Spontaneous Vaginal Delivery Paper

Group B. Postpartum:

Susan P. had a SVD (spontaneous vaginal delivery) today approximately 2 hours ago. The labor and delivery nurse is calling to give you report. She is new and not sure what you want to know from her.

What questions do you need to ask to provide comprehensive care to this patient once she is transferred into your care? Refer to the BUBBLEHE Assessment. Spontaneous Vaginal Delivery Paper

Note that you discover that Susan is Rh negative, her baby is Rh positive. What now?

Please discuss Rhogam. The drug, the need, the route, the risk.

When must you give this and under what circumstances will you give this injection?

Please also recall any other reason Rhogam would be given, and when.

You must have a reference and one in text citation

To give a clear report on the patient after a spontaneous vaginal delivery, I will use the BUBBLEHE assessment. I will begin with assessing her breast by asking her to palpate her breasts and ask her whether they feel soft or harder that the previous day. If there is a change, then her breasts have started to produce milk. I will also ask her whether she is experiencing any pain or tenderness in her breasts. Spontaneous Vaginal Delivery Paper

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            To assess her uterus, I will ask her to hold the bottom of the uterus and tell me whether it feels larger or soft than normal. If it feels larger than normal, it means there are clots developing in the uterus. I will then asses he bladder for any signs of infection by asking her if she feels burning, frequency, foul smell in the urine and retention of urine during urination

I will ask asked her whether her bowel is soft or hard to look for the presence of the BS q shift in the bowel.  To assess Lochia, I will ask her when the last time she changed her pad was and how the bleeding has been like. Furthermore, I will assess her episiotomy by asking her to stay in a lateral Sims position and bend her upper knee, then gently her buttocks to expose the perineum. I will then inspect using REEDA (redness, edema, ecchmosis, drainage, approximation) to asses for hemorrhoids.

To assess the patient’s homan’s sign, I will position the patient legs flat in the bed and place my hand under her knee to support her and flex the foot towards the ankle.  I will ask the patient whether she feels some pain in the calf when she flexes either of the feet. Finally, I asses the patient’s emotional status by asking about her sleeping conditions; the number of hours she slept on the Day 1 and the rest she has taken. Spontaneous Vaginal Delivery Paper

If the newborn is Rh-positive and the mother is RH positive, there is a high possibility the child’s blood mixed with the mother’s blood giving her an RH factor, thus causing Rh incompatibility condition. The mother will be at great risk of infecting subsequent child if she gets pregnant with an Rh-positive baby (Vats & Watchko, 2019).  The mother’s antibodies damage the fetus red blood cells and the child is born with anemic and jaundice or the fetus is born dead.

Rhogam is a drug that is used to prevent Rh immunization; when and individual who is Rh-negative develops antibodies for Rh-positive after blood mixes. The drug is free for human plasma that contains anti-Rh.  The plasma is sourced from a single donor who is carefully screened. Rhogam is administered through intramuscular injection. The drug can pose risk to the patient by transmitting infectious agents from the donor.

I would give the rhogam injection when the new born is an Rh-positive and the mother is Rh-negative.    The injection will be offered in circumstances where the mother was not Rh-sensitized during late pregnancy (Eleje et al., 2017).  Another circumstance for Rhogam injection is when the mother has Rh-negative blood; the mother will be treated as though the baby’s blood is Rh-positive to be on a safe side.

References

Eleje, G. U., Ilika, C. P., & Ezeama, C. O. (2017). Feto-maternal outcomes of women with Rhesus iso-immunization in a Nigerian tertiary health care institution. J Preg Neonatal Med 2017; 1 (1): 21-27. 22 J Preg Neonatal Med 2017 Volume 1 Issue, 1(3).

Vats, K., & Watchko, J. F. (2019). Coordinating Care Across the Perinatal Continuum in Hemolytic Disease of the Fetus and Newborn: The Timely Handoff of a Positive Maternal Anti-Erythrocyte Antibody Screen. The Journal of pediatrics, 214, 212-216. Spontaneous Vaginal Delivery Paper