Your postpartum patient is experiencing a hemorrhage. Vital signs are 156/94, heart rate 87, O2 saturation 95%. You increase the Pitocin drip wide open and prepare to give what medication to the patient next?

Choice A rationale

Gastric problems later in life are not an immediate concern for infants with myelomeningocele, as they often arise secondary to neurological impairments or medications but do not pose immediate life-threatening risks at birth.

Choice B rationale

Respiratory depression in infants with myelomeningocele is rare unless coexisting brainstem anomalies or complications from anesthesia are present, which are typically managed during medical interventions.

Choice C rationale

Decreased cardiac output is not a primary risk in infants with myelomeningocele unless there is a coexisting cardiac anomaly, which is not a routine feature of this congenital condition.

Choice D rationale

Infection is a critical immediate risk due to the open neural tube defect in myelomeningocele, which exposes the spinal cord and meninges to environmental pathogens, increasing the risk of meningitis or systemic infection.

Choice A rationale

Manually removing the placenta can introduce infection and cause uterine injury, which are not preventive measures for postpartum hemorrhage but treatments for retained placenta requiring sterile conditions and medical indication.

Choice B rationale

Administering antibiotics does not directly prevent postpartum hemorrhage, as it focuses on managing infections like endometritis. Hemorrhage prevention is better addressed by uterine tone management and avoiding excessive bleeding.

Choice C rationale

Applying pressure to the umbilical cord can lead to uterine inversion, worsening hemorrhage. Controlled cord traction during active management of the third stage is safer and reduces hemorrhage risk effectively.

Choice D rationale

Frequent urination prevents bladder distension, which enhances uterine contraction. A contracted uterus reduces hemorrhage risk by compressing blood vessels. Distended bladder inhibits proper uterine contraction, increasing hemorrhage likelihood.