- Involution
- Return of the uterus to its pre-pregnancy size after birth; the fundus descends about 1 cm (one fingerbreadth) per day.
- Lochia rubra
- Dark red postpartum discharge on days 1-3, made of blood, decidua, and trophoblastic debris. Small clots are normal.
- Lochia serosa
- Pinkish-brown postpartum discharge, about days 4-10, made of serous fluid, older blood, and leukocytes.
- Lochia alba
- Whitish-yellow postpartum discharge from about day 10 up to 2-6 weeks; leukocytes, mucus, and decidual cells.
- BUBBLE-HE
- Postpartum assessment mnemonic: Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy/perineum, Homans/lower extremities, Emotions.
- REEDA scale
- Perineal/episiotomy healing assessment: Redness, Edema, Ecchymosis, Discharge, Approximation of wound edges.
- Boggy fundus displaced to the right
- Sign of a full bladder preventing uterine contraction. Action: massage the fundus and have the woman empty her bladder.
- Rho(D) immune globulin (RhoGAM)
- Given within 72 hours to an Rh-negative, unsensitized mother of an Rh-positive infant to prevent isoimmunization. Prevents, cannot reverse, sensitization.
- Indirect Coombs (mother)
- Tests for maternal anti-Rh antibodies. NEGATIVE = unsensitized (give RhoGAM); POSITIVE = already sensitized (RhoGAM will not help).
- Lactogenesis II
- Onset of copious milk production around 2-5 days postpartum, triggered by the progesterone drop after the placenta delivers.
- Colostrum
- The first milk: thick, yellowish, rich in protein, immunoglobulins (secretory IgA), and calories, produced before mature milk comes in.
- Prolactin vs oxytocin (lactation)
- Prolactin drives milk PRODUCTION; oxytocin drives the let-down (milk-ejection) reflex. Production = prolactin, push-out = oxytocin.
- Deep (good) latch
- Infant takes in much of the areola with lips flanged outward and chin to the breast. A shallow latch causes sore, cracked nipples.
- Signs of adequate breastfeeding (day 4)
- Six or more wet diapers and several stools in 24 hours, audible swallowing, and steady weight gain.
- Breast milk storage
- Refrigerated about 4 days; do not refreeze thawed milk or microwave it (uneven heating, nutrient loss).
- Preferred breastfeeding contraception
- Progestin-only methods are preferred while breastfeeding; estrogen-containing methods can reduce milk supply.
- Baby blues
- Transient mood swings and tearfulness peaking around days 3-5, resolving within 2 weeks without treatment.
- Postpartum hemorrhage (PPH)
- Cumulative blood loss of 1,000 mL or more (or loss with signs of hypovolemia). Causes = the 4 T's; atony is #1.
- The 4 T's of PPH
- Tone (atony, #1), Trauma (laceration/hematoma/rupture), Tissue (retained fragments), Thrombin (coagulopathy/DIC).
- Uterine atony
- A soft, boggy, poorly contracting uterus; the leading cause of PPH. Treat with massage, emptying the bladder, and uterotonics.
- Postpartum uterotonic sequence
- Oxytocin first to methylergonovine to carboprost to misoprostol; give tranexamic acid (TXA) early.
- Methylergonovine (Methergine)
- Ergot-alkaloid uterotonic; contraindicated in hypertension/preeclampsia because it raises blood pressure. Methergine maxes BP.
- Carboprost (Hemabate)
- Prostaglandin uterotonic; contraindicated in asthma because it causes bronchoconstriction. Hemabate hits asthma.
- Firm fundus with ongoing bright-red bleeding
- Points to trauma (cervical/vaginal laceration or hematoma), not atony. Inspect the genital tract; look for a concealed hematoma if in shock.
- Postpartum DVT signs
- Unilateral calf warmth, redness, tenderness, and swelling; a complication of the postpartum hypercoagulable state.
- Postpartum pulmonary embolism
- Sudden dyspnea, pleuritic chest pain, tachycardia, and anxiety; a life-threatening emergency requiring immediate response.
- HELLP syndrome
- Hemolysis, Elevated Liver enzymes, Low Platelets; a severe variant of preeclampsia that can present or persist postpartum.
- Endometritis
- Postpartum uterine infection: fever (38 C or higher after 24 hr), uterine tenderness, foul-smelling lochia. Treat with IV antibiotics.
- Mastitis
- Hard, red, tender, wedge-shaped breast area with fever and flu-like symptoms. Keep emptying the breast; rest, fluids, antibiotics if bacterial.
