Your FREE RNC-OB Flashcards 2026 – 300+ Cards

Defined by progressive cervical change (dilation/effacement) — not contractions or pain alone.

Irregular contractions with NO cervical change; eased by rest, hydration, or activity change.

Onset of regular contractions to full (10 cm) dilation. Has a latent then an active phase; the longest stage.

Early first stage: slow cervical change up to about 6 cm.

Begins at about 6 cm dilation (modern ACOG); faster, more progressive cervical change.

Full (10 cm) dilation to delivery of the baby; maternal pushing.

Birth of the baby to delivery of the placenta (usually 5-30 minutes).

The first 1-4 hours postpartum; the highest-risk window for hemorrhage.

Cord lengthening, a sudden gush of blood, and a globular, firmer uterus.

Engagement, descent, flexion, internal rotation, extension, external rotation (restitution), expulsion.

Relationship of the presenting part to the ischial spines: 0 = at the spines; negative = above; positive = below.

Thinning and shortening of the cervix, expressed as a percentage (0-100%).

Descent of the fetus into the pelvis before labor; eases breathing but increases pelvic pressure.

Passage of the blood-tinged mucus plug as the cervix begins to change; a sign labor may be near.

Systematic abdominal palpation to determine fetal lie, presentation, position, and engagement.

The relationship of the fetal spine to the maternal spine: longitudinal, transverse, or oblique.

The fetal part entering the pelvis first: cephalic (vertex), breech, or shoulder.

Head-down with the occiput presenting; the optimal and most common presentation.

Buttocks or feet present first; types are frank, complete, and footling.

Fetal occiput toward the maternal back; causes 'back labor' and may slow descent.

0-13 cervical assessment (dilation, effacement, station, consistency, position) predicting induction success.

Unfavorable cervix; ripen first with a prostaglandin or mechanical (balloon) method before oxytocin.

Favorable cervix; induction is more likely to succeed.

Prostaglandins (misoprostol, dinoprostone) or mechanical methods (Foley/Cook balloon).

Induces or augments labor; titrate carefully and watch for tachysystole and a non-reassuring tracing.

More than 5 contractions in 10 minutes averaged over 30 minutes; reduce or STOP oxytocin (never increase).

Artificial rupture of membranes; can augment labor but raises the risk of cord prolapse and infection.

Clear and odorless; assess color, odor, and amount (oligohydramnios vs polyhydramnios).

Green-tinged fluid; with a stable tracing it warrants continued monitoring, with NRP readiness at birth.

Confirm ruptured membranes: amniotic fluid turns nitrazine paper blue and ferns when dried on a slide.

Measured from the start of one contraction to the start of the next.

Measured from the beginning to the end of a single contraction.

Uterine tone between contractions; should soften (relax) to allow fetal oxygenation.

Monitor blood pressure for hypotension (sympathetic blockade causes vasodilation).

IV fluid preload/bolus, lateral positioning, and a vasopressor (ephedrine or phenylephrine) if needed.

Hypotension, one-sided or inadequate block, urinary retention, fever, high spinal, post-dural-puncture headache.

Positional headache after dural puncture; treated with hydration, caffeine, and a blood patch if severe.

A single subarachnoid injection giving rapid, dense block; commonly used for cesarean birth.

Local anesthetic to the pudendal nerve for perineal anesthesia in a vaginal birth or repair.

Self-administered inhaled analgesia that takes the edge off pain without removing it.

Provide partial relief; risk maternal/neonatal respiratory depression, so avoid near delivery.

The fetal shoulder impacts behind the pubic symphysis after the head delivers (the 'turtle sign').

The fetal head delivers then retracts tightly against the perineum; a sign of shoulder dystocia.

Help, Evaluate for episiotomy, Legs (McRoberts), Pressure (suprapubic), Enter maneuvers, Remove posterior arm, Roll (Gaskin).

Sharp hyperflexion of the maternal hips onto the abdomen; first-line for shoulder dystocia.

Use SUPRAPUBIC pressure for shoulder dystocia; fundal pressure is CONTRAINDICATED (worsens impaction).

Brachial plexus injury (Erb palsy, C5-C6) and clavicular fracture in the neonate.

The cord slips ahead of the presenting part and is compressed, cutting off fetal oxygen.

Lift the presenting part off the cord with a gloved hand; knee-chest/Trendelenburg; STAT cesarean.

Never push the cord back in; minimize handling and keep the presenting part elevated until birth.

