Nursing Bullets: Maternity and Newborn Nursing

Rapid recall for maternity and newborn nursing. Each line is one discrete, high-yield fact for the bedside and the NCLEX, covering fertilization through fetal development, labor and delivery, the postpartum window, common complications, and the newborn exam. Know normal cold so the abnormal jumps out.

Basic Maternity Concepts

1. The male sperm contributes an X or a Y chromosome; the female ovum contributes an X.
2. Fertilization produces 46 chromosomes total, an XY combination (male) or an XX combination (female).
3. Organogenesis occurs in the first trimester, specifically days 14 to 56 of gestation.
4. Implantation in the uterus occurs 6 to 10 days after fertilization.
5. The chorion is the outermost extraembryonic membrane and gives rise to the placenta.
6. The corpus luteum secretes large quantities of progesterone.
7. From the 8th week of gestation through delivery, the developing cells are a fetus.
8. The union of a male and a female gamete produces a zygote, which divides into the fertilized ovum.
9. Spermatozoa remain in the vagina for 72 hours after intercourse.
10. If the ovum is fertilized by a sperm carrying a Y chromosome, a male zygote forms.
11. Implantation occurs when the blastocyte's cellular walls implant in the endometrium, usually 7 to 9 days after fertilization.
12. Heart development begins at 2 to 4 weeks and is complete by the end of the embryonic stage.

Menstruation

13. If a patient misses a period while taking an oral contraceptive exactly as prescribed, she should keep taking it.
14. The first menstrual flow is menarche and may be anovulatory (infertile).

Breastfeeding

15. When both breasts are used, the infant usually doesn't empty the second breast, so start the next feeding on that second breast.
16. Stress, dehydration, and fatigue can reduce a breastfeeding mother's milk supply.
17. To break the infant's suction, teach the mother to insert a finger at the corner of the infant's mouth.
18. Don't give cow's milk to infants younger than age 1; it is low in linoleic acid and its protein is hard to digest.
19. After each feeding, the mother should rub a mild emollient cream or a few drops of breast milk (or colostrum) on the nipples and let the breasts air-dry to prevent cracking.
20. Breastfeeding mothers should increase fluids to 2½ to 3 qt (2,500 to 3,000 ml) daily.
21. After feeding an infant with a cleft lip or palate, rinse the mouth with sterile water.
22. HIV has been cultured in breast milk and can be transmitted by an HIV-positive mother who breastfeeds.
23. Colostrum, the precursor of milk, is the first secretion from the breasts after delivery.
24. Let the infant breastfeed until satisfied; this may take 5 to 20 minutes.
25. Most drugs a breastfeeding mother takes appear in breast milk.
26. Prolactin stimulates and sustains milk production.
27. A premature neonate born at 32 weeks gestation can be breastfed if the mother expresses milk and feeds by gavage.
28. A mother with a positive HIV test should not breastfeed.
29. Hot compresses relieve breast tenderness after breastfeeding.
30. Unlike formula, breast milk provides maternal antibodies.

