- True labor
- Defined by progressive cervical change (dilation/effacement) — not contractions or pain alone.
- False labor (Braxton Hicks)
- Irregular contractions with NO cervical change; eased by rest, hydration, or activity change.
- First stage of labor
- Onset of regular contractions to full (10 cm) dilation. Has a latent then an active phase; the longest stage.
- Latent phase
- Early first stage: slow cervical change up to about 6 cm.
- Active phase of labor
- Begins at about 6 cm dilation (modern ACOG); faster, more progressive cervical change.
- Second stage of labor
- Full (10 cm) dilation to delivery of the baby; maternal pushing.
- Third stage of labor
- Birth of the baby to delivery of the placenta (usually 5-30 minutes).
- Fourth stage of labor
- The first 1-4 hours postpartum; the highest-risk window for hemorrhage.
- Signs of placental separation
- Cord lengthening, a sudden gush of blood, and a globular, firmer uterus.
- Cardinal movements of labor
- Engagement, descent, flexion, internal rotation, extension, external rotation (restitution), expulsion.
- Fetal station
- Relationship of the presenting part to the ischial spines: 0 = at the spines; negative = above; positive = below.
- Effacement
- Thinning and shortening of the cervix, expressed as a percentage (0-100%).
- Lightening
- Descent of the fetus into the pelvis before labor; eases breathing but increases pelvic pressure.
- Bloody show
- Passage of the blood-tinged mucus plug as the cervix begins to change; a sign labor may be near.
- Leopold maneuvers
- Systematic abdominal palpation to determine fetal lie, presentation, position, and engagement.
- Fetal lie
- The relationship of the fetal spine to the maternal spine: longitudinal, transverse, or oblique.
- Fetal presentation
- The fetal part entering the pelvis first: cephalic (vertex), breech, or shoulder.
- Vertex presentation
- Head-down with the occiput presenting; the optimal and most common presentation.
- Breech presentation
- Buttocks or feet present first; types are frank, complete, and footling.
- Occiput posterior (OP) position
- Fetal occiput toward the maternal back; causes 'back labor' and may slow descent.
- Bishop score
- 0-13 cervical assessment (dilation, effacement, station, consistency, position) predicting induction success.
- Bishop score 6 or less
- Unfavorable cervix; ripen first with a prostaglandin or mechanical (balloon) method before oxytocin.
- Bishop score 8 or more
- Favorable cervix; induction is more likely to succeed.
- Cervical ripening agents
- Prostaglandins (misoprostol, dinoprostone) or mechanical methods (Foley/Cook balloon).
- Oxytocin (Pitocin)
- Induces or augments labor; titrate carefully and watch for tachysystole and a non-reassuring tracing.
- Tachysystole
- More than 5 contractions in 10 minutes averaged over 30 minutes; reduce or STOP oxytocin (never increase).
- Amniotomy (AROM)
- Artificial rupture of membranes; can augment labor but raises the risk of cord prolapse and infection.
- Normal amniotic fluid
- Clear and odorless; assess color, odor, and amount (oligohydramnios vs polyhydramnios).
- Meconium-stained fluid
- Green-tinged fluid; with a stable tracing it warrants continued monitoring, with NRP readiness at birth.
- Nitrazine / fern test
- Confirm ruptured membranes: amniotic fluid turns nitrazine paper blue and ferns when dried on a slide.
- Contraction frequency
- Measured from the start of one contraction to the start of the next.
- Contraction duration
- Measured from the beginning to the end of a single contraction.
- Resting tone
- Uterine tone between contractions; should soften (relax) to allow fetal oxygenation.
- Epidural anesthesia priority
- Monitor blood pressure for hypotension (sympathetic blockade causes vasodilation).
- Epidural-related hypotension treatment
- IV fluid preload/bolus, lateral positioning, and a vasopressor (ephedrine or phenylephrine) if needed.
- Complications of epidural
- Hypotension, one-sided or inadequate block, urinary retention, fever, high spinal, post-dural-puncture headache.
- Post-dural-puncture headache
- Positional headache after dural puncture; treated with hydration, caffeine, and a blood patch if severe.
- Spinal anesthesia
- A single subarachnoid injection giving rapid, dense block; commonly used for cesarean birth.
- Pudendal block
- Local anesthetic to the pudendal nerve for perineal anesthesia in a vaginal birth or repair.
- Nitrous oxide in labor
- Self-administered inhaled analgesia that takes the edge off pain without removing it.