- Postpartum depression
- Persistent low mood, loss of interest, sleep/appetite change, possible self-harm thoughts; requires treatment (distinct from baby blues).
- Postpartum psychosis
- Hallucinations, delusions, disorganized thinking; a psychiatric emergency with risk of harm to mother or infant.
- Postpartum fever threshold
- A temperature of 38 C (100.4 F) or higher after the first 24 hours suggests infection and must be reported.
- APGAR score
- Newborn assessment at 1 and 5 minutes scoring Appearance, Pulse, Grimace, Activity, Respiration 0-2 each (total 0-10); 7-10 is reassuring.
- Cold stress
- Newborn heat loss increasing oxygen and glucose use; can cause hypoglycemia and respiratory distress. Keep the infant at 36.5-37.5 C.
- Four routes of newborn heat loss
- Evaporation, conduction, convection, radiation. Dry the infant immediately and remove wet linens to prevent evaporative loss.
- Acrocyanosis
- Bluish hands and feet with a pink body in the newborn; a NORMAL finding, not central cyanosis.
- Mongolian spots
- Benign bluish-gray pigmented areas over the sacrum/buttocks (congenital dermal melanocytosis), common in darker-skinned infants. No treatment.
- Caput succedaneum vs cephalohematoma
- Caput = scalp edema that CROSSES suture lines; cephalohematoma = blood BOUNDED by suture lines.
- Ortolani sign
- A clunk felt as a dislocated femoral head reduces into the acetabulum; suggests developmental dysplasia of the hip (orthopedic referral).
- Rooting reflex
- Stroking the cheek makes the newborn turn toward the stimulus and open the mouth; an adaptive feeding reflex.
- Dry cord care
- Keep the umbilical cord clean and dry and fold the diaper below it to promote drying and separation and reduce infection.
- Safe sleep (SIDS prevention)
- Back to sleep on a firm flat surface, no soft bedding, room-share not bed-share; avoid overheating and smoke exposure.
- Newborn vitamin K
- Given to prevent hemorrhagic disease of the newborn; the gut has not yet established the bacteria that synthesize vitamin K.
- Failed newborn hearing screen
- Common (often fluid/debris) and does NOT confirm hearing loss. Reassure parents and arrange a rescreen or audiology referral.
- Small for gestational age (SGA)
- Weight below the 10th percentile for gestational age; raises the risk of hypoglycemia, hypothermia, and polycythemia.
- Neonatal Resuscitation Program (NRP)
- The algorithm that DRIVES newborn resuscitation (warm/dry/stimulate, ventilate, compress as HR dictates). The APGAR describes but does not drive it.
- Physiologic jaundice
- Newborn jaundice appearing AFTER 24 hours (peak days 3-5) from normal red-cell breakdown and an immature liver; usually benign.
- Pathologic jaundice
- Jaundice appearing WITHIN the first 24 hours (or rising fast); signals ABO/Rh hemolytic disease, G6PD deficiency, or sepsis. Evaluate promptly.
- Phototherapy
- Light treatment converting bilirubin to a water-soluble form for excretion. Shield the eyes; monitor temperature and hydration.
- Kernicterus
- Permanent bilirubin-induced brain injury from severe, untreated hyperbilirubinemia; the reason high bilirubin is treated promptly.
- Neonatal hypoglycemia
- Low newborn glucose with jitteriness, weak cry, lethargy, poor feeding. At risk: infant of a diabetic mother, LGA/SGA, preterm, cold-stressed.
- Infant of a diabetic mother (hypoglycemia)
- Hyperinsulinemic at birth; when the maternal glucose supply stops, high insulin drives glucose down. Feed early and monitor closely.
- Respiratory distress syndrome (RDS)
- Surfactant deficiency (especially preterm) causing alveolar collapse; grunting, flaring, retractions. Treat with respiratory support and surfactant.
- Transient tachypnea of the newborn (TTN)
- Self-limited distress from retained fetal lung fluid, more common after cesarean; usually resolves in 24-72 hours.
- Central cyanosis unresponsive to oxygen
- Suggests a cyanotic congenital heart defect (right-to-left shunt), not a lung problem; needs urgent cardiology evaluation.
- Neonatal sepsis
- Subtle and dangerous: temperature instability, lethargy, and poor feeding warrant a sepsis workup given the immature immune system.
- Neonatal abstinence syndrome (NAS)
- In-utero opioid exposure: high-pitched cry, tremors, hypertonia, poor feeding, autonomic signs. Low-stimulation care first; meds if severe.
