A client who is now a G6 P6006 is 15 minutes postpartum from a normal vaginal delivery. The newborn weighed 10 lbs 13 ounces (4595 grams) at birth. Which of the following complications should the nurse monitor for in this client?

A macrosomic infant, weighing over 4000 grams (8 lbs 13 oz), significantly stretches the uterine muscles, leading to a diminished ability to contract effectively after birth. This uterine atony is the primary cause of postpartum hemorrhage. The uterus fails to clamp down on the blood vessels at the placental site, resulting in continuous bleeding. The client’s G6 status further increases this risk due to repeated uterine stretching. Choice B rationale Thrombosis is a risk in the postpartum period due to hypercoagulability and venous stasis, but it is not the primary complication associated with a macrosomic infant and high parity. The most immediate and significant risk following this type of delivery is the uterus's inability to contract properly, leading to uncontrolled bleeding. While thrombosis is a concern, it is a secondary risk compared to hemorrhage. Choice C rationale Postpartum seizures, also known as eclampsia, are typically associated with preeclampsia and hypertension, not specifically with macrosomic infants or high parity. While a client may have other risk factors for seizures, a large infant and multiparity do not directly cause them. The primary and most immediate physiological risk is the inability of the uterus to involute and stop bleeding. Choice D rationale While infection is a risk following any delivery, especially if there are lacerations or a prolonged rupture of membranes, it is not the immediate or most significant complication related to a macrosomic infant. The overwhelming primary concern in this specific scenario is the uterine atony caused by the large infant and multiple pregnancies, which predisposes the client to hemorrhage.