- IV opioids in labor
- Provide partial relief; risk maternal/neonatal respiratory depression, so avoid near delivery.
- Shoulder dystocia
- The fetal shoulder impacts behind the pubic symphysis after the head delivers (the 'turtle sign').
- Turtle sign
- The fetal head delivers then retracts tightly against the perineum; a sign of shoulder dystocia.
- HELPERR mnemonic
- Help, Evaluate for episiotomy, Legs (McRoberts), Pressure (suprapubic), Enter maneuvers, Remove posterior arm, Roll (Gaskin).
- McRoberts maneuver
- Sharp hyperflexion of the maternal hips onto the abdomen; first-line for shoulder dystocia.
- Suprapubic vs fundal pressure
- Use SUPRAPUBIC pressure for shoulder dystocia; fundal pressure is CONTRAINDICATED (worsens impaction).
- Shoulder dystocia complications
- Brachial plexus injury (Erb palsy, C5-C6) and clavicular fracture in the neonate.
- Umbilical cord prolapse
- The cord slips ahead of the presenting part and is compressed, cutting off fetal oxygen.
- Cord prolapse first action
- Lift the presenting part off the cord with a gloved hand; knee-chest/Trendelenburg; STAT cesarean.
- Cord prolapse - what NOT to do
- Never push the cord back in; minimize handling and keep the presenting part elevated until birth.
- Uterine rupture
- Tearing of the uterine wall; sudden pain, loss of fetal station, and an abnormal tracing; emergent cesarean.
- Uterine rupture risk factor
- Prior classical (vertical) uterine incision or prior rupture; excessive oxytocin.
- Amniotic fluid embolism
- Sudden cardiovascular collapse, hypoxia, and DIC during labor or just after birth; supportive care and code response.
- VBAC
- Vaginal birth after cesarean; appropriate for a prior low-transverse incision; main risk is uterine rupture.
- TOLAC contraindication
- A prior classical (vertical) uterine incision contraindicates a trial of labor after cesarean.
- Cesarean birth indications
- Non-reassuring fetal status, failure to progress, malpresentation, placenta previa, prior classical incision.
- Operative vaginal birth
- Forceps or vacuum-assisted birth; complications include lacerations and neonatal scalp/facial injury.
- Vacuum extraction caution
- Limit attempts and 'pop-offs'; risks cephalohematoma and subgaleal hemorrhage.
- Episiotomy
- A surgical incision of the perineum; midline or mediolateral; performed selectively, not routinely.
- Perineal laceration degrees
- 1st = skin/mucosa; 2nd = perineal muscle; 3rd = anal sphincter; 4th = rectal mucosa.
- Precipitous labor
- Labor lasting under 3 hours from onset to birth; risks lacerations, hemorrhage, and fetal hypoxia.
- Prolonged second stage
- Greater than 3 h (nullipara) / 2 h (multipara), or +1 h each with an epidural.
- Failure to progress
- Inadequate cervical change/descent in active labor; a leading indication for cesarean.
- Cephalopelvic disproportion (CPD)
- Fetal size/position too large for the maternal pelvis; can cause arrest of labor.
- External cephalic version (ECV)
- Manual rotation of a breech fetus to vertex, usually near term, under monitoring.
- Group B strep (GBS) prophylaxis
- Intrapartum IV penicillin (or ampicillin) for GBS-positive patients to prevent neonatal sepsis.
- GBS screening timing
- Vaginal-rectal culture at 36 0/7 to 37 6/7 weeks (current ACOG).
- Definitive treatment of preeclampsia
- Delivery of the fetus and placenta.
- Active management of third stage
- Oxytocin after delivery, controlled cord traction, and uterine massage to reduce hemorrhage.
- Uterine inversion
- The uterus turns inside out, often with excessive cord traction; causes hemorrhage and shock.
- Hydramnios (polyhydramnios)
- Excess amniotic fluid; associated with diabetes, fetal anomalies, and multiple gestation.
- Oligohydramnios
- Too little amniotic fluid; associated with IUGR, post-dates, and renal anomalies; risk of cord compression.
- Preeclampsia
- New hypertension (BP 140/90 or higher) after 20 weeks PLUS proteinuria or end-organ signs.
- Gestational hypertension
- New BP 140/90 or higher after 20 weeks WITHOUT proteinuria or severe features.
- Chronic hypertension in pregnancy
- Hypertension present before pregnancy or before 20 weeks; can develop superimposed preeclampsia.
- Preeclampsia severe features
- BP 160/110+, platelets <100,000, elevated liver enzymes with RUQ/epigastric pain, doubled creatinine, pulmonary edema, or new headache/visual changes.
