associated with late pregnancy bleeding.

Choice B rationale:

Placenta previa is characterized by painless, bright red vaginal bleeding in the third trimester. It occurs when the placenta covers the cervix, leading to bleeding as the cervix begins to dilate.

Choice C rationale:

Preterm labor involves uterine contractions leading to cervical changes before 37 weeks of gestation. While it can cause bleeding, it is usually accompanied by regular contractions and not typically described as bright red bleeding.

Choice D rationale:

Abruptio placentae involves the premature separation of the placenta from the uterine wall, leading to painful, dark red vaginal bleeding. It is often associated with abdominal pain and uterine tenderness, which differentiates it from placenta previa.