Tearing of the uterine wall; sudden pain, loss of fetal station, and an abnormal tracing; emergent cesarean.

Prior classical (vertical) uterine incision or prior rupture; excessive oxytocin.

Sudden cardiovascular collapse, hypoxia, and DIC during labor or just after birth; supportive care and code response.

Vaginal birth after cesarean; appropriate for a prior low-transverse incision; main risk is uterine rupture.

A prior classical (vertical) uterine incision contraindicates a trial of labor after cesarean.

Non-reassuring fetal status, failure to progress, malpresentation, placenta previa, prior classical incision.

Forceps or vacuum-assisted birth; complications include lacerations and neonatal scalp/facial injury.

Limit attempts and 'pop-offs'; risks cephalohematoma and subgaleal hemorrhage.

A surgical incision of the perineum; midline or mediolateral; performed selectively, not routinely.

1st = skin/mucosa; 2nd = perineal muscle; 3rd = anal sphincter; 4th = rectal mucosa.

Labor lasting under 3 hours from onset to birth; risks lacerations, hemorrhage, and fetal hypoxia.

Greater than 3 h (nullipara) / 2 h (multipara), or +1 h each with an epidural.

Inadequate cervical change/descent in active labor; a leading indication for cesarean.

Fetal size/position too large for the maternal pelvis; can cause arrest of labor.

Manual rotation of a breech fetus to vertex, usually near term, under monitoring.

Intrapartum IV penicillin (or ampicillin) for GBS-positive patients to prevent neonatal sepsis.

Vaginal-rectal culture at 36 0/7 to 37 6/7 weeks (current ACOG).

Delivery of the fetus and placenta.

Oxytocin after delivery, controlled cord traction, and uterine massage to reduce hemorrhage.

The uterus turns inside out, often with excessive cord traction; causes hemorrhage and shock.

Excess amniotic fluid; associated with diabetes, fetal anomalies, and multiple gestation.

Too little amniotic fluid; associated with IUGR, post-dates, and renal anomalies; risk of cord compression.

Modern ACOG defines active labor at 6 cm (not the older Friedman 4 cm), allowing more time for progress.

A latent phase longer than expected; managed with rest, hydration, and support rather than immediate cesarean.

No cervical change in active labor (6+ cm) for 4 hours with adequate contractions, or 6 hours with inadequate.

About 200+ Montevideo units (or palpable strong contractions every 2-3 minutes lasting 45-60 seconds).

The widest part of the fetal head distends the vaginal opening just before birth.

Controlled delivery of the fetal head to ease it out and reduce perineal trauma.

The umbilical cord around the fetal neck at birth; usually reduced over the head or clamped and cut if tight.

Waiting 30-60+ seconds before clamping to improve neonatal iron stores; standard for vigorous newborns.

Immersion during labor/birth for comfort; requires protocols and is avoided with risk factors.

Upright, side-lying, hands-and-knees positions can ease pain and aid descent and rotation.

Continuous labor support is associated with improved birth experience and outcomes.

Inability to achieve labor/cervical change despite ripening and adequate oxytocin; may lead to cesarean.

Fully dilated cervix, ruptured membranes, engaged head with known position, and adequate anesthesia.

Spontaneous/delayed pushing is generally preferred over directed Valsalva; protect fetal oxygenation.

Record time of head delivery, maneuvers used, time to body delivery, and personnel present.

A pathologic retraction ring; a warning sign of obstructed labor and impending uterine rupture.

Expedite delivery if it does not resolve with intrauterine resuscitation; notify the provider urgently.

A tocolytic given to relax the uterus if tachysystole with a non-reassuring tracing persists after stopping oxytocin.

General anesthesia may be used when there is no time for neuraxial block; risk of aspiration and difficult airway.

Supine position after 20 weeks compresses the vena cava; use left lateral tilt to maintain cardiac output.

New hypertension (BP 140/90 or higher) after 20 weeks PLUS proteinuria or end-organ signs.

New BP 140/90 or higher after 20 weeks WITHOUT proteinuria or severe features.

Hypertension present before pregnancy or before 20 weeks; can develop superimposed preeclampsia.

BP 160/110+, platelets <100,000, elevated liver enzymes with RUQ/epigastric pain, doubled creatinine, pulmonary edema, or new headache/visual changes.

New-onset generalized tonic-clonic seizures in a patient with preeclampsia.

Hemolysis, Elevated Liver enzymes, Low Platelets; a severe variant of preeclampsia.