- Eclampsia
- New-onset generalized tonic-clonic seizures in a patient with preeclampsia.
- HELLP syndrome
- Hemolysis, Elevated Liver enzymes, Low Platelets; a severe variant of preeclampsia.
- Magnesium sulfate purpose
- Prevents and treats seizures in preeclampsia with severe features and eclampsia; NOT an antihypertensive.
- Magnesium for neuroprotection
- Given before anticipated preterm birth (before 32 weeks) to reduce the risk of cerebral palsy.
- Magnesium therapeutic range
- About 4-7 mEq/L for seizure prophylaxis.
- Earliest sign of magnesium toxicity
- Loss of deep tendon reflexes (DTRs) — before respiratory or cardiac effects.
- Magnesium toxicity order
- Loss of DTRs, then respiratory depression, then cardiac arrest.
- Hold magnesium if
- Respiratory rate below 12, absent DTRs, or urine output below 30 mL/hr.
- Magnesium toxicity antidote
- IV calcium gluconate.
- Severe-range BP treatment in pregnancy
- IV labetalol, IV hydralazine, or immediate-release oral nifedipine.
- Labetalol caution
- Avoid in maternal asthma and bradycardia (it is a beta-blocker).
- Placental abruption
- Premature separation of the placenta; PAINFUL bleeding with a rigid, tender uterus.
- Placenta previa
- Placenta covering the cervical os; PAINLESS bright-red bleeding; NO digital vaginal exam.
- Abruption vs previa hook
- Abruption = agony (painful); previa = painless ('previa, probe never').
- Abruption risk factors
- Hypertension, trauma, cocaine use, prior abruption, smoking.
- Couvelaire uterus
- Blood extravasating into the myometrium during a severe abruption; a bluish, boggy uterus.
- Placenta accreta spectrum (PAS)
- Abnormal placental attachment/invasion; major hemorrhage risk; associated with prior cesarean and previa.
- Gestational diabetes (GDM)
- Glucose intolerance first recognized in pregnancy; screened at 24-28 weeks.
- GDM screening (two-step)
- 1-hour 50-g glucose challenge; if abnormal, a 3-hour 100-g oral glucose tolerance test.
- GDM first-line management
- Diet and exercise; insulin is the preferred drug when glucose targets are not met.
- GDM fetal/neonatal risks
- Macrosomia, shoulder dystocia, operative birth, and neonatal hypoglycemia.
- Diabetic ketoacidosis in pregnancy
- An emergency for mother and fetus; can occur at lower glucose levels than in nonpregnant adults.
- Infant of a diabetic mother (IDM)
- At risk for hypoglycemia (high fetal insulin), macrosomia, respiratory distress, and hypocalcemia.
- Preterm labor
- Regular contractions with cervical change before 37 weeks.
- Tocolytics
- Drugs that suppress contractions (nifedipine, indomethacin, terbutaline) to buy time for steroids/transfer.
- Indomethacin caution
- Avoid after 32 weeks (risk of premature ductus arteriosus closure and oligohydramnios).
- Terbutaline caution
- A beta-agonist tocolytic; watch for maternal tachycardia, chest pain, and pulmonary edema; short-term use.
- Antenatal corticosteroids
- Betamethasone or dexamethasone to accelerate fetal lung maturity in anticipated preterm birth.
- Betamethasone regimen
- 12 mg IM, two doses 24 hours apart, between 24 0/7 and 33 6/7 weeks (and late-preterm in some cases).
- PPROM
- Preterm premature rupture of membranes (before 37 weeks); risks infection, cord prolapse, and preterm birth.
- Chorioamnionitis (intra-amniotic infection)
- Maternal fever, uterine tenderness, fetal tachycardia; treat with antibiotics and delivery.
- Disseminated intravascular coagulation (DIC)
- Consumptive coagulopathy from abruption, AFE, severe HELLP, or sepsis; bleeding plus clotting.
- Multiple gestation risk order
- Di-di (safest), then mono-di, then mono-mono (highest risk: cord entanglement).
- Twin-twin transfusion syndrome (TTTS)
- Unequal placental blood sharing in monochorionic twins; one donor, one recipient.
- Hyperemesis gravidarum
- Severe, persistent vomiting with weight loss, dehydration, and electrolyte/ketone abnormalities.
- Intrahepatic cholestasis of pregnancy
- Pruritus (often palms/soles) with elevated bile acids; raises the risk of fetal demise.
