Rh, immune globulin will be ordered after birth if which situation occurs?

A. Excessive uterine bleeding:
Bladder distention can displace the uterus to the right and elevate it above the umbilicus, interfering with uterine contraction. This displacement prevents the uterus from contracting effectively, which can lead to excessive uterine bleeding, a serious complication. When the uterus does not contract properly, it may not effectively compress the blood vessels, increasing the risk of hemorrhage. Immediate attention to bladder distention is crucial to prevent this potentially life-threatening issue.

B. Urinary tract infection:
While urinary tract infections (UTIs) can occur in the postpartum period, especially if the bladder is not emptied completely, they are not the most immediate or serious consequence of bladder distention. The priority is to address the distended bladder to prevent complications like excessive bleeding. A UTI would be a concern later, but it would not be the most acute risk following delivery.

C. Ruptured bladder:
A ruptured bladder is a rare and severe complication but is not the most likely consequence of bladder distention in the immediate postpartum period. Bladder rupture typically occurs due to significant trauma or extreme distention, which is not common in this situation. The more immediate concern is uterine atony and hemorrhage due to displaced uterine tone from bladder distention.

D. Bladder wall atony:
Bladder wall atony could result from severe bladder distention, causing difficulty in voiding. However, this is not the most serious consequence immediately after birth. Bladder distention typically results in impaired uterine contraction, which causes bleeding rather than atony of the bladder wall itself. Addressing bladder distention will help prevent complications such as hemorrhage rather than focusing on bladder atony initially.

The Apgar score is calculated based on five criteria, each scored from 0 to 2:

1. Heart rate

   • 0 = Absent
   • 1 = Below 100 beats per minute ✅
   • 2 = 100 or more beats per minute

2. Respiratory effort

   • 0 = Absent
   • 1 = Slow, irregular ✅
   • 2 = Good, crying

3. Muscle tone

   • 0 = Limp
   • 1 = Some flexion of extremities ✅
   • 2 = Active motion

4. Reflex irritability (response to stimulation, e.g., suctioning)

   • 0 = No response
   • 1 = Grimace ✅
   • 2 = Crying, active withdrawal

5. Color

   • 0 = Blue, pale
   • 1 = Body pink, extremities blue
   • 2 = Completely pink

Apgar Score Calculation:

• Heart rate: 1
• Respiratory effort: 1
• Muscle tone: 1
• Reflex irritability: 1
• Color: 0

Total Apgar Score: 4

A score of 4 suggests the newborn is in distress and requires immediate medical intervention, such as oxygen support and further assessment.