Rho immune globulin (Rhogam) will be ordered postpartum if which situation occurs?

A) Manual Expression:
Manual expression is an excellent way to show a new mother that she does have milk or colostrum. By gently massaging and expressing the breast, the mother can see or feel the small amount of colostrum being released. This helps reassure her that milk production has begun, even if it’s not abundant right away. Colostrum is often produced in small amounts during the first few days postpartum, and learning how to express it can provide immediate visual confirmation that milk is available for the baby.

B) Massaging breast to bring milk to the nipple:
While massaging the breast can help facilitate the milk ejection reflex (let-down), it doesn’t necessarily show the mother that she has milk. The milk flow may not be immediately visible without manual expression. The process of massaging can help increase milk flow over time but is not the most effective way to demonstrate the presence of colostrum in the immediate postpartum period.

C) Using a nipple shield:
A nipple shield can sometimes be used to help babies latch more effectively if there are latch issues, but it won’t directly show the mother that she has milk or colostrum. In fact, frequent use of a nipple shield without proper latching technique can interfere with establishing breastfeeding. It’s more important to help the mother with proper latching and positioning, along with demonstrating manual expression.

D) Keeping infant skin to skin:
Skin-to-skin contact is incredibly beneficial for bonding and promoting breastfeeding, as it stimulates the release of oxytocin and encourages the baby to latch. However, it does not directly show the mother that she has milk or colostrum. While it can help initiate milk production, manual expression provides a more direct and immediate way to demonstrate that milk is available.

A) Intracostal retractions:
Intracostal retractions indicate respiratory distress in the newborn and should be reported immediately to the neonatologist. Retractions occur when the muscles between the ribs (intercostal muscles) are drawn in with each breath, signifying increased effort to breathe. This could indicate a serious condition such as respiratory distress syndrome (RDS), pneumonia, or other respiratory compromise. This finding requires urgent assessment and potential intervention to ensure the neonate is receiving adequate oxygenation.

B) Caput succedaneum:
Caput succedaneum is a common and benign finding in newborns, especially after a vaginal delivery. It refers to a swelling of the soft tissue on the baby's head, often seen after prolonged labor or use of forceps during delivery. This condition is typically resolves on its own within a few days and does not require immediate intervention or reporting to the neonatologist.

C) Positive Babinski sign:
A positive Babinski sign (fanning of the toes when the sole is stroked) is a normal reflex in neonates and is expected up to about 2 years of age. It is part of the newborn's neurological development and indicates the functioning of the central nervous system. Therefore, this finding does not require reporting to the neonatologist.

D) Pink-tinged urine in the diaper:
Pink-tinged urine, also known as "brick dust" or uric acid crystals, is a common finding in the first few days of life. It is typically harmless and results from concentrated urine or from the breakdown of urates. It usually resolves as the newborn begins to consume more fluids and the urine becomes more diluted. This finding does not necessitate immediate reporting unless it persists or is associated with other symptoms.