- Failure to pass meconium in 48 hours
- With distension and bilious vomiting, suggests intestinal obstruction (e.g., Hirschsprung disease or atresia). Urgent evaluation.
- Tracheoesophageal fistula / esophageal atresia
- Choking, coughing, cyanosis with feeds, and excessive oral secretions. Withhold oral feeds and evaluate immediately.
- ABO incompatibility (newborn)
- Maternal antibodies hemolyze fetal red cells (positive direct Coombs), causing rising bilirubin; treat hyperbilirubinemia with phototherapy.
- Meconium-stained amniotic fluid
- Greenish fluid from in-utero meconium passage; signals possible fetal stress and the need for readiness to resuscitate.
- Placenta previa
- Placenta covering the cervical os; painless bright-red bleeding. No digital vaginal exam (previa, probe never).
- Placental abruption
- Premature separation of the placenta; painful bleeding with a rigid, tender uterus and DIC risk. Abruption = agony.
- Gestational diabetes effect on the newborn
- Raises the risk of macrosomia, shoulder dystocia, and neonatal hypoglycemia. Tight first-trimester control reduces congenital anomalies.
- Definitive sign of true labor
- Progressive cervical change (dilation/effacement) over time, NOT contractions or pain alone (which occur in false labor).
- Naegele's rule
- Estimates the due date: take the first day of the last menstrual period, subtract 3 months, add 7 days (and 1 year). Assumes a regular 28-day cycle.
- GTPAL
- Obstetric history: Gravida (total pregnancies), Term births (37+ wk), Preterm births (20-36 6/7 wk), Abortions/losses (<20 wk), Living children.
- Gravida vs para
- Gravida = total number of pregnancies regardless of outcome; para = number of pregnancies carried to 20 weeks or more (not number of babies).
- Term gestation
- Full term is 39 0/7 to 40 6/7 weeks; early term 37-38 6/7, late term 41, postterm 42 0/7 and beyond.
- Quickening
- The mother's first perception of fetal movement, typically felt around 16-20 weeks of gestation.
- Fundal height (McDonald's rule)
- From about 20-36 weeks, fundal height in centimeters roughly equals the gestational age in weeks (+/- 2 cm).
- Goodell, Chadwick, and Hegar signs
- Probable signs of pregnancy: Goodell = softening of the cervix; Chadwick = bluish vaginal/cervical color; Hegar = softening of the lower uterine segment.
- Supine hypotensive syndrome
- Gravid uterus compresses the vena cava when supine, dropping venous return and BP. Position the woman in a left lateral tilt.
- Group B Streptococcus (GBS) screening
- Vaginal/rectal culture at 36 0/7-37 6/7 weeks; if positive, give intrapartum IV penicillin (or ampicillin) to prevent neonatal early-onset GBS sepsis.
- Gestational hypertension
- New-onset BP 140/90 or higher after 20 weeks WITHOUT proteinuria or severe features; can progress to preeclampsia.
- Preeclampsia
- New-onset hypertension after 20 weeks plus proteinuria (or end-organ dysfunction). Definitive treatment is delivery of the placenta.
- Preeclampsia with severe features
- BP 160/110 or higher, thrombocytopenia, impaired liver/renal function, pulmonary edema, headache, or visual changes; high seizure/stroke risk.
- Eclampsia
- Onset of generalized tonic-clonic seizures in a woman with preeclampsia; an obstetric emergency. Protect the airway and give magnesium sulfate.
- Magnesium sulfate (obstetric)
- Used for seizure prophylaxis in preeclampsia/eclampsia and for fetal neuroprotection in preterm labor. It is a CNS depressant, not an antihypertensive.
- Magnesium sulfate toxicity
- Loss of deep tendon reflexes (first sign), respiratory depression (<12/min), decreased urine output, low O2 sat. Stop infusion; give calcium gluconate.
- Therapeutic magnesium level
- Roughly 4-7 mEq/L (4.8-8.4 mg/dL). Reflexes are lost around 10 mEq/L and respiratory arrest occurs near 15 mEq/L.
- Antihypertensives in pregnancy
- Labetalol, hydralazine, and nifedipine are first-line for acute severe hypertension. ACE inhibitors and ARBs are contraindicated (fetal harm).
- Hyperemesis gravidarum
- Severe, persistent pregnancy vomiting causing weight loss (>5%), dehydration, ketonuria, and electrolyte imbalance. Treat with IV fluids and antiemetics.