- Rh isoimmunization
- Maternal anti-D antibodies attack Rh-positive fetal cells; prevented with Rh immune globulin (RhoGAM).
- RhoGAM timing
- About 28 weeks and within 72 hours after birth of an Rh-positive infant (and after bleeding events).
- Intrauterine growth restriction (IUGR)
- Fetal weight below the 10th percentile; from placental insufficiency, hypertension, or infection.
- Post-term pregnancy
- Pregnancy beyond 42 0/7 weeks; risks macrosomia, oligohydramnios, and meconium aspiration.
- Substance use in pregnancy
- Screen for alcohol, opioids, and tobacco; anticipate neonatal abstinence syndrome with opioid exposure.
- Sepsis in pregnancy
- Suspect with fever, tachycardia, and hypotension; early antibiotics and fluids; a leading cause of maternal death.
- Amniocentesis
- Aspiration of amniotic fluid for genetic testing or fetal lung maturity; small risk of loss and infection.
- Cervical insufficiency
- Painless cervical dilation in the second trimester; may be treated with a cerclage.
- Cerclage
- A surgical stitch to keep the cervix closed in cervical insufficiency.
- Fetal heart rate baseline
- Mean FHR over 10 minutes; normal is 110-160 bpm.
- Fetal bradycardia
- Baseline below 110 bpm.
- Fetal tachycardia
- Baseline above 160 bpm; causes include maternal fever, infection, and medications.
- Moderate variability
- Amplitude 6-25 bpm; reassuring ('moderate is marvelous') — rules out significant acidosis.
- Minimal variability
- Amplitude 5 bpm or less; an indeterminate (Category II) finding.
- Absent variability
- Undetectable amplitude; concerning, especially with recurrent decelerations.
- Marked variability
- Amplitude greater than 25 bpm.
- Acceleration
- An abrupt FHR increase of at least 15 bpm for at least 15 seconds (10 x 10 before 32 weeks); reassuring.
- VEAL CHOP
- Variable-Cord compression, Early-Head compression, Accelerations-Okay, Late-Placental insufficiency.
- Early deceleration
- Gradual FHR drop whose nadir mirrors the contraction peak; caused by head compression; benign.
- Late deceleration
- Gradual FHR drop whose nadir comes AFTER the contraction peak; uteroplacental insufficiency; worrisome.
- Variable deceleration
- Abrupt FHR drop (15+ bpm, 15 sec to <2 min), variable timing; caused by cord compression.
- Prolonged deceleration
- FHR drop of 15+ bpm lasting at least 2 minutes but less than 10 minutes.
- Sinusoidal pattern
- A smooth, undulating wave (3-5 cycles/min) for 20+ minutes; Category III; severe fetal anemia/hypoxia.
- Recurrent decelerations
- Decelerations occurring with at least 50% of contractions in a 20-minute window.
- Category I tracing
- Normal: baseline 110-160, moderate variability, no late/variable decels; predicts normal acid-base status.
- Category II tracing
- Indeterminate: anything not Category I or III (about 80% of tracings); evaluate and surveil.
- Category III tracing
- Abnormal: sinusoidal OR absent variability with recurrent late/variable decels or bradycardia.
- Absent variability alone
- Category II by itself — it becomes Category III only when paired with recurrent decels/bradycardia.
- Intrauterine resuscitation
- Stop oxytocin, reposition lateral, IV fluid bolus, treat hypotension; consider amnioinfusion/tocolytic.
- Maternal oxygen update
- Routine oxygen is NO longer recommended for a non-hypoxic mother; reserve it for maternal hypoxemia.
- Amnioinfusion
- Infusing saline into the uterus to relieve recurrent variable decelerations from cord compression.
- Nonstress test (NST)
- Reactive = at least 2 accelerations in 20 minutes; a reassuring sign of fetal well-being.
- Biophysical profile (BPP)
- Scores 5 components 0/2 each: fetal tone, breathing, movement, amniotic fluid, and the NST.
- Contraction stress test (CST)
- Evaluates fetal response to contractions; positive = late decels with most contractions (concerning).
- Umbilical artery Doppler
- Assesses placental resistance; absent/reversed end-diastolic flow is ominous in IUGR.
- Normal umbilical artery pH
- About 7.20-7.30 at birth.
- Fetal acidemia
- Umbilical arterial pH below 7.0.
- Pathologic metabolic acidosis
- Umbilical arterial pH below 7.0 WITH a base deficit of 12 mmol/L or more.
