Your FREE Maternal Newborn Nursing Flashcards 2026 – 200+ Cards

Return of the uterus to its pre-pregnancy size after birth; the fundus descends about 1 cm (one fingerbreadth) per day.

Dark red postpartum discharge on days 1-3, made of blood, decidua, and trophoblastic debris. Small clots are normal.

Pinkish-brown postpartum discharge, about days 4-10, made of serous fluid, older blood, and leukocytes.

Whitish-yellow postpartum discharge from about day 10 up to 2-6 weeks; leukocytes, mucus, and decidual cells.

Postpartum assessment mnemonic: Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy/perineum, Homans/lower extremities, Emotions.

Perineal/episiotomy healing assessment: Redness, Edema, Ecchymosis, Discharge, Approximation of wound edges.

Sign of a full bladder preventing uterine contraction. Action: massage the fundus and have the woman empty her bladder.

Given within 72 hours to an Rh-negative, unsensitized mother of an Rh-positive infant to prevent isoimmunization. Prevents, cannot reverse, sensitization.

Tests for maternal anti-Rh antibodies. NEGATIVE = unsensitized (give RhoGAM); POSITIVE = already sensitized (RhoGAM will not help).

Onset of copious milk production around 2-5 days postpartum, triggered by the progesterone drop after the placenta delivers.

The first milk: thick, yellowish, rich in protein, immunoglobulins (secretory IgA), and calories, produced before mature milk comes in.

Prolactin drives milk PRODUCTION; oxytocin drives the let-down (milk-ejection) reflex. Production = prolactin, push-out = oxytocin.

Infant takes in much of the areola with lips flanged outward and chin to the breast. A shallow latch causes sore, cracked nipples.

Six or more wet diapers and several stools in 24 hours, audible swallowing, and steady weight gain.

Refrigerated about 4 days; do not refreeze thawed milk or microwave it (uneven heating, nutrient loss).

Progestin-only methods are preferred while breastfeeding; estrogen-containing methods can reduce milk supply.

Transient mood swings and tearfulness peaking around days 3-5, resolving within 2 weeks without treatment.

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.

Intermittent uterine cramping from postpartum contractions, stronger in multiparas and during breastfeeding (oxytocin release); manage with analgesics and reassurance.

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.

Profuse urination and night sweats in the first days as the body excretes the excess fluid volume of pregnancy; a normal finding.

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.

Give the MMR vaccine before discharge to a nonimmune mother; advise avoiding pregnancy for about 4 weeks. Breastfeeding is not a contraindication.

Recommended every pregnancy at 27-36 weeks so maternal pertussis antibodies cross the placenta and protect the newborn before their own vaccination.

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.

Localized tender lump without systemic illness; continue frequent feeding/emptying, apply warmth, and massage toward the nipple to prevent progression to mastitis.

Early ambulation, hydration, and sequential compression devices reduce VTE risk in the hypercoagulable postpartum period, especially after cesarean.

Use REEDA principles: inspect for redness, edema, ecchymosis, discharge, and approximation; report separation, purulent drainage, or fever as signs of infection.

Cumulative blood loss of 1,000 mL or more (or loss with signs of hypovolemia). Causes = the 4 T's; atony is #1.

Tone (atony, #1), Trauma (laceration/hematoma/rupture), Tissue (retained fragments), Thrombin (coagulopathy/DIC).

A soft, boggy, poorly contracting uterus; the leading cause of PPH. Treat with massage, emptying the bladder, and uterotonics.

Oxytocin first to methylergonovine to carboprost to misoprostol; give tranexamic acid (TXA) early.

Ergot-alkaloid uterotonic; contraindicated in hypertension/preeclampsia because it raises blood pressure. Methergine maxes BP.

Prostaglandin uterotonic; contraindicated in asthma because it causes bronchoconstriction. Hemabate hits asthma.

Points to trauma (cervical/vaginal laceration or hematoma), not atony. Inspect the genital tract; look for a concealed hematoma if in shock.

Unilateral calf warmth, redness, tenderness, and swelling; a complication of the postpartum hypercoagulable state.