- Ectopic pregnancy
- Implantation outside the uterus (usually fallopian tube): unilateral pain, amenorrhea, spotting; rupture causes shock and shoulder pain. Surgical/medical emergency.
- Hydatidiform mole (molar pregnancy)
- Abnormal trophoblastic growth: very high hCG, uterus large for dates, grapelike vesicles, no fetal heart tones. Risk of choriocarcinoma; follow hCG to zero.
- Incompetent (insufficient) cervix
- Painless cervical dilation causing second-trimester loss. Managed with a cerclage (cervical stitch) and activity modification.
- Preterm labor
- Regular contractions with cervical change between 20 0/7 and 36 6/7 weeks. Management may include tocolytics, antenatal steroids, magnesium, and GBS coverage.
- Antenatal corticosteroids (betamethasone)
- Given to the mother in anticipated preterm birth (24-34 weeks) to accelerate fetal lung maturity and reduce RDS, IVH, and necrotizing enterocolitis.
- Tocolytics
- Drugs that suppress preterm contractions (nifedipine, indomethacin, terbutaline) to buy time for steroids/transfer. They do not stop labor indefinitely.
- PPROM
- Preterm premature rupture of membranes: rupture before 37 weeks and before labor. Main risks are chorioamnionitis, cord prolapse, and preterm birth.
- Chorioamnionitis
- Intra-amniotic infection: maternal fever, uterine tenderness, fetal/maternal tachycardia, foul fluid. Treat with antibiotics and expedite delivery.
- Nitrazine and fern tests
- Confirm rupture of membranes: amniotic fluid turns nitrazine paper blue (alkaline) and shows a fern pattern when dried on a slide.
- Polyhydramnios
- Excess amniotic fluid (AFI >24 cm); associated with fetal GI/neural anomalies and maternal diabetes. Raises risk of cord prolapse and preterm labor.
- Oligohydramnios
- Too little amniotic fluid (AFI <5 cm); associated with renal anomalies, IUGR, and PPROM. Raises risk of cord compression and variable decelerations.
- Intrauterine growth restriction (IUGR)
- Failure of the fetus to reach genetic growth potential; placental insufficiency is a common cause. Monitored with serial ultrasound and Doppler studies.
- Nonstress test (NST)
- Reactive = at least 2 accelerations of 15 bpm lasting 15 seconds within 20 minutes (in a term fetus); a reassuring sign of fetal well-being.
- Biophysical profile (BPP)
- Ultrasound plus NST scoring 5 parameters (fetal breathing, movement, tone, amniotic fluid, NST) 0-2 each; 8-10 is reassuring.
- Leopold's maneuvers
- Systematic abdominal palpation to determine fetal lie, presentation, and position and to locate the back for fetal heart tone auscultation.
- Fetal lie
- Relationship of the fetal spine to the maternal spine: longitudinal (vertical), transverse (horizontal), or oblique. Transverse lie requires cesarean.
- Fetal presentation
- The fetal part entering the pelvis first: cephalic (vertex, ideal), breech, or shoulder. Vertex presentation is most favorable for vaginal birth.
- Station
- Position of the presenting part relative to the ischial spines, from -5 (high) to +5 (crowning); 0 station means engaged at the spines.
- Effacement
- Thinning and shortening of the cervix expressed as a percentage (0-100%); occurs along with dilation in the first stage of labor.
- First stage of labor
- Onset of regular contractions to full (10 cm) dilation; divided into latent, active (about 6 cm onward), and transition phases.
- Second stage of labor
- From complete (10 cm) dilation to delivery of the baby; the pushing stage.
- Third stage of labor
- From delivery of the baby to delivery of the placenta. Signs of separation: cord lengthening, gush of blood, globular uterus.
- Fourth stage of labor
- The first 1-2 hours after placental delivery; the immediate recovery period with the highest risk of postpartum hemorrhage.
- Cardinal movements of labor
- Engagement, descent, flexion, internal rotation, extension, external rotation (restitution), and expulsion of the fetus through the birth canal.
- Transition phase
- Cervical dilation from about 8 to 10 cm with intense, frequent contractions; often accompanied by nausea, shaking, and an urge to push.
- Bloody show
- Pink-tinged mucus discharge as the cervix dilates and the mucus plug is released; a sign that labor may be near.
- Cord prolapse
- Umbilical cord slips below the presenting part and is compressed; an emergency. Relieve pressure (knee-chest/Trendelenburg, lift the presenting part) and prepare for cesarean.
