Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for:

Choice A reason: Cerebral compression is the cause of early decelerations, as it reflects the fetal head compression during uterine contractions. Early decelerations are decreases in the FHR that begin and end with the onset and end of a contraction, respectively. They are symmetrical and mirror the shape of the contraction. Early decelerations are normal and benign, as they indicate that the fetus is responding to the increased intracranial pressure and maintaining adequate oxygenation.

Choice B reason: Cord compression is not the cause of early decelerations but of variable decelerations. Variable decelerations are abrupt and irregular decreases in the FHR that vary in onset, duration, and depth. They are usually caused by the umbilical cord being compressed or occluded by the fetal body, the maternal pelvis, or the uterine contractions. Variable decelerations can indicate fetal distress or hypoxia, especially if they are severe, frequent, or prolonged.

Choice C reason: Uteroplacental insufficiency is not the cause of early decelerations, but of late decelerations. Late decelerations are decreases in the FHR that begin after the peak of a contraction and return to the baseline after the contraction ends. They are symmetrical and have a gradual onset and recovery. They are usually caused by the reduced blood flow and oxygen delivery to the placenta and the fetus due to maternal or fetal factors. Late decelerations can indicate fetal distress or hypoxia, and require immediate intervention.

Choice D reason: Spontaneous rupture of membranes is not the cause of early decelerations, but it can be a risk factor for cord compression and variable decelerations. Spontaneous rupture of membranes is the breaking of the amniotic sac and the release of the amniotic fluid, which usually occurs during labor or shortly before it. Spontaneous rupture of membranes can cause the umbilical cord to prolapse or slip into the vagina, where it can be compressed or kinked by the fetal head or the contractions.

Choice A reason: Limiting fluid intake throughout the day is not recommended, as dehydration can worsen nausea and vomiting. Instead, pregnant women should sip fluids gradually throughout the day to maintain hydration. Proper hydration supports digestion and helps prevent complications like electrolyte imbalances. Clinical guidelines emphasize the importance of maintaining adequate fluid intake during pregnancy

Choice B reason: Drinking a glass of water with a fat-free carbohydrate before getting out of bed in the morning is a good strategy to prevent nausea and vomiting, as it can stabilize the blood sugar level and prevent an empty stomach. However, it is not the best answer, as it does not address the dietary needs throughout the day.

Choice C reason: Increasing the intake of high-fat foods is not recommended, as it can worsen nausea and vomiting. High-fat foods are harder to digest and can cause gastric irritation and reflux. The pregnant woman should choose low-fat, bland, and easy-to-digest foods.

Choice D reason: Eating small, frequent meals every 2 to 3 hours is the best approach to managing nausea and vomiting during pregnancy. This strategy helps stabilize blood sugar levels and prevents the stomach from becoming too empty or too full, both of which can trigger nausea. Clinical guidelines widely support this dietary adjustment as a primary intervention for nausea and vomiting in pregnancy