A client at 43 week's gestation has just given birth to an infant with typical postmaturity characteristics. Which signs of postmaturity would the nurse identify? Select all that apply.

Choice A rationale Increased lanugo is characteristic of a preterm infant, not a postmature infant. Lanugo is fine, downy hair that develops during gestation and typically begins to thin and disappear closer to term, especially after 37 weeks. A postmature infant, born after 42 weeks, would characteristically show a decrease in lanugo or be completely bald as the pregnancy progresses past term. Choice B rationale Vernix caseosa, the white, cheesy protective covering, typically begins to diminish around 40 weeks gestation. A postmature infant (≥ 42 weeks) will often have very little or no vernix remaining, particularly in the creases. If present, it would be sparse, dry, and possibly only in the folds, not covering large areas like the back and buttocks. Choice C rationale A red, puffy appearance of the face and neck is commonly associated with a large-for-gestational-age infant or a fetus that experienced polycythemia or venous congestion, not a specific, typical characteristic of postmaturity resulting from placental aging. Postmaturity features primarily relate to skin, fat, nails, and muscle wasting. Choice D rationale Long scalp hair and fingernails are a common finding in a postmature infant. Continued growth of fetal appendages, such as the hair and nails, occurs throughout the prolonged gestation period, leading to noticeably long fingernails that may extend beyond the fingertips and abundant scalp hair. Choice E rationale Cracked and peeling skin is a classic sign of postmaturity. The lack of vernix caseosa combined with prolonged exposure to the amniotic fluid causes the skin to dry out, leading to a parchment-like appearance, cracking, and peeling, especially on the palms and soles. Choice F rationale Creases covering the neonate's full soles and palms are a sign of greater maturity and prolonged gestation. Term infants (38 to 42 weeks) have creases over two-thirds to the full sole, and a postmature infant (≥ 42 weeks) typically exhibits creases covering the entire sole and palm surface. Choice G rationale Decreased subcutaneous fat is a characteristic of postmaturity due to the aging placenta's reduced efficiency in nutrient and oxygen delivery. This often leads to chronic fetal hypoxia and malnutrition (wasting), resulting in a thin, emaciated appearance as the body utilizes fat stores. Choice H rationale Umbilical meconium staining is frequently seen in postmature infants. Post-term fetuses are at an increased risk for uteroplacental insufficiency, which can lead to fetal distress and subsequent passage of meconium into the amniotic fluid, staining the umbilical cord, skin, and nails yellow-green.