- Shoulder dystocia
- Anterior shoulder lodges behind the pubic symphysis after the head delivers (turtle sign). First maneuver is McRoberts plus suprapubic pressure; never apply fundal pressure.
- McRoberts maneuver
- Sharp flexion of the mother's thighs onto the abdomen to flatten the sacrum and free the shoulder in shoulder dystocia.
- Uterine rupture
- Tearing of the uterine wall (risk after prior cesarean/VBAC): sudden severe abdominal pain, loss of fetal station, abnormal FHR, and signs of shock. Emergency cesarean.
- Amniotic fluid embolism
- Amniotic fluid enters maternal circulation causing sudden hypoxia, hypotension, cardiovascular collapse, and DIC. Rare, often fatal; supportive resuscitation.
- Oxytocin (Pitocin) induction/augmentation
- IV infusion to start or strengthen contractions; titrate to adequate labor. Monitor for tachysystole and nonreassuring FHR; have it on a pump and stop if either occurs.
- Uterine tachysystole
- More than 5 contractions in 10 minutes averaged over 30 minutes; reduces placental perfusion. Stop oxytocin, reposition, give fluids/O2, consider terbutaline.
- Amniotomy (AROM)
- Artificial rupture of membranes to augment labor; assess FHR immediately before and after, and watch for cord prolapse and the color/amount of fluid.
- Cervical ripening (prostaglandins)
- Dinoprostone or misoprostol soften and dilate an unfavorable cervix before induction. Monitor for tachysystole; remove dinoprostone insert if it occurs.
- Bishop score
- Predicts induction success from cervical dilation, effacement, station, consistency, and position; a higher score (8 or more) favors a successful vaginal birth.
- Baseline fetal heart rate
- Normal is 110-160 bpm, assessed over 10 minutes excluding accelerations/decelerations; below 110 is bradycardia, above 160 is tachycardia.
- FHR variability
- Fluctuations in the baseline FHR: absent, minimal (<=5 bpm), moderate (6-25 bpm), or marked (>25 bpm). Moderate variability is the most reassuring single sign.
- Category I FHR tracing
- Normal/reassuring: baseline 110-160, moderate variability, no late or variable decelerations; accelerations and early decelerations may be present.
- Category II FHR tracing
- Indeterminate tracing not predictive of fetal status; requires continued surveillance and intrauterine resuscitation measures. The largest category.
- Category III FHR tracing
- Abnormal: absent variability with recurrent late or variable decelerations or bradycardia, or a sinusoidal pattern. Intervene and expedite delivery.
- FHR accelerations
- Abrupt increases of at least 15 bpm above baseline for at least 15 seconds (term); a reassuring sign of adequate fetal oxygenation.
- Early deceleration
- Gradual FHR drop mirroring the contraction (nadir at the peak), caused by fetal head compression. Benign; no intervention needed.
- Late deceleration
- Gradual FHR drop beginning AFTER the contraction peaks, caused by uteroplacental insufficiency. Nonreassuring; act with the VEAL CHOP/LION measures.
- Variable deceleration
- Abrupt, variable-shaped FHR drop caused by umbilical cord compression. Reposition the mother; consider amnioinfusion for recurrent variables.
- Prolonged deceleration
- FHR drop of at least 15 bpm lasting 2-10 minutes; if it lasts 10 minutes or more it is a baseline change. Find and correct the cause urgently.
- VEAL CHOP
- FHR pattern mnemonic: Variable=Cord compression, Early=Head compression, Accelerations=OK (oxygenated), Late=Placental insufficiency.
- Intrauterine resuscitation
- For nonreassuring FHR: reposition (left side), give IV fluid bolus, apply oxygen, stop oxytocin, and consider terbutaline or amnioinfusion. Notify the provider.
- Sinusoidal FHR pattern
- Smooth, regular wave-like baseline with absent variability; associated with severe fetal anemia or hypoxia. An ominous (Category III) finding.
- Amnioinfusion
- Instillation of warmed sterile saline into the uterus to cushion the cord and relieve recurrent variable decelerations from oligohydramnios/cord compression.
- Epidural-related maternal hypotension
- Sympathetic blockade lowers maternal BP and can reduce placental perfusion (late decelerations). Treat with IV fluids, left tilt, and ephedrine/phenylephrine.
- Breech presentation
- Buttocks or feet present first; raises the risk of cord prolapse and head entrapment. Often managed by external cephalic version or planned cesarean.