Sudden dyspnea, pleuritic chest pain, tachycardia, and anxiety; a life-threatening emergency requiring immediate response.

Hemolysis, Elevated Liver enzymes, Low Platelets; a severe variant of preeclampsia that can present or persist postpartum.

Postpartum uterine infection: fever (38 C or higher after 24 hr), uterine tenderness, foul-smelling lochia. Treat with IV antibiotics.

Hard, red, tender, wedge-shaped breast area with fever and flu-like symptoms. Keep emptying the breast; rest, fluids, antibiotics if bacterial.

Persistent low mood, loss of interest, sleep/appetite change, possible self-harm thoughts; requires treatment (distinct from baby blues).

Hallucinations, delusions, disorganized thinking; a psychiatric emergency with risk of harm to mother or infant.

A temperature of 38 C (100.4 F) or higher after the first 24 hours suggests infection and must be reported.

Blues = mild, transient, resolves in 2 weeks; depression = persistent, impairing, needs treatment; psychosis = hallucinations/delusions, an emergency. Screen all mothers (e.g., EPDS).

A validated 10-item self-report screen for postpartum depression; a higher score or any endorsement of self-harm requires prompt referral.

Newborn jaundice appearing AFTER 24 hours (peak days 3-5) from normal red-cell breakdown and an immature liver; usually benign.

Jaundice appearing WITHIN the first 24 hours (or rising fast); signals ABO/Rh hemolytic disease, G6PD deficiency, or sepsis. Evaluate promptly.

Light treatment converting bilirubin to a water-soluble form for excretion. Shield the eyes; monitor temperature and hydration.

Permanent bilirubin-induced brain injury from severe, untreated hyperbilirubinemia; the reason high bilirubin is treated promptly.

Low newborn glucose with jitteriness, weak cry, lethargy, poor feeding. At risk: infant of a diabetic mother, LGA/SGA, preterm, cold-stressed.

Hyperinsulinemic at birth; when the maternal glucose supply stops, high insulin drives glucose down. Feed early and monitor closely.

Surfactant deficiency (especially preterm) causing alveolar collapse; grunting, flaring, retractions. Treat with respiratory support and surfactant.

Self-limited distress from retained fetal lung fluid, more common after cesarean; usually resolves in 24-72 hours.

Suggests a cyanotic congenital heart defect (right-to-left shunt), not a lung problem; needs urgent cardiology evaluation.

Subtle and dangerous: temperature instability, lethargy, and poor feeding warrant a sepsis workup given the immature immune system.

In-utero opioid exposure: high-pitched cry, tremors, hypertonia, poor feeding, autonomic signs. Low-stimulation care first; meds if severe.

With distension and bilious vomiting, suggests intestinal obstruction (e.g., Hirschsprung disease or atresia). Urgent evaluation.

Choking, coughing, cyanosis with feeds, and excessive oral secretions. Withhold oral feeds and evaluate immediately.

Maternal antibodies hemolyze fetal red cells (positive direct Coombs), causing rising bilirubin; treat hyperbilirubinemia with phototherapy.

Central venous hematocrit above 65%; causes a ruddy, plethoric appearance and risks hyperviscosity, jaundice, and hypoglycemia. Seen in IDM, SGA, and delayed cord clamping.

Aspiration of meconium-stained fluid causing airway obstruction and respiratory distress; for a non-vigorous infant, follow NRP with possible tracheal suctioning.

Failure of pulmonary vascular resistance to fall after birth, causing right-to-left shunting and severe hypoxemia; associated with MAS, sepsis, and asphyxia.

Inflammatory bowel injury, mainly in preterm infants: feeding intolerance, abdominal distension, bloody stools, and pneumatosis on x-ray. Stop feeds; decompress the gut.

Bleeding into the brain's ventricles, common in very preterm infants from fragile germinal matrix vessels; can cause apnea, seizures, and a bulging fontanelle.

Abnormal retinal vessel growth in preterm infants, worsened by excessive oxygen; can lead to blindness. Carefully titrate oxygen and arrange eye screening.