Prevents and treats seizures in preeclampsia with severe features and eclampsia; NOT an antihypertensive.

Given before anticipated preterm birth (before 32 weeks) to reduce the risk of cerebral palsy.

About 4-7 mEq/L for seizure prophylaxis.

Loss of deep tendon reflexes (DTRs) — before respiratory or cardiac effects.

Loss of DTRs, then respiratory depression, then cardiac arrest.

Respiratory rate below 12, absent DTRs, or urine output below 30 mL/hr.

IV calcium gluconate.

IV labetalol, IV hydralazine, or immediate-release oral nifedipine.

Avoid in maternal asthma and bradycardia (it is a beta-blocker).

Premature separation of the placenta; PAINFUL bleeding with a rigid, tender uterus.

Placenta covering the cervical os; PAINLESS bright-red bleeding; NO digital vaginal exam.

Abruption = agony (painful); previa = painless ('previa, probe never').

Hypertension, trauma, cocaine use, prior abruption, smoking.

Blood extravasating into the myometrium during a severe abruption; a bluish, boggy uterus.

Abnormal placental attachment/invasion; major hemorrhage risk; associated with prior cesarean and previa.

Glucose intolerance first recognized in pregnancy; screened at 24-28 weeks.

1-hour 50-g glucose challenge; if abnormal, a 3-hour 100-g oral glucose tolerance test.

Diet and exercise; insulin is the preferred drug when glucose targets are not met.

Macrosomia, shoulder dystocia, operative birth, and neonatal hypoglycemia.

An emergency for mother and fetus; can occur at lower glucose levels than in nonpregnant adults.

At risk for hypoglycemia (high fetal insulin), macrosomia, respiratory distress, and hypocalcemia.

Regular contractions with cervical change before 37 weeks.

Drugs that suppress contractions (nifedipine, indomethacin, terbutaline) to buy time for steroids/transfer.

Avoid after 32 weeks (risk of premature ductus arteriosus closure and oligohydramnios).

A beta-agonist tocolytic; watch for maternal tachycardia, chest pain, and pulmonary edema; short-term use.

Betamethasone or dexamethasone to accelerate fetal lung maturity in anticipated preterm birth.

12 mg IM, two doses 24 hours apart, between 24 0/7 and 33 6/7 weeks (and late-preterm in some cases).

Preterm premature rupture of membranes (before 37 weeks); risks infection, cord prolapse, and preterm birth.

Maternal fever, uterine tenderness, fetal tachycardia; treat with antibiotics and delivery.

Consumptive coagulopathy from abruption, AFE, severe HELLP, or sepsis; bleeding plus clotting.

Di-di (safest), then mono-di, then mono-mono (highest risk: cord entanglement).

Unequal placental blood sharing in monochorionic twins; one donor, one recipient.

Severe, persistent vomiting with weight loss, dehydration, and electrolyte/ketone abnormalities.

Pruritus (often palms/soles) with elevated bile acids; raises the risk of fetal demise.

Maternal anti-D antibodies attack Rh-positive fetal cells; prevented with Rh immune globulin (RhoGAM).

About 28 weeks and within 72 hours after birth of an Rh-positive infant (and after bleeding events).

Fetal weight below the 10th percentile; from placental insufficiency, hypertension, or infection.

Pregnancy beyond 42 0/7 weeks; risks macrosomia, oligohydramnios, and meconium aspiration.

Screen for alcohol, opioids, and tobacco; anticipate neonatal abstinence syndrome with opioid exposure.

Suspect with fever, tachycardia, and hypotension; early antibiotics and fluids; a leading cause of maternal death.

Aspiration of amniotic fluid for genetic testing or fetal lung maturity; small risk of loss and infection.

Painless cervical dilation in the second trimester; may be treated with a cerclage.

A surgical stitch to keep the cervix closed in cervical insufficiency.

Low-dose aspirin from 12-28 weeks for patients at high risk of preeclampsia.

Protect the airway, position safely, give magnesium sulfate, and prepare for delivery once stable.

Hemolysis (low haptoglobin, high LDH/bilirubin), elevated AST/ALT, platelets below 100,000.

Gestational begins in pregnancy; pregestational (type 1/2) predates it and carries higher anomaly risk.

Estimated fetal weight 4,000-4,500 g or more; raises the risk of shoulder dystocia and cesarean.

Gestational trophoblastic disease; high hCG, 'snowstorm' ultrasound, no viable fetus; risk of choriocarcinoma.