- Base excess / deficit
- Normal base excess is about -2 to +2; a large base deficit indicates metabolic acidosis.
- Fetal scalp stimulation
- An acceleration in response to stimulation suggests the fetus is not acidotic.
- Pseudosinusoidal vs sinusoidal
- Pseudosinusoidal (e.g., from narcotics) is benign; true sinusoidal is Category III (anemia/hypoxia).
- Fetal movement counting
- 'Kick counts' let the patient track fetal activity; decreased movement warrants evaluation.
- Electronic fetal monitoring terminology
- The exam uses NICHD 2008 terminology, reaffirmed 2019.
- Internal fetal monitoring
- A fetal scalp electrode (FSE) and intrauterine pressure catheter (IUPC) require ruptured membranes.
- Intrauterine pressure catheter (IUPC)
- Measures actual contraction strength in mmHg (Montevideo units).
- Montevideo units
- Sum of contraction intensities over 10 minutes; about 200+ indicates adequate labor.
- Postpartum hemorrhage (PPH)
- Cumulative blood loss of 1,000 mL or more (or loss with hypovolemia) within 24 hours of birth.
- 4 T's of PPH
- Tone (atony, #1), Trauma, Tissue (retained placenta), Thrombin (coagulopathy).
- Uterine atony
- A soft, boggy, poorly contracting uterus; the leading cause of postpartum hemorrhage.
- First action for a boggy fundus
- Massage the uterus (and ensure the bladder is empty); then give uterotonics.
- Firm fundus with bleeding
- Points away from atony toward trauma (laceration) or retained tissue.
- Oxytocin for PPH
- The first-line uterotonic for postpartum hemorrhage.
- Methylergonovine (Methergine)
- A uterotonic CONTRAINDICATED in hypertension/preeclampsia ('Methergine maxes BP').
- Carboprost (Hemabate)
- A uterotonic CONTRAINDICATED in asthma ('Hemabate hits asthma').
- Misoprostol (Cytotec)
- A backup uterotonic; common side effects are fever and shivering.
- Tranexamic acid (TXA)
- An antifibrinolytic for PPH; give early, ideally within 3 hours of onset.
- PPH escalation
- Bakri balloon/uterine packing, uterine artery embolization, B-Lynch suture, and hysterectomy if refractory.
- Uterotonic sequence
- Oxytocin, then methylergonovine, then carboprost, then misoprostol (matched to patient contraindications).
- Quantitative blood loss (QBL)
- Measuring rather than estimating blood loss improves early PPH recognition.
- BUBBLE-HE assessment
- Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy/perineum, Homans/extremities, Emotions.
- Uterine involution
- The uterus descends about 1 cm (one fingerbreadth) per day after birth.
- Fundal position after birth
- About at the umbilicus on day 1, descending daily; midline and firm is normal.
- Displaced fundus
- A fundus deviated to the side (often right) usually means a full bladder; have the patient void.
- Lochia rubra
- Red postpartum discharge in the first 3-4 days.
- Lochia serosa
- Pinkish-brown discharge from about day 4 to day 10.
- Lochia alba
- Whitish-yellow discharge after about day 10, lasting up to several weeks.
- Foul or excessive lochia
- Suggests infection (endometritis) or hemorrhage; assess and report.
- REEDA scale
- Perineal/wound assessment: Redness, Edema, Ecchymosis, Discharge, Approximation.
- Postpartum endometritis
- Uterine infection with fever, uterine tenderness, and foul lochia; treat with antibiotics.
- Postpartum VTE risk
- Pregnancy and postpartum are hypercoagulable; assess for DVT/PE; encourage early ambulation.
- Postpartum depression
- Persistent depressed mood/anxiety beyond 2 weeks postpartum; screen and refer.
- Postpartum baby blues
- Transient mood swings/tearfulness in the first 1-2 weeks; self-limited (vs depression/psychosis).
- Postpartum psychosis
- A psychiatric emergency with delusions/hallucinations; risk of harm to self or infant.
- APGAR score
- Appearance, Pulse, Grimace, Activity, Respiration; each 0-2, scored at 1 and 5 minutes.
- APGAR interpretation
- 7-10 reassuring, 4-6 moderately depressed, 0-3 severely depressed; describes condition, does not drive NRP.
- Newborn vital sign ranges
- HR 110-160, respirations 30-60, temperature 36.5-37.5 C (axillary).
- Neonatal Resuscitation Program (NRP)
- The algorithm guiding newborn resuscitation: warm/dry/stimulate, then PPV, then compressions.