Chronic lung disease of prematurity from prolonged ventilation/oxygen and lung injury; defined by oxygen need at 36 weeks corrected age.

Brain injury from perinatal asphyxia; managed with therapeutic hypothermia (cooling) within 6 hours for moderate-to-severe cases at term.

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.

Upper-arm paralysis with the arm adducted/internally rotated (waiter's tip) from C5-C6 stretch, often after shoulder dystocia; usually managed conservatively.

The most common birth fracture (often with shoulder dystocia/macrosomia): crepitus, asymmetric Moro, and decreased arm movement. Usually heals with gentle handling.

Facial clefts that complicate feeding and risk aspiration; use specialized bottles/nipples, upright positioning, and frequent burping. Plan staged surgical repair.

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 = bowel herniates through a defect beside the cord, uncovered; omphalocele = herniation INTO the cord, covered by a membrane sac. Both: cover, keep moist/sterile.

Neural tube defect with an exposed spinal sac; position prone, cover with sterile moist saline dressing, prevent infection and rupture, and avoid latex.

Prenatal alcohol exposure causing growth restriction, characteristic facial features, microcephaly, and neurodevelopmental impairment; there is no safe amount of alcohol in pregnancy.

Maternal anti-D antibodies cross the placenta and hemolyze Rh-positive fetal cells, causing anemia, jaundice, and hydrops. Prevented by maternal RhoGAM.

Removal and replacement of the newborn's blood to rapidly lower severe hyperbilirubinemia and prevent kernicterus when phototherapy is insufficient.

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.

Often subtle (lip smacking, eye deviation, bicycling, apnea) rather than tonic-clonic; causes include HIE, hypoglycemia, hypocalcemia, infection, and IVH. Evaluate urgently.

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.

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.

Newborn assessment at 1 and 5 minutes scoring Appearance, Pulse, Grimace, Activity, Respiration 0-2 each (total 0-10); 7-10 is reassuring.

Newborn heat loss increasing oxygen and glucose use; can cause hypoglycemia and respiratory distress. Keep the infant at 36.5-37.5 C.

Evaporation, conduction, convection, radiation. Dry the infant immediately and remove wet linens to prevent evaporative loss.

Bluish hands and feet with a pink body in the newborn; a NORMAL finding, not central cyanosis.

Benign bluish-gray pigmented areas over the sacrum/buttocks (congenital dermal melanocytosis), common in darker-skinned infants. No treatment.

Caput = scalp edema that CROSSES suture lines; cephalohematoma = blood BOUNDED by suture lines.

A clunk felt as a dislocated femoral head reduces into the acetabulum; suggests developmental dysplasia of the hip (orthopedic referral).

Stroking the cheek makes the newborn turn toward the stimulus and open the mouth; an adaptive feeding reflex.

Keep the umbilical cord clean and dry and fold the diaper below it to promote drying and separation and reduce infection.

Back to sleep on a firm flat surface, no soft bedding, room-share not bed-share; avoid overheating and smoke exposure.

Given to prevent hemorrhagic disease of the newborn; the gut has not yet established the bacteria that synthesize vitamin K.

Common (often fluid/debris) and does NOT confirm hearing loss. Reassure parents and arrange a rescreen or audiology referral.

Weight below the 10th percentile for gestational age; raises the risk of hypoglycemia, hypothermia, and polycythemia.

The algorithm that DRIVES newborn resuscitation (warm/dry/stimulate, ventilate, compress as HR dictates). The APGAR describes but does not drive it.

Heart rate 110-160 bpm (awake), respirations 30-60/min, axillary temperature 36.5-37.5 C (97.7-99.5 F).

Brief pauses in newborn breathing of less than 20 seconds without color or heart-rate change; a normal pattern, distinct from apnea.

A respiratory pause of 20 seconds or longer, OR a shorter pause with bradycardia, cyanosis, or pallor; abnormal and requires evaluation.

Assesses gestational age (20-44 weeks) by neuromuscular maturity (posture, square window, recoil) and physical maturity (skin, sole creases, breast, genitals).