Implantation outside the uterus (usually tubal); unilateral pain and bleeding; an early-pregnancy emergency.

Vaginal bleeding in early pregnancy with a closed cervix and a viable pregnancy.

Most often iron-deficiency; physiologic hemodilution lowers hematocrit; raises hemorrhage risk.

Inherited/acquired clotting disorders raising VTE and pregnancy-loss risk; may need anticoagulation.

Pregnancy stresses the heart; a leading cause of maternal death; coordinate multidisciplinary care.

Heart failure late in pregnancy or postpartum with no other cause; dyspnea, edema, and fatigue.

Raises the risk of crises, infection, and fetal growth restriction; needs close monitoring.

Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes; can cause congenital infection/anomalies.

GBS colonization warrants intrapartum prophylaxis to prevent early-onset neonatal sepsis.

Autoimmune clotting disorder linked to recurrent loss; managed with aspirin and heparin.

Magnesium reduces FHR variability and can cause neonatal respiratory depression at high maternal levels.

Generally deliver at 34 weeks (or sooner if unstable); without severe features, often 37 weeks.

Continuous monitoring is essential; watch for late decelerations, bradycardia, and rising uterine tone.

Causes vasoconstriction and hypertension; strongly associated with placental abruption.

Mean FHR over 10 minutes; normal is 110-160 bpm.

Baseline below 110 bpm.

Baseline above 160 bpm; causes include maternal fever, infection, and medications.

Amplitude 6-25 bpm; reassuring ('moderate is marvelous') — rules out significant acidosis.

Amplitude 5 bpm or less; an indeterminate (Category II) finding.

Undetectable amplitude; concerning, especially with recurrent decelerations.

Amplitude greater than 25 bpm.

An abrupt FHR increase of at least 15 bpm for at least 15 seconds (10 x 10 before 32 weeks); reassuring.

Variable-Cord compression, Early-Head compression, Accelerations-Okay, Late-Placental insufficiency.

Gradual FHR drop whose nadir mirrors the contraction peak; caused by head compression; benign.

Gradual FHR drop whose nadir comes AFTER the contraction peak; uteroplacental insufficiency; worrisome.

Abrupt FHR drop (15+ bpm, 15 sec to <2 min), variable timing; caused by cord compression.

FHR drop of 15+ bpm lasting at least 2 minutes but less than 10 minutes.

A smooth, undulating wave (3-5 cycles/min) for 20+ minutes; Category III; severe fetal anemia/hypoxia.

Decelerations occurring with at least 50% of contractions in a 20-minute window.

Normal: baseline 110-160, moderate variability, no late/variable decels; predicts normal acid-base status.

Indeterminate: anything not Category I or III (about 80% of tracings); evaluate and surveil.

Abnormal: sinusoidal OR absent variability with recurrent late/variable decels or bradycardia.

Category II by itself — it becomes Category III only when paired with recurrent decels/bradycardia.

Stop oxytocin, reposition lateral, IV fluid bolus, treat hypotension; consider amnioinfusion/tocolytic.

Routine oxygen is NO longer recommended for a non-hypoxic mother; reserve it for maternal hypoxemia.

Infusing saline into the uterus to relieve recurrent variable decelerations from cord compression.

Reactive = at least 2 accelerations in 20 minutes; a reassuring sign of fetal well-being.

Scores 5 components 0/2 each: fetal tone, breathing, movement, amniotic fluid, and the NST.

Evaluates fetal response to contractions; positive = late decels with most contractions (concerning).

Assesses placental resistance; absent/reversed end-diastolic flow is ominous in IUGR.

About 7.20-7.30 at birth.

Umbilical arterial pH below 7.0.

Umbilical arterial pH below 7.0 WITH a base deficit of 12 mmol/L or more.

Normal base excess is about -2 to +2; a large base deficit indicates metabolic acidosis.

An acceleration in response to stimulation suggests the fetus is not acidotic.

Pseudosinusoidal (e.g., from narcotics) is benign; true sinusoidal is Category III (anemia/hypoxia).

'Kick counts' let the patient track fetal activity; decreased movement warrants evaluation.

The exam uses NICHD 2008 terminology, reaffirmed 2019.

A fetal scalp electrode (FSE) and intrauterine pressure catheter (IUPC) require ruptured membranes.

Measures actual contraction strength in mmHg (Montevideo units).

Sum of contraction intensities over 10 minutes; about 200+ indicates adequate labor.