- NRP positive-pressure ventilation
- Start PPV if the newborn is apneic/gasping or HR is below 100; the key step in most resuscitations.
- NRP chest compressions
- Begin if HR stays below 60 despite effective PPV; ratio 3:1 (90 compressions + 30 breaths/min).
- Cold stress
- Newborn heat loss raising oxygen and glucose use; can cause hypoglycemia and respiratory distress.
- Newborn heat-loss mechanisms
- Evaporation, conduction, convection, and radiation.
- Neonatal hypoglycemia at-risk infants
- Infants of diabetic mothers, large- or small-for-gestational-age, and preterm/late-preterm infants.
- Neonatal hypoglycemia signs
- Jitteriness, poor feeding, lethargy, temperature instability, and respiratory distress.
- Caput succedaneum
- Scalp edema that CROSSES suture lines; resolves on its own ('caput crosses').
- Cephalohematoma
- Subperiosteal blood BOUNDED by suture lines; raises jaundice risk ('cephalohematoma contained').
- Subgaleal hemorrhage
- Bleeding that crosses sutures and can be life-threatening (can exsanguinate); watch after vacuum birth.
- Newborn vitamin K
- Given IM to prevent hemorrhagic disease; needed because the newborn gut lacks the bacteria that make it.
- Erythromycin eye ointment
- Prophylaxis against neonatal gonococcal/chlamydial eye infection.
- Physiologic jaundice
- Jaundice appearing after 24 hours; from immature bilirubin conjugation; usually benign.
- Pathologic jaundice
- Jaundice within the first 24 hours; needs evaluation (e.g., hemolysis, ABO/Rh incompatibility).
- Newborn screening
- Heel-stick metabolic panel, hearing screen, and critical congenital heart disease (pulse oximetry) screen.
- Prolactin
- Anterior pituitary hormone that drives milk PRODUCTION.
- Oxytocin (lactation)
- Posterior pituitary hormone that drives the milk-ejection (let-down) reflex.
- Lactation hook
- Production = Prolactin (anterior); Push-out (let-down) = Oxytocin (posterior).
- Newborn feeding cues
- Rooting, hand-to-mouth, lip-smacking; feed on demand, 8-12 times per day for breastfed infants.
- Signs of adequate intake
- Appropriate wet/soiled diapers, weight regain by 2 weeks, and contentment after feeds.
- Engorgement
- Painful breast fullness as milk comes in; relieved by frequent feeding, not by skipping feeds.
- Mastitis
- Breast infection with a tender, red, warm area plus fever; continue breastfeeding and treat with antibiotics.
- Maternal safety bundles
- Standardized evidence-based practice sets (e.g., hemorrhage, severe hypertension) to reduce harm.
- Safety bundle framework
- Readiness, Recognition, Response, and Reporting/systems learning.
- Chain of command
- The formal escalation pathway used when a patient is at risk and a provider's response is inadequate.
- SBAR
- Structured handoff communication: Situation, Background, Assessment, Recommendation.
- Just culture
- A non-punitive environment that encourages reporting of errors and near-misses to improve safety.
- Informed consent
- The nurse confirms understanding and witnesses consent; the provider obtains it after explaining risks/benefits.
- Patient advocacy
- Acting in the patient's best interest, including escalating concerns about unsafe care.
- Perinatal documentation
- Objective, complete, timely charting; the perinatal record is a frequent legal focus.
- Mandatory reporting
- The duty to report suspected abuse, neglect, or certain conditions to authorities.
- HIPAA
- Protects patient health information privacy and confidentiality.
- Social determinants of health
- Conditions (housing, access, income) that affect maternal and newborn outcomes; addressed across the outline.
- Quality improvement
- Using data, drills, and core measures to close gaps and improve perinatal outcomes.
- Scope of practice and delegation
- Delegate within scope and competency; the RN remains accountable for the outcome.
- EMTALA
- Requires screening and stabilization of patients (including laboring patients) regardless of ability to pay.
- Cultural competence
- Providing equitable, respectful, individualized care across diverse backgrounds and birth preferences.
- Friedman vs modern labor curve
- Modern ACOG defines active labor at 6 cm (not the older Friedman 4 cm), allowing more time for progress.
- Prolonged latent phase
- A latent phase longer than expected; managed with rest, hydration, and support rather than immediate cesarean.
- Arrest of dilation
- No cervical change in active labor (6+ cm) for 4 hours with adequate contractions, or 6 hours with inadequate.
