Effects of Maternal

and Infant Blood

Types
Rh Isoimmunization

Rh Isoimmunization
Mom is Rh-negative
Baby is Rh-positive (antigens are foreign
to moms immune system)
Development of maternal antibodies in
response to Rh-antigens

Mom is not affected

If sensitization occurs crosses the
placenta may affect the baby (and
subsequent pregnancies)

Rh Immune Globulin:
Rh Immune globulin (RhIG or Rhogam) is a
concentrated solution of IgG and anti-D derived from
human plasma.
Indications
Dosage

RhoGam Workup
Alternate Name
Test includes:
Mother

Rh (D) Immune Globulin Human

ABO and Rh
Indirect Coombs

Baby

ABO and Rh
Direct Coombs

Timing:

Specimen collected AFTER delivery.

Testing and administration of RhoGam
should be within 72 hours of delivery

Expected Results:

Coombs Negative (< 15 ml fetal RBCs)

Then 300 mcg IM given

What if results are positive:

(> 15 ml fetal RBCs)

Kleihauer-Betke test will be done to

determine the dose of RhoGam to be
administered

Rhogam Nursing
Interventions
Patient teaching
Consent form (if required by agency)
Confirm dose and lot number (blood
product)
Observe 20 minutes allergic
response

Rubella vaccine
Rubella non-immune (10-20%)
Titer of 1:8
Enzyme immunoassay level (EIA) less than 0.8
Rubella recommended during PP period
Given SQ
O.K. with breastfeeding
Live virus
Caution with members of household who are
immunocompromised
Viral shedding in urine and body fluids
Contraception for 1 month after vaccine (birth
defects)

Postpartum
Discomfort

Postpartum Discomfort
#1 Priority identify and treat the cause
Afterbirth pains
Episiotomy or lacerations
Hemorrhoids

Postpartum Discomfort
Nonpharmacologic Interventions

Side lying
Pillow with sitting
Application of ice
Topical (as ordered)
Dry heat
Cleansing with squeeze
bottle, cleansing shower
or sitz baths
Witch hazel pads
(hemorrhoids)

Pharmacologic Interventions

Opioids
Morphine
Percocet
Percodan

Nonopioid
Tylenol, Ibuprofen

NSAIDS
Naproxen, Anaprox

Topical antiseptic or
anesthetic ointments
and/or sprays
PCA (C-section)

Psychological assessment
Taking

in

Taking hold

Letting go
Table 20-4, page 516

Postpartum blues
Postpartum depression
Box 21-4, page 547

Breastfeeding
Commitment
Positioning and latching
Early hunger cues
Late hunger cues

Frequency
Early and often
Increase # of receptor sites

Aids to BF
Pillows, nipple shields, breast cream
Breast pumps
Bras and clothing

Breast milk Storage

Containers
Temperature

Refrigerator vs. Freezer

Patient Teaching, page 650

Breastfeeding
Contraindications

Infants with galactosemia

Active, untreated TB in mother
Maternal HIV
Maternal human T-cell lymphotropic virus type I or II
positive
Moms who are receiving diagnostic or therapeutic
radioactive isotopes pump and dump (for as long as
there is radioactivity in the milk)
Moms with herpes lesions on the breast
Moms receiving chemotherapy
Moms who are abusing street drugs

Medications & Breastfeeding

Lactation Risk Categories

L1 safest
L2 safer
L3 moderately safe
L4 potentially hazardous
L5 - contraindicated

FDA Categories

A
B
C
D
X

Table 21-1, page 547 Antidepressant Medications

Bottlefeeding
Equipment
Bottles, nipples, sterilizing equipment
Type of formula
Regular, soy, special-needs
Heating sources
Suppression of lactation
Ace wrap/tight fitting bra
Cold packs
NSAIDS

Postpartum Discharge
Before 24 hours
Shortens hospital stay for low risk births
Reduces health care costs
Less medical intervention and more family-focused
experience
Newborns and Mothers Health Protection Act of 1996
48 hours
96 hours

Patient Teaching
Signs/Symptoms call MD/CNM

Fever
Breasts
Bleeding
Pain
Edema
Neurologic
Emotional
Elimination

End of Content for Exam II