A primigravida with a history of no prenatal care delivers a normal neonate by sterile vaginal delivery with no complications. The practical nurse (PN) enters the room with an injection of Rho immune globulin and explains the rationale for the injection.
Which situation warrants this injection?

Choice A rationale

While nausea can occur from analgesics used during labor, and solid foods might exacerbate it, this is not the primary or most critical reason for withholding them. The major concern is related to potential aspiration during anesthesia or an emergency. Analgesics can also cause gastric stasis, but the aspiration risk remains paramount.

Choice B rationale

If general anesthesia becomes necessary during labor, the risk of pulmonary aspiration of gastric contents is significantly increased due to delayed gastric emptying and relaxation of the gastroesophageal sphincter. Aspiration pneumonitis can lead to severe respiratory complications. Therefore, withholding solid foods minimizes this critical risk.

Choice C rationale

Gastric emptying time actually increases during labor, meaning food remains in the stomach for a longer duration. This prolonged retention of gastric contents heightens the risk of aspiration if the client requires general anesthesia or experiences emesis. Reduced peristalsis contributes to this extended emptying time.

Choice D rationale

Autonomic nervous system stimulation, specifically sympathetic activation, during labor leads to a decrease in gastrointestinal motility and peristalsis. This physiological response contributes to delayed gastric emptying, increasing the volume of gastric contents and subsequently elevating the risk of aspiration.

Choice A rationale

Applying a cold pack to the perineum after a vaginal delivery effectively reduces localized edema and inflammation. Cold therapy causes vasoconstriction, which decreases blood flow to the area, thereby minimizing fluid extravasation into the interstitial spaces and reducing swelling of the episiotomy site.

Choice B rationale

While cold packs do provide a degree of comfort by numbing nerve endings and reducing pain signals, their primary physiological benefit in the postpartum period is the reduction of swelling and inflammation, which indirectly contributes to comfort. Comfort is a secondary effect.

Choice C rationale

The statement is incorrect. Cold therapy is a recognized and effective intervention postpartum. While it may help reduce bruising by limiting subcutaneous bleeding, its most significant and immediate benefit relates to the reduction of swelling and pain.

Choice D rationale

While cold can induce vasoconstriction and thus potentially reduce bleeding, it is not the primary or most effective method for controlling significant postpartum hemorrhage. Fundal massage and uterotonics are the primary interventions for controlling postpartum bleeding.