A charge nurse is teaching a newly licensed nurse about Rho(D) immune globulin administration. Which of the following should the charge nurse include as an indication for the administration of Rho(D) immune globulin?

A client who has had two prior cesarean births is at an increased risk for uterine rupture during labor. Uterine rupture is a serious complication in which there is a complete or partial tear in the uterine wall, potentially leading to significant maternal and fetal morbidity or mortality.

The risk of uterine rupture increases with each prior cesarean birth due to the presence of a scar on the uterus. The scar tissue is weaker than the normal uterine tissue and can potentially rupture during contractions and labor. The risk of uterine rupture is particularly high if the client attempts a vaginal birth after cesarean (VBAC).

Option a) Precipitous labor refers to an extremely fast labor that lasts less than three hours from the onset of contractions to birth. While clients with prior cesarean births may be at increased risk for certain complications, such as uterine rupture, it does not necessarily increase the risk of precipitous labor.

Option b) Abruptio placentae is the premature separation of the placenta from the uterine wall before the birth of the baby. While it is a potential complication during pregnancy, it is not directly associated with prior cesarean births.

Option d) Failure to progress refers to a lack of cervical dilation or descent of the baby during labor. While prior cesarean births can increase the risk of certain labor complications, such as uterine rupture, they do not necessarily increase the risk of failure to progress.

Group B Streptococcus β-hemolytic (GBS) is a type of bacteria that can cause serious infections in newborns, such as sepsis, pneumonia, and meningitis. GBS can be transmitted from the mother to the baby during labor and delivery if the mother is colonized with GBS in her vagina or rectum¹.
To prevent GBS infection in newborns, pregnant women who test positive for GBS or have risk factors for GBS should receive intravenous (IV) antibiotics during labor. The antibiotics can reduce the amount of GBS bacteria in the mother's body and lower the chance of passing them to the baby¹².
The recommended antibiotic for GBS prophylaxis is penicillin, which is safe and effective for most women. However, some women may be allergic to penicillin and need an alternative antibiotic. Ampicillin is one of the alternative antibiotics that can be used for GBS prophylaxis in women who have a mild allergy to penicillin (such as rash or itching). Ampicillin is also a type of penicillin, but it has a slightly different structure and may not cause an allergic reaction in some people²³.
Therefore, the nurse should plan to administer ampicillin to the client who tested positive for GBS and has a mild allergy to penicillin. The nurse should also monitor the client for any signs of anaphylaxis (a severe allergic reaction) and have epinephrine ready in case of emergency²³.

The other options are not medications that the nurse should administer to the client:
- a) Cefotetan is another alternative antibiotic that can be used for GBS prophylaxis in women who have a severe allergy to penicillin (such as anaphylaxis or angioedema). However, it is not indicated for women who have a mild allergy to penicillin, as it may still cause cross-reactivity and an allergic reaction²³.
- b) Fluconazole is an antifungal medication that is used to treat fungal infections, such as candidiasis (thrush) or cryptococcal meningitis. It is not effective against bacterial infections, such as GBS, and it is not indicated for GBS prophylaxis⁴.
- d) Doxycycline is an antibiotic that is used to treat bacterial infections, such as chlamydia, gonorrhea, or Lyme disease. It is not effective against GBS and it is not indicated for GBS prophylaxis. Moreover, doxycycline is contraindicated in pregnancy, as it can cause harm to the fetus, such as tooth discoloration or bone growth problems.