Which of the following findings should the nurse expect for a newborn who has neonatal abstinence syndrome? (Select all that apply)

Choice A reason: Stating that rubella vaccination prevents breastfeeding is incorrect. The rubella vaccine, a live-attenuated virus, is safe for postpartum administration in non-immune mothers, as it does not significantly excrete in breast milk or harm the infant. Breastfeeding supports neonatal immunity through maternal antibodies, and this statement misrepresents vaccine safety and breastfeeding physiology.

Choice B reason: Repeating a rubella titer in the third trimester is unnecessary unless new exposure is suspected. A titer of 1:8 indicates susceptibility, requiring postpartum immunization, not repeated testing. Serological testing monitors antibody levels, but rubella immunity status typically remains stable during pregnancy unless infection occurs, making routine retesting scientifically unjustified in this context.

Choice C reason: Administering rubella immunization during pregnancy is contraindicated, as it is a live vaccine that poses a theoretical risk to the fetus. A titer of 1:8 indicates susceptibility, warranting postpartum vaccination. The immune system’s response to live vaccines could potentially cross the placenta, affecting fetal development, so immunization is deferred until after delivery.

Choice D reason: A rubella titer of 1:8 indicates susceptibility, as titers below 1:10 suggest insufficient antibodies to confer immunity. Rubella infection during pregnancy can cause congenital rubella syndrome, leading to fetal anomalies. This statement accurately reflects the need for postpartum immunization to protect future pregnancies, aligning with serological evidence and prenatal care guidelines.

Choice A reason: A newborn weight of 2.948 kg is normal and not a risk factor for postpartum hemorrhage. Large-for-gestational-age infants (>4 kg) increase uterine overdistension, impairing contraction and causing bleeding. This weight does not strain uterine muscle tone, maintaining normal postpartum hemostasis, per obstetric physiology.

Choice B reason: Uterine atony, failure of the uterus to contract post-delivery, is a major cause of postpartum hemorrhage. Ineffective contractions prevent hemostasis at placental separation sites, leading to excessive bleeding. Myometrial fatigue or previous atony increases risk, as poor uterine tone disrupts clotting cascades, necessitating vigilant monitoring and oxytocic intervention.

Choice C reason: Vacuum-assisted delivery increases postpartum hemorrhage risk due to potential uterine or cervical trauma. Instrumentation can cause lacerations or hematomas, disrupting hemostasis. Tissue trauma triggers local bleeding, and prolonged labor may weaken uterine contractions, impairing clot formation at the placental site, per obstetric complication studies.

Choice D reason: History of human papillomavirus (HPV) does not increase postpartum hemorrhage risk, as it affects cervical epithelium, not uterine contractility or hemostasis. HPV is linked to cervical cancer, not obstetric complications. Postpartum bleeding stems from uterine or traumatic factors, making HPV irrelevant to hemorrhage pathophysiology in the postpartum period.

Choice E reason: Labor induction with oxytocin increases postpartum hemorrhage risk, as prolonged exposure may desensitize myometrial receptors, leading to uterine atony. Ineffective contractions post-delivery impair hemostasis at the placental site, causing bleeding. Oxytocin’s effect on uterine muscle tone requires careful monitoring to prevent excessive blood loss, per obstetric pharmacology.