- Adequate contractions
- About 200+ Montevideo units (or palpable strong contractions every 2-3 minutes lasting 45-60 seconds).
- Crowning
- The widest part of the fetal head distends the vaginal opening just before birth.
- Ritgen maneuver
- Controlled delivery of the fetal head to ease it out and reduce perineal trauma.
- Nuchal cord
- The umbilical cord around the fetal neck at birth; usually reduced over the head or clamped and cut if tight.
- Delayed cord clamping
- Waiting 30-60+ seconds before clamping to improve neonatal iron stores; standard for vigorous newborns.
- Water birth
- Immersion during labor/birth for comfort; requires protocols and is avoided with risk factors.
- Position changes in labor
- Upright, side-lying, hands-and-knees positions can ease pain and aid descent and rotation.
- Doula support
- Continuous labor support is associated with improved birth experience and outcomes.
- Failed induction
- Inability to achieve labor/cervical change despite ripening and adequate oxytocin; may lead to cesarean.
- Forceps prerequisites
- Fully dilated cervix, ruptured membranes, engaged head with known position, and adequate anesthesia.
- Maternal pushing techniques
- Spontaneous/delayed pushing is generally preferred over directed Valsalva; protect fetal oxygenation.
- Shoulder dystocia documentation
- Record time of head delivery, maneuvers used, time to body delivery, and personnel present.
- Bandl ring
- A pathologic retraction ring; a warning sign of obstructed labor and impending uterine rupture.
- Category III tracing action
- Expedite delivery if it does not resolve with intrauterine resuscitation; notify the provider urgently.
- Terbutaline for tachysystole
- A tocolytic given to relax the uterus if tachysystole with a non-reassuring tracing persists after stopping oxytocin.
- Anesthesia for emergency cesarean
- General anesthesia may be used when there is no time for neuraxial block; risk of aspiration and difficult airway.
- Aortocaval compression
- Supine position after 20 weeks compresses the vena cava; use left lateral tilt to maintain cardiac output.
- Aspirin for preeclampsia prevention
- Low-dose aspirin from 12-28 weeks for patients at high risk of preeclampsia.
- Eclampsia seizure management
- Protect the airway, position safely, give magnesium sulfate, and prepare for delivery once stable.
- HELLP key labs
- Hemolysis (low haptoglobin, high LDH/bilirubin), elevated AST/ALT, platelets below 100,000.
- Gestational vs pregestational diabetes
- Gestational begins in pregnancy; pregestational (type 1/2) predates it and carries higher anomaly risk.
- Macrosomia
- Estimated fetal weight 4,000-4,500 g or more; raises the risk of shoulder dystocia and cesarean.
- Hydatidiform mole
- Gestational trophoblastic disease; high hCG, 'snowstorm' ultrasound, no viable fetus; risk of choriocarcinoma.
- Ectopic pregnancy
- Implantation outside the uterus (usually tubal); unilateral pain and bleeding; an early-pregnancy emergency.
- Threatened abortion
- Vaginal bleeding in early pregnancy with a closed cervix and a viable pregnancy.
- Anemia in pregnancy
- Most often iron-deficiency; physiologic hemodilution lowers hematocrit; raises hemorrhage risk.
- Thrombophilia in pregnancy
- Inherited/acquired clotting disorders raising VTE and pregnancy-loss risk; may need anticoagulation.
- Cardiac disease in pregnancy
- Pregnancy stresses the heart; a leading cause of maternal death; coordinate multidisciplinary care.
- Peripartum cardiomyopathy
- Heart failure late in pregnancy or postpartum with no other cause; dyspnea, edema, and fatigue.
- Sickle cell disease in pregnancy
- Raises the risk of crises, infection, and fetal growth restriction; needs close monitoring.
- TORCH infections
- Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes; can cause congenital infection/anomalies.
- Group B strep status
- GBS colonization warrants intrapartum prophylaxis to prevent early-onset neonatal sepsis.
- Antiphospholipid syndrome
- Autoimmune clotting disorder linked to recurrent loss; managed with aspirin and heparin.
- Magnesium and the fetus
- Magnesium reduces FHR variability and can cause neonatal respiratory depression at high maternal levels.
- Severe preeclampsia delivery timing
- Generally deliver at 34 weeks (or sooner if unstable); without severe features, often 37 weeks.
- Abruption and fetal monitoring
- Continuous monitoring is essential; watch for late decelerations, bradycardia, and rising uterine tone.
- Cocaine use in pregnancy
- Causes vasoconstriction and hypertension; strongly associated with placental abruption.
