What is the first line medication for postpartum hemorrhage?

Choice A reason: Hypoglycemia is a low blood sugar level that can affect newborns, especially those who are premature, small for gestational age, or have diabetic mothers. However, hypoglycemia does not explain the high FHR, the low Apgar scores, or the pale and tachypneic appearance of the newborn.

Choice B reason: Phrenic nerve injury is a rare complication of cesarean section that can cause diaphragmatic paralysis and respiratory distress in the newborn. However, phrenic nerve injury usually affects only one side of the chest, and does not cause high FHR, low Apgar scores, or pallor.

Choice C reason: Sepsis is a serious infection that can affect newborns, especially those who are exposed to prolonged rupture of membranes, as in this case. Sepsis can cause high FHR, low Apgar scores, pale and tachypneic appearance, and other signs of shock and organ failure.

Choice D reason: Meconium aspiration syndrome is a condition where the newborn inhales meconium-stained amniotic fluid into the lungs, causing respiratory distress. However, meconium aspiration syndrome usually occurs in term or post-term infants, and is associated with low FHR, not high FHR. Meconium aspiration syndrome also causes cyanosis, not pallor.

Choice A reason: Increased risk of anemia is not a likely cause of respiratory distress in a term macrosomic newborn, as it can affect any newborn regardless of the maternal diabetes status or the fetal size. Anemia can cause pallor, tachycardia, and poor feeding, but not respiratory distress.

Choice B reason: Hyperinsulinemia is a likely cause of respiratory distress in a term macrosomic newborn, as it results from the fetal exposure to high maternal glucose levels and the subsequent overproduction of insulin. Hyperinsulinemia can impair the synthesis of surfactant, which is a substance that prevents the alveoli from collapsing and facilitates gas exchange. Hyperinsulinemia can also cause hypoglycemia, which can affect the respiratory center and cause apnea.

Choice C reason: Increased blood viscosity is not a likely cause of respiratory distress in a term macrosomic newborn, as it can affect any newborn with polycythemia, which is an abnormally high number of red blood cells. Polycythemia can cause cyanosis, jaundice, and thrombosis, but not respiratory distress.

Choice D reason: Brachial plexus injury is not a likely cause of respiratory distress in a term macrosomic newborn, as it affects the nerves that supply the arm and hand, not the lungs. Brachial plexus injury can occur due to the excessive traction or stretching of the shoulder during delivery, and can cause weakness, paralysis, or sensory loss in the affected arm.