Normal baseline, moderate variability, and accelerations with no late or variable decelerations (Category I).

Maternal fever/infection (chorioamnionitis), dehydration, medications, and fetal hypoxia.

Cord compression/prolapse, rapid descent, maternal hypotension, and uterine rupture.

Reposition the mother; amnioinfusion for recurrent variables from cord compression.

Intrauterine resuscitation: stop oxytocin, reposition lateral, IV bolus, treat hypotension; expedite if recurrent.

Fetal sleep cycle, prematurity, medications (opioids, magnesium), and hypoxia/acidosis.

A benign cause of temporarily decreased variability, typically lasting 20-40 minutes.

A sound stimulus to elicit a fetal acceleration and assess well-being during an NST.

An NST plus amniotic fluid index; a quicker antepartum surveillance test.

Sums fluid pockets in 4 quadrants; low AFI suggests oligohydramnios.

Absent or reversed umbilical artery end-diastolic flow signals severe placental insufficiency.

Compare arterial and venous values; metabolic acidosis (low pH + high base deficit) suggests hypoxic stress.

Assess at set intervals per protocol during active labor and second stage; more often if high risk.

An option for low-risk labor; switch to continuous EFM if abnormalities arise.

Cumulative blood loss of 1,000 mL or more (or loss with hypovolemia) within 24 hours of birth.

Tone (atony, #1), Trauma, Tissue (retained placenta), Thrombin (coagulopathy).

A soft, boggy, poorly contracting uterus; the leading cause of postpartum hemorrhage.

Massage the uterus (and ensure the bladder is empty); then give uterotonics.

Points away from atony toward trauma (laceration) or retained tissue.

The first-line uterotonic for postpartum hemorrhage.

A uterotonic CONTRAINDICATED in hypertension/preeclampsia ('Methergine maxes BP').

A uterotonic CONTRAINDICATED in asthma ('Hemabate hits asthma').

A backup uterotonic; common side effects are fever and shivering.

An antifibrinolytic for PPH; give early, ideally within 3 hours of onset.

Bakri balloon/uterine packing, uterine artery embolization, B-Lynch suture, and hysterectomy if refractory.

Oxytocin, then methylergonovine, then carboprost, then misoprostol (matched to patient contraindications).

Measuring rather than estimating blood loss improves early PPH recognition.

Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy/perineum, Homans/extremities, Emotions.

The uterus descends about 1 cm (one fingerbreadth) per day after birth.

About at the umbilicus on day 1, descending daily; midline and firm is normal.

A fundus deviated to the side (often right) usually means a full bladder; have the patient void.

Red postpartum discharge in the first 3-4 days.

Pinkish-brown discharge from about day 4 to day 10.

Whitish-yellow discharge after about day 10, lasting up to several weeks.

Suggests infection (endometritis) or hemorrhage; assess and report.

Perineal/wound assessment: Redness, Edema, Ecchymosis, Discharge, Approximation.

Uterine infection with fever, uterine tenderness, and foul lochia; treat with antibiotics.

Pregnancy and postpartum are hypercoagulable; assess for DVT/PE; encourage early ambulation.

Persistent depressed mood/anxiety beyond 2 weeks postpartum; screen and refer.

Transient mood swings/tearfulness in the first 1-2 weeks; self-limited (vs depression/psychosis).

A psychiatric emergency with delusions/hallucinations; risk of harm to self or infant.

Appearance, Pulse, Grimace, Activity, Respiration; each 0-2, scored at 1 and 5 minutes.

7-10 reassuring, 4-6 moderately depressed, 0-3 severely depressed; describes condition, does not drive NRP.

HR 110-160, respirations 30-60, temperature 36.5-37.5 C (axillary).

The algorithm guiding newborn resuscitation: warm/dry/stimulate, then PPV, then compressions.

Start PPV if the newborn is apneic/gasping or HR is below 100; the key step in most resuscitations.

Begin if HR stays below 60 despite effective PPV; ratio 3:1 (90 compressions + 30 breaths/min).

Newborn heat loss raising oxygen and glucose use; can cause hypoglycemia and respiratory distress.

Evaporation, conduction, convection, and radiation.

Infants of diabetic mothers, large- or small-for-gestational-age, and preterm/late-preterm infants.

Jitteriness, poor feeding, lethargy, temperature instability, and respiratory distress.

Scalp edema that CROSSES suture lines; resolves on its own ('caput crosses').