- External cephalic version (ECV)
- Manual abdominal manipulation (around 37 weeks) to turn a breech fetus to vertex; done with monitoring and tocolysis, with cesarean readiness.
- Gestational diabetes screening
- Universal screening at 24-28 weeks; a 50 g glucose challenge, then a diagnostic 3-hour 100 g oral glucose tolerance test if the screen is elevated.
- Macrosomia
- Estimated fetal weight of 4,000-4,500 g or more, common with poorly controlled diabetes; raises the risk of shoulder dystocia and birth trauma.
- Hypothyroidism in pregnancy
- Untreated maternal hypothyroidism risks miscarriage, preeclampsia, and impaired fetal neurodevelopment; levothyroxine needs usually increase in pregnancy.
- Iron-deficiency anemia of pregnancy
- Hemoglobin below about 11 g/dL; raises the risk of preterm birth and low birth weight. Treat with oral iron taken with vitamin C; expect dark stools.
- Physiologic anemia of pregnancy
- Plasma volume expands more than red cell mass, diluting the hemoglobin/hematocrit; a normal finding, not true anemia.
- Folic acid in pregnancy
- 0.4 mg daily (preconception through the first trimester) reduces neural tube defects; 4 mg if there is a prior affected pregnancy.
- Postdate (postterm) pregnancy
- Pregnancy at 42 0/7 weeks or beyond; risks include placental insufficiency, oligohydramnios, meconium aspiration, and macrosomia. Increase antenatal surveillance.
- Newborn vital sign ranges
- Heart rate 110-160 bpm (awake), respirations 30-60/min, axillary temperature 36.5-37.5 C (97.7-99.5 F).
- Periodic breathing
- Brief pauses in newborn breathing of less than 20 seconds without color or heart-rate change; a normal pattern, distinct from apnea.
- Newborn apnea
- A respiratory pause of 20 seconds or longer, OR a shorter pause with bradycardia, cyanosis, or pallor; abnormal and requires evaluation.
- New Ballard score
- Assesses gestational age (20-44 weeks) by neuromuscular maturity (posture, square window, recoil) and physical maturity (skin, sole creases, breast, genitals).
- Large for gestational age (LGA)
- Birth weight above the 90th percentile; common with maternal diabetes. Watch for birth trauma, hypoglycemia, and polycythemia.
- Newborn weight loss
- Up to about 7-10% loss in the first few days is normal; birth weight is typically regained by 10-14 days of age.
- Moro (startle) reflex
- Symmetric arm abduction then adduction with finger fanning in response to a sudden movement or noise; an asymmetric response may indicate clavicle fracture or nerve injury.
- Babinski reflex
- Stroking the sole causes the toes to fan and the great toe to dorsiflex; NORMAL in newborns (would be abnormal in older children/adults).
- Tonic neck (fencing) reflex
- When the head turns to one side, the arm and leg on that side extend while the opposite limbs flex; normally disappears by 3-4 months.
- Stepping and palmar grasp reflexes
- Stepping = walking motions when held upright with feet touching a surface; palmar grasp = fingers curl around an object placed in the palm. Both are normal newborn reflexes.
- Anterior vs posterior fontanelle
- Anterior is diamond-shaped and closes by 12-18 months; posterior is triangular and closes by about 2 months. A bulging fontanelle suggests increased intracranial pressure.
- Molding
- Temporary overlapping of the cranial bones during vaginal birth that elongates the head shape; resolves within a few days.
- Vernix caseosa
- White, cheesy protective coating on the fetal skin; more abundant in preterm infants and decreases with advancing gestation.
- Lanugo
- Fine downy hair covering the fetus; abundant in preterm infants and largely shed by term, which helps in gestational age assessment.
- Erythema toxicum neonatorum
- Benign blotchy red macules with central white/yellow papules (newborn rash) appearing in the first days; resolves without treatment.
- Milia
- Tiny white epidermal cysts on the newborn's nose, chin, and cheeks; benign and resolve spontaneously. Do not squeeze them.
- Epstein pearls
- Small white inclusion cysts on the newborn's hard palate or gums; a benign, self-resolving finding.
- Pseudomenstruation
- Small amount of blood-tinged vaginal discharge in a female newborn from withdrawal of maternal hormones; a normal, transient finding.
- Witch's milk
- Transient breast enlargement with milky secretion in newborns of both sexes from maternal hormones; benign and self-limited. Do not express it.
