A woman has given birth at 42 weeks gestation. When assessing the neonate which physical finding is expected?

WCL Staff Nurse - 2019

Obstetrics & Gynaecology

Medium

Appeared in: WCL Staff Nurse - 2019

Explanation

A neonate born at 42 weeks is defined as post-term.
A classic physical finding in post-term infants is desquamation, which is the peeling or shedding of the outer layer of the epidermis.
This skin change occurs because the protective vernix caseosa disappears after term, and prolonged exposure to amniotic fluid leads to drying and cracking of the skin.
The skin of a post-term infant is often described as dry, leathery, or parchment-like.

Option A: Post-term infants are often described as being wide-eyed and alert. While lethargy can occur due to complications like hypoglycemia, it is not a primary expected characteristic of post-maturity itself.
Option B: Lanugo is the fine, downy hair that is most abundant on preterm infants. It progressively disappears as the fetus approaches term, so it would be minimal or absent in a post-term infant.
Option D: Vernix caseosa is a waxy, protective substance that is abundant on preterm infants. Its amount decreases significantly by term and is scant or absent in post-term infants.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Physical assessment findings in a post-term neonate as background academic context rather than a clinical decision trigger.
Nurses must perform a thorough gestational age assessment to identify post-term infants, as they are at an increased risk for several complications.
Key nursing assessments for a post-term neonate include monitoring blood glucose for hypoglycemia (due to depleted glycogen stores), observing for respiratory distress (from potential meconium aspiration), and maintaining thermoregulation (as they have less subcutaneous fat).
What if? If the neonate was born at 36 weeks gestation (late preterm), the nurse would expect to find some lanugo (especially on the shoulders and back) and a moderate amount of vernix caseosa, with less prominent skin peeling.

How to Approach the Question

First, identify the key information in the question stem: the neonate is born at '42 weeks gestation' and the question asks for an 'expected physical finding'.
Recognize that a gestation of 42 weeks or more defines the infant as post-term.
Recall the classic physical characteristics of a post-term infant, particularly how they differ from term and preterm infants.
Systematically evaluate each option against your knowledge of post-maturity:
Sleepy/lethargic: Unlikely, as they are often alert.
Lanugo: Incorrect, this is a feature of prematurity.

Concept Tested & Keywords

Concept Tested: Physical assessment findings in a post-term neonate
Stem keywords: 42 weeks gestation, neonate, physical finding
Lead-in keywords: expected
Clinical cues: Gestation of 42 weeks indicates a post-term pregnancy, which has specific associated physical findings and risks for the neonate.
Negative lead-in flag: false

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1057-1059

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 6-11

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 2790-2792