Birth weight above the 90th percentile; common with maternal diabetes. Watch for birth trauma, hypoglycemia, and polycythemia.

Up to about 7-10% loss in the first few days is normal; birth weight is typically regained by 10-14 days of age.

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.

Stroking the sole causes the toes to fan and the great toe to dorsiflex; NORMAL in newborns (would be abnormal in older children/adults).

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 = 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 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.

Temporary overlapping of the cranial bones during vaginal birth that elongates the head shape; resolves within a few days.

White, cheesy protective coating on the fetal skin; more abundant in preterm infants and decreases with advancing gestation.

Fine downy hair covering the fetus; abundant in preterm infants and largely shed by term, which helps in gestational age assessment.

Benign blotchy red macules with central white/yellow papules (newborn rash) appearing in the first days; resolves without treatment.

Tiny white epidermal cysts on the newborn's nose, chin, and cheeks; benign and resolve spontaneously. Do not squeeze them.

Small white inclusion cysts on the newborn's hard palate or gums; a benign, self-resolving finding.

Small amount of blood-tinged vaginal discharge in a female newborn from withdrawal of maternal hormones; a normal, transient finding.

Transient breast enlargement with milky secretion in newborns of both sexes from maternal hormones; benign and self-limited. Do not express it.

Prophylaxis applied to the newborn's eyes to prevent gonococcal and chlamydial ophthalmia neonatorum; may be delayed up to an hour for bonding.

First dose recommended within 24 hours of birth; if the mother is HBsAg-positive, also give hepatitis B immune globulin (HBIG).

Waiting 30-60 seconds (or longer) to clamp the umbilical cord increases neonatal iron stores and blood volume; recommended for vigorous newborns.

Placing the naked newborn on the parent's bare chest stabilizes temperature, heart rate, and glucose, and promotes bonding and breastfeeding.

At birth the first breaths inflate the lungs and the fetal shunts (ductus arteriosus, foramen ovale, ductus venosus) functionally close as pulmonary resistance falls.

Blood spot collected after 24 hours of feeding to detect PKU, congenital hypothyroidism, galactosemia, and other treatable disorders; may need repeat if drawn early.

Pulse oximetry on the right hand and one foot after 24 hours; a low or discrepant reading prompts evaluation for a cardiac defect.

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.

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.

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.

Specialized newborn fat that generates heat through nonshivering thermogenesis; the newborn's main heat source because they cannot shiver effectively.

Greenish fluid from in-utero meconium passage; signals possible fetal stress and the need for readiness to resuscitate.

Placenta covering the cervical os; painless bright-red bleeding. No digital vaginal exam (previa, probe never).

Premature separation of the placenta; painful bleeding with a rigid, tender uterus and DIC risk. Abruption = agony.

Raises the risk of macrosomia, shoulder dystocia, and neonatal hypoglycemia. Tight first-trimester control reduces congenital anomalies.

Progressive cervical change (dilation/effacement) over time, NOT contractions or pain alone (which occur in false labor).

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.

Obstetric history: Gravida (total pregnancies), Term births (37+ wk), Preterm births (20-36 6/7 wk), Abortions/losses (<20 wk), Living children.

Gravida = total number of pregnancies regardless of outcome; para = number of pregnancies carried to 20 weeks or more (not number of babies).

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.

The mother's first perception of fetal movement, typically felt around 16-20 weeks of gestation.

From about 20-36 weeks, fundal height in centimeters roughly equals the gestational age in weeks (+/- 2 cm).

Probable signs of pregnancy: Goodell = softening of the cervix; Chadwick = bluish vaginal/cervical color; Hegar = softening of the lower uterine segment.

Gravid uterus compresses the vena cava when supine, dropping venous return and BP. Position the woman in a left lateral tilt.

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.

New-onset BP 140/90 or higher after 20 weeks WITHOUT proteinuria or severe features; can progress to preeclampsia.

New-onset hypertension after 20 weeks plus proteinuria (or end-organ dysfunction). Definitive treatment is delivery of the placenta.

