A nurse is assisting in the care of a client who is in the second stage of labor.
Which of the following findings should the nurse report to the provider?

Choice A rationale:

Uterine atony is the most common cause of postpartum hemorrhage, and it is characterized by a lack of uterine muscle tone,

which leads to excessive bleeding after delivery.

A macrosomic newborn (weighing over 4000 g) is a significant risk factor for uterine atony because the overdistention of the

uterus during pregnancy can impair its ability to contract effectively after delivery.

Other risk factors for uterine atony include prolonged labor, multiple gestations, rapid labor, use of oxytocin or magnesium

sulfate during labor, and a history of uterine atony in previous deliveries.

It's crucial for a nurse to closely monitor clients with these risk factors for signs of uterine atony, such as excessive vaginal

bleeding, a soft and boggy uterus, and a rising fundus.

Prompt recognition and management of uterine atony are essential to prevent life-threatening hemorrhage.

Choice B rationale:

Retained placental fragments can also contribute to postpartum hemorrhage; however, they are not as strongly associated

with macrosomia as uterine atony.

Risk factors for retained placental fragments include premature separation of the placenta, placenta accreta, and manual

removal of the placenta.

Choice C rationale:

Thrombophlebitis, a blood clot formation in a vein, is a postpartum complication, but it's not directly related to macrosomia.

Risk factors for thrombophlebitis include venous stasis, hypercoagulability, and trauma to the veins, such as from prolonged

bed rest or cesarean delivery.

Choice D rationale:

Perineal infection is also a potential postpartum complication, but it's not specifically linked to macrosomia.

Risk factors for perineal infection include perineal lacerations, episiotomy, and poor hygiene.

Choice A rationale:

Rh positive individuals already have the Rh factor on their red blood cells, so they do not need Rho(D) immune globulin to

prevent sensitization.

The newborn being Rh positive does not pose a risk to an Rh positive mother, as their blood types are compatible.

Choice B rationale:

Rh positive individuals cannot develop antibodies against the Rh factor, as it is already present on their own red blood cells.

The newborn's Rh negative status does not create a risk of sensitization for the mother, as there is no Rh factor to trigger an

immune response.

Choice C rationale:

If both the mother and the newborn are Rh negative, there is no risk of Rh incompatibility.

This is because neither individual has the Rh factor on their red blood cells, so there is no potential for sensitization.

Choice D rationale:

When an Rh negative mother carries an Rh positive fetus, there is a risk of Rh sensitization during pregnancy and delivery.

This occurs when fetal blood cells cross the placenta and enter the mother's bloodstream, exposing her immune system to the

Rh factor.

If the mother's immune system recognizes the Rh factor as foreign, it can produce antibodies against it.

These antibodies can cross the placenta in subsequent pregnancies and attack the red blood cells of Rh positive fetuses,

leading to hemolytic disease of the newborn (HDN).

Rho(D) immune globulin is a medication that can prevent Rh sensitization by binding to Rh positive fetal blood cells that have

entered the mother's bloodstream.

This prevents the mother's immune system from recognizing the Rh factor and producing antibodies.

Rho(D) immune globulin is typically given to Rh negative mothers within 72 hours of delivery of an Rh positive newborn, as well as after other events that could lead to Rh sensitization, such as miscarriage, abortion, or ectopic pregnancy.