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

A. Suction the nose with a bulb syringe: While clearing nasal secretions is important, suctioning the mouth takes priority over the nose. Stimulating the nares before clearing the oral airway can cause aspiration if secretions are present in the mouth, especially in newborns with underdeveloped airway protective reflexes.

B. Use a suction catheter with low negative pressure: Suction catheters are typically reserved for cases requiring deeper or more controlled suctioning, such as in NICU settings. For routine post-delivery care, a bulb syringe is the safest and most effective tool to clear the newborn’s airway without risking trauma or excessive negative pressure.

C. Suction the mouth with a bulb syringe: Clearing the mouth first is the priority to prevent aspiration and ensure an open airway. Bulb syringe suctioning is gentle and effective for removing excess mucus or amniotic fluid from the oropharynx, facilitating spontaneous breathing and reducing respiratory distress in the immediate newborn period.

D. Turn the newborn on his side: Positioning the newborn on their side may aid in drainage of secretions, but it is not sufficient as a first action when secretions are visibly bubbling from the nose and mouth. Active suctioning is necessary to clear the airway and prevent obstruction or aspiration as the first step and the head should be placed in a sniffing position rather than turning.

A. Femur: The femur is not typically involved in birth-related trauma during shoulder dystocia. This long bone is located in the thigh and is relatively well protected during delivery, making it an unlikely site for injury in this context.

B. Humerus: While the humerus can occasionally be fractured during difficult deliveries, especially if excessive traction is applied, it is less commonly injured than the clavicle during shoulder dystocia. Fractures of the humerus are usually secondary to more forceful maneuvers or malpositioning.

C. Clavicle: During shoulder dystocia, the baby's anterior shoulder gets stuck behind the mother's pubic bone. The clavicle is the most commonly fractured bone. Fracture can occur as a natural mechanism to reduce shoulder width or may result from delivery maneuvers, and it often facilitates passage of the shoulder through the birth canal.

D. Skull: Skull fractures are rare in shoulder dystocia because the head is typically already delivered by the time the dystocia is recognized. Skull fractures are more often associated with instrumental deliveries or cephalopelvic disproportion rather than shoulder entrapment.