A client at 31 weeks gestation is admitted in preterm labor.
Which medication would the nurse provide education for?

Choice A rationale

Rho(D) immune globulin, or RhoGAM, is an exogenous preparation of anti-D antibodies that bind to any fetal Rh-positive red blood cells that enter the maternal circulation, effectively clearing them before the mother's immune system recognizes the D antigen and mounts an immune response. This prevents sensitization, allowing the woman to have unlimited subsequent Rh-positive children without the risk of developing hemolytic disease of the fetus and newborn (HDFN).

Choice B rationale

The recommendation is not limited to only two children if Rho(D) immune globulin is administered correctly. The medication provides passive immunity to prevent the mother from producing her own anti-D antibodies, which are the cause of HDFN in subsequent Rh-positive fetuses. Administration within 72 hours postpartum and often prophylactically around 28 weeks gestation is standard practice.

Choice C rationale

If Rh sensitization has occurred in a prior pregnancy or due to other exposure and Rho(D) immune globulin was not given, the mother's immune system will have produced anti-D antibodies. These immunoglobulin G (IgG) antibodies can cross the placenta and affect all subsequent Rh-positive fetuses, not just the next one, potentially causing fetal hemolysis and severe anemia.

Choice D rationale

Hemolytic disease of the fetus and newborn (HDFN) is determined by the fetal Rh status, specifically the presence of the D antigen on the fetal red blood cells, which is an autosomal dominant trait. The sex of the fetus (male or female) is genetically unrelated to the inheritance of the Rh factor and does not influence the severity or occurrence of the Rh incompatibility reaction.

Choice A rationale

Postpartum hemorrhage (PPH) is a significant risk for this client due to several factors including a macrosomic neonate (birth weight >4000 grams), which causes overdistention of the uterus. Uterine overdistention stretches the muscle fibers, impairing the uterus's ability to contract effectively (uterine atony) after birth, which is the leading cause of PPH (normal blood loss range: ≤ 500 mL for vaginal birth).

Choice B rationale

A rapid labor (4 hours) and the birth of a macrosomic neonate (4200 grams) increase the risk of vaginal lacerations and tears to the soft tissues of the birth canal. The rapid passage of a large fetal head/shoulder diameter can cause uncontrolled and forceful tearing, often extending into the perineal musculature, leading to potential complications and excessive blood loss.

Choice C rationale

Uterine inversion, the collapse of the fundus into the endometrial cavity, is a rare but severe complication. While associated with factors like aggressive cord traction or fundal pressure, this client's history of macrosomia and rapid labor primarily increases the risk for uterine atony and lacerations, making inversion a much less likely, though possible, complication.

Choice D rationale

Postpartum hypertension (PHTN) is generally related to a history of pre-eclampsia or chronic hypertension. This client's presentation of macrosomia and rapid labor primarily increases the risk for mechanical/anatomical complications like uterine atony and lacerations rather than a primary vasospastic or systemic vascular disorder such as PHTN.