- Erythromycin eye ointment
- Prophylaxis applied to the newborn's eyes to prevent gonococcal and chlamydial ophthalmia neonatorum; may be delayed up to an hour for bonding.
- Newborn hepatitis B vaccine
- First dose recommended within 24 hours of birth; if the mother is HBsAg-positive, also give hepatitis B immune globulin (HBIG).
- Delayed cord clamping
- Waiting 30-60 seconds (or longer) to clamp the umbilical cord increases neonatal iron stores and blood volume; recommended for vigorous newborns.
- Skin-to-skin contact (kangaroo care)
- Placing the naked newborn on the parent's bare chest stabilizes temperature, heart rate, and glucose, and promotes bonding and breastfeeding.
- Fetal-to-neonatal circulation transition
- At birth the first breaths inflate the lungs and the fetal shunts (ductus arteriosus, foramen ovale, ductus venosus) functionally close as pulmonary resistance falls.
- Newborn metabolic (heel-stick) screen
- Blood spot collected after 24 hours of feeding to detect PKU, congenital hypothyroidism, galactosemia, and other treatable disorders; may need repeat if drawn early.
- Critical congenital heart disease (CCHD) screen
- Pulse oximetry on the right hand and one foot after 24 hours; a low or discrepant reading prompts evaluation for a cardiac defect.
- Newborn glucose screening threshold
- Routinely screen at-risk infants (IDM, LGA, SGA, preterm, late preterm); intervene for plasma glucose below about 40-45 mg/dL with feeding or IV dextrose.
- Choanal atresia
- Bony/membranous blockage of the nasal passage; newborns are obligate nose breathers, so it causes cyanosis that improves with crying. Suspect if a catheter won't pass.
- First newborn bath timing
- Delay the bath at least 24 hours (or several hours minimum) to stabilize temperature and glucose and preserve vernix; ensure the temperature is stable first.
- Brown adipose tissue (brown fat)
- Specialized newborn fat that generates heat through nonshivering thermogenesis; the newborn's main heat source because they cannot shiver effectively.
- Polycythemia (newborn)
- Central venous hematocrit above 65%; causes a ruddy, plethoric appearance and risks hyperviscosity, jaundice, and hypoglycemia. Seen in IDM, SGA, and delayed cord clamping.
- Meconium aspiration syndrome (MAS)
- Aspiration of meconium-stained fluid causing airway obstruction and respiratory distress; for a non-vigorous infant, follow NRP with possible tracheal suctioning.
- Persistent pulmonary hypertension of the newborn (PPHN)
- Failure of pulmonary vascular resistance to fall after birth, causing right-to-left shunting and severe hypoxemia; associated with MAS, sepsis, and asphyxia.
- Necrotizing enterocolitis (NEC)
- Inflammatory bowel injury, mainly in preterm infants: feeding intolerance, abdominal distension, bloody stools, and pneumatosis on x-ray. Stop feeds; decompress the gut.
- Intraventricular hemorrhage (IVH)
- Bleeding into the brain's ventricles, common in very preterm infants from fragile germinal matrix vessels; can cause apnea, seizures, and a bulging fontanelle.
- Retinopathy of prematurity (ROP)
- Abnormal retinal vessel growth in preterm infants, worsened by excessive oxygen; can lead to blindness. Carefully titrate oxygen and arrange eye screening.
- Bronchopulmonary dysplasia (BPD)
- Chronic lung disease of prematurity from prolonged ventilation/oxygen and lung injury; defined by oxygen need at 36 weeks corrected age.
- Hypoxic-ischemic encephalopathy (HIE)
- Brain injury from perinatal asphyxia; managed with therapeutic hypothermia (cooling) within 6 hours for moderate-to-severe cases at term.
- Early-onset vs late-onset neonatal sepsis
- Early-onset (<72 hours) is usually from maternal flora (GBS, E. coli) acquired around birth; late-onset (>72 hours) is often hospital- or community-acquired.
- Erb's palsy (brachial plexus injury)
- Upper-arm paralysis with the arm adducted/internally rotated (waiter's tip) from C5-C6 stretch, often after shoulder dystocia; usually managed conservatively.
- Clavicle fracture (newborn)
- The most common birth fracture (often with shoulder dystocia/macrosomia): crepitus, asymmetric Moro, and decreased arm movement. Usually heals with gentle handling.
- Cleft lip and palate
- Facial clefts that complicate feeding and risk aspiration; use specialized bottles/nipples, upright positioning, and frequent burping. Plan staged surgical repair.