BP 160/110 or higher, thrombocytopenia, impaired liver/renal function, pulmonary edema, headache, or visual changes; high seizure/stroke risk.

Onset of generalized tonic-clonic seizures in a woman with preeclampsia; an obstetric emergency. Protect the airway and give magnesium sulfate.

Used for seizure prophylaxis in preeclampsia/eclampsia and for fetal neuroprotection in preterm labor. It is a CNS depressant, not an antihypertensive.

Loss of deep tendon reflexes (first sign), respiratory depression (<12/min), decreased urine output, low O2 sat. Stop infusion; give calcium gluconate.

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.

Labetalol, hydralazine, and nifedipine are first-line for acute severe hypertension. ACE inhibitors and ARBs are contraindicated (fetal harm).

Severe, persistent pregnancy vomiting causing weight loss (>5%), dehydration, ketonuria, and electrolyte imbalance. Treat with IV fluids and antiemetics.

Implantation outside the uterus (usually fallopian tube): unilateral pain, amenorrhea, spotting; rupture causes shock and shoulder pain. Surgical/medical emergency.

Abnormal trophoblastic growth: very high hCG, uterus large for dates, grapelike vesicles, no fetal heart tones. Risk of choriocarcinoma; follow hCG to zero.

Painless cervical dilation causing second-trimester loss. Managed with a cerclage (cervical stitch) and activity modification.

Regular contractions with cervical change between 20 0/7 and 36 6/7 weeks. Management may include tocolytics, antenatal steroids, magnesium, and GBS coverage.

Given to the mother in anticipated preterm birth (24-34 weeks) to accelerate fetal lung maturity and reduce RDS, IVH, and necrotizing enterocolitis.

Drugs that suppress preterm contractions (nifedipine, indomethacin, terbutaline) to buy time for steroids/transfer. They do not stop labor indefinitely.

Preterm premature rupture of membranes: rupture before 37 weeks and before labor. Main risks are chorioamnionitis, cord prolapse, and preterm birth.

Intra-amniotic infection: maternal fever, uterine tenderness, fetal/maternal tachycardia, foul fluid. Treat with antibiotics and expedite delivery.

Confirm rupture of membranes: amniotic fluid turns nitrazine paper blue (alkaline) and shows a fern pattern when dried on a slide.

Excess amniotic fluid (AFI >24 cm); associated with fetal GI/neural anomalies and maternal diabetes. Raises risk of cord prolapse and preterm labor.

Too little amniotic fluid (AFI <5 cm); associated with renal anomalies, IUGR, and PPROM. Raises risk of cord compression and variable decelerations.

Failure of the fetus to reach genetic growth potential; placental insufficiency is a common cause. Monitored with serial ultrasound and Doppler studies.

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.

Ultrasound plus NST scoring 5 parameters (fetal breathing, movement, tone, amniotic fluid, NST) 0-2 each; 8-10 is reassuring.

Systematic abdominal palpation to determine fetal lie, presentation, and position and to locate the back for fetal heart tone auscultation.

Relationship of the fetal spine to the maternal spine: longitudinal (vertical), transverse (horizontal), or oblique. Transverse lie requires cesarean.

The fetal part entering the pelvis first: cephalic (vertex, ideal), breech, or shoulder. Vertex presentation is most favorable for vaginal birth.

Position of the presenting part relative to the ischial spines, from -5 (high) to +5 (crowning); 0 station means engaged at the spines.

Thinning and shortening of the cervix expressed as a percentage (0-100%); occurs along with dilation in the first stage of labor.

Onset of regular contractions to full (10 cm) dilation; divided into latent, active (about 6 cm onward), and transition phases.

From complete (10 cm) dilation to delivery of the baby; the pushing stage.

From delivery of the baby to delivery of the placenta. Signs of separation: cord lengthening, gush of blood, globular uterus.

The first 1-2 hours after placental delivery; the immediate recovery period with the highest risk of postpartum hemorrhage.