Subperiosteal blood BOUNDED by suture lines; raises jaundice risk ('cephalohematoma contained').

Bleeding that crosses sutures and can be life-threatening (can exsanguinate); watch after vacuum birth.

Given IM to prevent hemorrhagic disease; needed because the newborn gut lacks the bacteria that make it.

Prophylaxis against neonatal gonococcal/chlamydial eye infection.

Jaundice appearing after 24 hours; from immature bilirubin conjugation; usually benign.

Jaundice within the first 24 hours; needs evaluation (e.g., hemolysis, ABO/Rh incompatibility).

Heel-stick metabolic panel, hearing screen, and critical congenital heart disease (pulse oximetry) screen.

Anterior pituitary hormone that drives milk PRODUCTION.

Posterior pituitary hormone that drives the milk-ejection (let-down) reflex.

Production = Prolactin (anterior); Push-out (let-down) = Oxytocin (posterior).

Rooting, hand-to-mouth, lip-smacking; feed on demand, 8-12 times per day for breastfed infants.

Appropriate wet/soiled diapers, weight regain by 2 weeks, and contentment after feeds.

Painful breast fullness as milk comes in; relieved by frequent feeding, not by skipping feeds.

Breast infection with a tender, red, warm area plus fever; continue breastfeeding and treat with antibiotics.

Hemorrhage 24 hours to 12 weeks postpartum; often from retained tissue or subinvolution.

Delayed return of the uterus to its prepregnancy size; can cause late postpartum bleeding.

Concealed bleeding into tissues causing severe pain and a firm fundus; suspect with disproportionate pain.

Common after birth/epidural; a full bladder displaces the fundus and worsens bleeding.

Give RhoGAM within 72 hours if the newborn is Rh-positive.

Vaccinate postpartum (a live vaccine deferred during pregnancy); avoid pregnancy for ~1 month.

Transient bradycardia and a mild temperature rise (under 38 C in first 24 h) can be normal.

Unilateral leg pain, swelling, warmth, and redness; confirm and anticoagulate.

First 30 minutes after birth: alert, active, good time to initiate breastfeeding and bonding.

Retained lung fluid causing tachypnea; more common after cesarean; usually self-resolving.

Surfactant deficiency in preterm newborns; grunting, retractions, and nasal flaring.

Aspirated meconium causing respiratory distress; supportive care and NRP at birth.

Withdrawal in opioid-exposed newborns: tremors, irritability, poor feeding, high-pitched cry.

Early feeding for at-risk infants; IV dextrose if symptomatic or persistently low.

Bilirubin-induced brain damage from severe untreated hyperbilirubinemia.

Light therapy that converts bilirubin for excretion in significant neonatal jaundice.

Promotes thermoregulation, bonding, and breastfeeding initiation immediately after birth.

Dry the infant, use a warmer/skin-to-skin, cap the head, and avoid drafts and cold surfaces.

Rare collapse of a seemingly well term newborn; monitor positioning during early skin-to-skin.

The first breast milk: rich in antibodies and protein; small-volume, ideal early nutrition.

Standardized evidence-based practice sets (e.g., hemorrhage, severe hypertension) to reduce harm.

Readiness, Recognition, Response, and Reporting/systems learning.

The formal escalation pathway used when a patient is at risk and a provider's response is inadequate.

Structured handoff communication: Situation, Background, Assessment, Recommendation.

A non-punitive environment that encourages reporting of errors and near-misses to improve safety.

The nurse confirms understanding and witnesses consent; the provider obtains it after explaining risks/benefits.

Acting in the patient's best interest, including escalating concerns about unsafe care.

Objective, complete, timely charting; the perinatal record is a frequent legal focus.

The duty to report suspected abuse, neglect, or certain conditions to authorities.

Protects patient health information privacy and confidentiality.

Conditions (housing, access, income) that affect maternal and newborn outcomes; addressed across the outline.

Using data, drills, and core measures to close gaps and improve perinatal outcomes.

Delegate within scope and competency; the RN remains accountable for the outcome.

Requires screening and stabilization of patients (including laboring patients) regardless of ability to pay.

Providing equitable, respectful, individualized care across diverse backgrounds and birth preferences.

Standardized quality metrics (e.g., elective delivery before 39 weeks, cesarean rates) tracked for improvement.

Rehearsing emergencies (hemorrhage, shoulder dystocia, eclampsia) improves team response.

Integrating best research evidence with clinical expertise and patient values.