- Reassuring tracing summary
- Normal baseline, moderate variability, and accelerations with no late or variable decelerations (Category I).
- Tachycardia causes
- Maternal fever/infection (chorioamnionitis), dehydration, medications, and fetal hypoxia.
- Bradycardia causes
- Cord compression/prolapse, rapid descent, maternal hypotension, and uterine rupture.
- Variable deceleration management
- Reposition the mother; amnioinfusion for recurrent variables from cord compression.
- Late deceleration management
- Intrauterine resuscitation: stop oxytocin, reposition lateral, IV bolus, treat hypotension; expedite if recurrent.
- Decreased variability causes
- Fetal sleep cycle, prematurity, medications (opioids, magnesium), and hypoxia/acidosis.
- Fetal sleep cycle
- A benign cause of temporarily decreased variability, typically lasting 20-40 minutes.
- Vibroacoustic stimulation
- A sound stimulus to elicit a fetal acceleration and assess well-being during an NST.
- Modified biophysical profile
- An NST plus amniotic fluid index; a quicker antepartum surveillance test.
- Amniotic fluid index (AFI)
- Sums fluid pockets in 4 quadrants; low AFI suggests oligohydramnios.
- Doppler in IUGR
- Absent or reversed umbilical artery end-diastolic flow signals severe placental insufficiency.
- Cord gas interpretation
- Compare arterial and venous values; metabolic acidosis (low pH + high base deficit) suggests hypoxic stress.
- FHR monitoring frequency (low risk)
- Assess at set intervals per protocol during active labor and second stage; more often if high risk.
- Intermittent auscultation
- An option for low-risk labor; switch to continuous EFM if abnormalities arise.
- Secondary (late) PPH
- Hemorrhage 24 hours to 12 weeks postpartum; often from retained tissue or subinvolution.
- Subinvolution
- Delayed return of the uterus to its prepregnancy size; can cause late postpartum bleeding.
- Postpartum hematoma
- Concealed bleeding into tissues causing severe pain and a firm fundus; suspect with disproportionate pain.
- Postpartum urinary retention
- Common after birth/epidural; a full bladder displaces the fundus and worsens bleeding.
- Rh-negative mother postpartum
- Give RhoGAM within 72 hours if the newborn is Rh-positive.
- Rubella-nonimmune mother
- Vaccinate postpartum (a live vaccine deferred during pregnancy); avoid pregnancy for ~1 month.
- Postpartum vital sign changes
- Transient bradycardia and a mild temperature rise (under 38 C in first 24 h) can be normal.
- Postpartum DVT signs
- Unilateral leg pain, swelling, warmth, and redness; confirm and anticoagulate.
- Newborn first period of reactivity
- First 30 minutes after birth: alert, active, good time to initiate breastfeeding and bonding.
- Transient tachypnea of the newborn (TTN)
- Retained lung fluid causing tachypnea; more common after cesarean; usually self-resolving.
- Respiratory distress syndrome (RDS)
- Surfactant deficiency in preterm newborns; grunting, retractions, and nasal flaring.
- Meconium aspiration syndrome
- Aspirated meconium causing respiratory distress; supportive care and NRP at birth.
- Neonatal abstinence syndrome (NAS)
- Withdrawal in opioid-exposed newborns: tremors, irritability, poor feeding, high-pitched cry.
- Hypoglycemia treatment
- Early feeding for at-risk infants; IV dextrose if symptomatic or persistently low.
- Kernicterus
- Bilirubin-induced brain damage from severe untreated hyperbilirubinemia.
- Phototherapy
- Light therapy that converts bilirubin for excretion in significant neonatal jaundice.
- Skin-to-skin contact
- Promotes thermoregulation, bonding, and breastfeeding initiation immediately after birth.
- Newborn hypothermia prevention
- Dry the infant, use a warmer/skin-to-skin, cap the head, and avoid drafts and cold surfaces.
- Sudden unexpected postnatal collapse (SUPC)
- Rare collapse of a seemingly well term newborn; monitor positioning during early skin-to-skin.
- Colostrum
- The first breast milk: rich in antibodies and protein; small-volume, ideal early nutrition.
- Perinatal core measures
- Standardized quality metrics (e.g., elective delivery before 39 weeks, cesarean rates) tracked for improvement.
- Drills and simulation
- Rehearsing emergencies (hemorrhage, shoulder dystocia, eclampsia) improves team response.
- Evidence-based practice
- Integrating best research evidence with clinical expertise and patient values.