Engagement, descent, flexion, internal rotation, extension, external rotation (restitution), and expulsion of the fetus through the birth canal.

Cervical dilation from about 8 to 10 cm with intense, frequent contractions; often accompanied by nausea, shaking, and an urge to push.

Pink-tinged mucus discharge as the cervix dilates and the mucus plug is released; a sign that labor may be near.

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.

Anterior shoulder lodges behind the pubic symphysis after the head delivers (turtle sign). First maneuver is McRoberts plus suprapubic pressure; never apply fundal pressure.

Sharp flexion of the mother's thighs onto the abdomen to flatten the sacrum and free the shoulder in shoulder dystocia.

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 enters maternal circulation causing sudden hypoxia, hypotension, cardiovascular collapse, and DIC. Rare, often fatal; supportive resuscitation.

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.

More than 5 contractions in 10 minutes averaged over 30 minutes; reduces placental perfusion. Stop oxytocin, reposition, give fluids/O2, consider terbutaline.

Artificial rupture of membranes to augment labor; assess FHR immediately before and after, and watch for cord prolapse and the color/amount of fluid.

Dinoprostone or misoprostol soften and dilate an unfavorable cervix before induction. Monitor for tachysystole; remove dinoprostone insert if it occurs.

Predicts induction success from cervical dilation, effacement, station, consistency, and position; a higher score (8 or more) favors a successful vaginal birth.

Normal is 110-160 bpm, assessed over 10 minutes excluding accelerations/decelerations; below 110 is bradycardia, above 160 is tachycardia.

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.

Normal/reassuring: baseline 110-160, moderate variability, no late or variable decelerations; accelerations and early decelerations may be present.

Indeterminate tracing not predictive of fetal status; requires continued surveillance and intrauterine resuscitation measures. The largest category.

Abnormal: absent variability with recurrent late or variable decelerations or bradycardia, or a sinusoidal pattern. Intervene and expedite delivery.

Abrupt increases of at least 15 bpm above baseline for at least 15 seconds (term); a reassuring sign of adequate fetal oxygenation.

Gradual FHR drop mirroring the contraction (nadir at the peak), caused by fetal head compression. Benign; no intervention needed.

Gradual FHR drop beginning AFTER the contraction peaks, caused by uteroplacental insufficiency. Nonreassuring; act with the VEAL CHOP/LION measures.

Abrupt, variable-shaped FHR drop caused by umbilical cord compression. Reposition the mother; consider amnioinfusion for recurrent variables.

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.

FHR pattern mnemonic: Variable=Cord compression, Early=Head compression, Accelerations=OK (oxygenated), Late=Placental insufficiency.

For nonreassuring FHR: reposition (left side), give IV fluid bolus, apply oxygen, stop oxytocin, and consider terbutaline or amnioinfusion. Notify the provider.

Smooth, regular wave-like baseline with absent variability; associated with severe fetal anemia or hypoxia. An ominous (Category III) finding.

Instillation of warmed sterile saline into the uterus to cushion the cord and relieve recurrent variable decelerations from oligohydramnios/cord compression.

Sympathetic blockade lowers maternal BP and can reduce placental perfusion (late decelerations). Treat with IV fluids, left tilt, and ephedrine/phenylephrine.

Buttocks or feet present first; raises the risk of cord prolapse and head entrapment. Often managed by external cephalic version or planned cesarean.

Manual abdominal manipulation (around 37 weeks) to turn a breech fetus to vertex; done with monitoring and tocolysis, with cesarean readiness.

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.

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.

Untreated maternal hypothyroidism risks miscarriage, preeclampsia, and impaired fetal neurodevelopment; levothyroxine needs usually increase in 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.

Plasma volume expands more than red cell mass, diluting the hemoglobin/hematocrit; a normal finding, not true anemia.

0.4 mg daily (preconception through the first trimester) reduces neural tube defects; 4 mg if there is a prior affected pregnancy.

Pregnancy at 42 0/7 weeks or beyond; risks include placental insufficiency, oligohydramnios, meconium aspiration, and macrosomia. Increase antenatal surveillance.