- Congenital diaphragmatic hernia
- Abdominal organs herniate into the chest, compressing the lungs: scaphoid abdomen, respiratory distress, bowel sounds in the chest. Avoid bag-mask ventilation; intubate and decompress.
- Gastroschisis vs omphalocele
- Gastroschisis = bowel herniates through a defect beside the cord, uncovered; omphalocele = herniation INTO the cord, covered by a membrane sac. Both: cover, keep moist/sterile.
- Spina bifida (myelomeningocele)
- Neural tube defect with an exposed spinal sac; position prone, cover with sterile moist saline dressing, prevent infection and rupture, and avoid latex.
- Fetal alcohol spectrum disorder
- Prenatal alcohol exposure causing growth restriction, characteristic facial features, microcephaly, and neurodevelopmental impairment; there is no safe amount of alcohol in pregnancy.
- Rh hemolytic disease of the newborn
- Maternal anti-D antibodies cross the placenta and hemolyze Rh-positive fetal cells, causing anemia, jaundice, and hydrops. Prevented by maternal RhoGAM.
- Exchange transfusion
- Removal and replacement of the newborn's blood to rapidly lower severe hyperbilirubinemia and prevent kernicterus when phototherapy is insufficient.
- Hypotonia (floppy newborn)
- Decreased muscle tone with a frog-leg posture and poor head control; may signal sepsis, asphyxia, hypoglycemia, or a neuromuscular/genetic disorder and warrants evaluation.
- Newborn seizures
- Often subtle (lip smacking, eye deviation, bicycling, apnea) rather than tonic-clonic; causes include HIE, hypoglycemia, hypocalcemia, infection, and IVH. Evaluate urgently.
- Late preterm infant
- Born 34 0/7-36 6/7 weeks; though near term, at higher risk for hypothermia, hypoglycemia, jaundice, feeding difficulty, and respiratory distress than term infants.
- Subgaleal hemorrhage
- Bleeding into the loose tissue beneath the scalp aponeurosis (often after vacuum delivery); a boggy, expanding swelling crossing sutures that can cause life-threatening blood loss.
- Postpartum vital sign monitoring
- Check vitals every 15 minutes in the first hour, then per protocol; watch for the narrowing pulse pressure and rising heart rate that precede a falling BP in hemorrhage.
- Afterpains
- Intermittent uterine cramping from postpartum contractions, stronger in multiparas and during breastfeeding (oxytocin release); manage with analgesics and reassurance.
- Postpartum urinary retention
- Bladder distension from decreased tone and perineal trauma; it displaces the uterus and promotes atony/hemorrhage. Encourage voiding within 6-8 hours; catheterize if needed.
- Postpartum diuresis and diaphoresis
- Profuse urination and night sweats in the first days as the body excretes the excess fluid volume of pregnancy; a normal finding.
- Perineal care after birth
- Use ice packs for the first 24 hours, then warm sitz baths; peri-bottle rinsing, witch hazel pads, and front-to-back wiping promote healing and prevent infection.
- Rubella vaccination postpartum
- Give the MMR vaccine before discharge to a nonimmune mother; advise avoiding pregnancy for about 4 weeks. Breastfeeding is not a contraindication.
- Tdap in pregnancy
- Recommended every pregnancy at 27-36 weeks so maternal pertussis antibodies cross the placenta and protect the newborn before their own vaccination.
- Engorgement (breastfeeding)
- Painful, firm, full breasts as milk comes in (days 3-5); for breastfeeding mothers, feed frequently and use warmth before and cold after; cabbage leaves for those weaning.
- Plugged milk duct
- Localized tender lump without systemic illness; continue frequent feeding/emptying, apply warmth, and massage toward the nipple to prevent progression to mastitis.
- Postpartum thromboembolism prophylaxis
- Early ambulation, hydration, and sequential compression devices reduce VTE risk in the hypercoagulable postpartum period, especially after cesarean.
- Cesarean incision assessment
- Use REEDA principles: inspect for redness, edema, ecchymosis, discharge, and approximation; report separation, purulent drainage, or fever as signs of infection.
- Postpartum blues vs depression vs psychosis
- Blues = mild, transient, resolves in 2 weeks; depression = persistent, impairing, needs treatment; psychosis = hallucinations/delusions, an emergency. Screen all mothers (e.g., EPDS).
- Edinburgh Postnatal Depression Scale (EPDS)
- A validated 10-item self-report screen for postpartum depression; a higher score or any endorsement of self-harm requires prompt referral.