Neonatal Care

31. Initial weight loss for a healthy neonate is 5% to 10% of birth weight.
32. Normal neonatal hemoglobin is 17 to 20 g/dl.
33. A neonate's head circumference is normally 2 to 3 cm greater than the chest.
34. After delivery, the first nursing action is to establish the neonate's airway.
35. Neonatal urine specific gravity is 1.003 to 1.030; lower suggests overhydration, higher suggests dehydration.
36. During the first hour after birth (the period of reactivity), the neonate is alert and awake.
37. The neonatal period runs from birth to day 28, also called the first 4 weeks or first month of life.
38. A low-birth-weight neonate weighs 2,500 g (5 lb 8 oz) or less at birth.
39. A very-low-birth-weight neonate weighs 1,500 g (3 lb 5 oz) or less at birth.
40. High oxygen levels in a premature neonate can cause blindness from retrolental fibroplasia.
41. An Apgar score of 7 to 10 indicates no immediate distress, 4 to 6 moderate distress, and 0 to 3 severe distress.
42. To elicit Moro's reflex, hold the neonate and gently drop the head backward; normally the neonate abducts and extends all extremities symmetrically, forms a C with the thumb and forefinger, then adducts and flexes them.
43. If jaundice is suspected, examine the infant under natural window light; if unavailable, use a white light.
44. Vitamin K is given to neonates to prevent hemorrhagic disorders because the neonatal intestine can't synthesize it.
45. Variability is any change in the fetal heart rate (FHR) from its normal 120 to 160 beats/minute; acceleration is increased FHR, deceleration is decreased FHR.
46. Fetal alcohol syndrome presents in the first 24 hours and produces lethargy, seizures, poor sucking, abdominal distention, and respiratory difficulty.
47. Heroin withdrawal in a neonate may begin several hours to 4 days after birth.
48. Methadone withdrawal may begin 7 days to several weeks after birth.
49. Cardinal signs of narcotic withdrawal: coarse flapping tremors, sleepiness, restlessness, a prolonged high-pitched cry, and irritability.
50. Count a neonate's respirations for 1 full minute.
51. Chlorpromazine (Thorazine) is used for neonates addicted to narcotics.
52. Provide a dark, quiet environment for a neonate in narcotic withdrawal.
53. Drugs for neonatal withdrawal include phenobarbital (Luminal), camphorated opium tincture (paregoric), and diazepam (Valium).
54. Signs of respiratory distress in a premature neonate: nostril flaring, substernal retractions, and inspiratory grunting.
55. Respiratory distress syndrome (hyaline membrane disease) develops in premature infants because their pulmonary alveoli lack surfactant.
56. Put every infant down to sleep on the back. Remember "back to sleep."
57. Water makes up about 78% to 80% of a neonate's body.
58. For nasotracheal suctioning in an infant, position with the neck slightly hyperextended in a "sniffing" position, chin up and head tilted back slightly.
59. After birth, tie the umbilical cord 1″ (2.5 cm) from the abdominal wall with a cotton cord, plastic clamp, or rubber band.
60. For umbilical cord care, clean the area with a cotton ball saturated with alcohol after every diaper change to prevent infection and promote drying.
61. Ortolani's sign (an audible click or palpable jerk with thigh abduction) confirms congenital hip dislocation.
62. Cutis marmorata is mottling or purple discoloration, a transient vasomotor response to cold seen mainly in the arms and legs.
63. The first immunization for a neonate is the hepatitis B vaccine, given in the nursery shortly after birth.
64. Infants with Down syndrome typically show marked hypotonia, floppiness, slanted eyes, excess skin at the back of the neck, a flattened nasal bridge, flat facies, spade-like hands, short broad feet, small male genitalia, absent Moro's reflex, and a simian crease.
65. Erythromycin is instilled in a neonate's eyes to prevent blindness from gonorrhea or chlamydia.
66. A fever in the first 24 hours postpartum is most likely dehydration, not infection.
67. Preterm neonates, or any neonate who can't maintain a skin temperature of at least 97.6° F (36.4° C), need an incubator (Isolette) or radiant warmer; in a radiant warmer a heat-sensitive skin probe activates the heater automatically.
68. Cesarean-born neonates have a higher incidence of respiratory distress syndrome.
69. During phototherapy, cover the neonate's eyes and genital area.
70. Naloxone (Narcan) may be given to a neonate to reverse respiratory depression from narcotics given to the mother during labor.
71. Signs of respiratory distress syndrome in a neonate: expiratory grunting or whining, sandpaper breath sounds, and seesaw retractions.
72. Cerebral palsy presents as asymmetrical movement, irritability, and excessive feeble crying in a long, thin infant.
73. Assess a breech-birth neonate for hydrocephalus, hematomas, fractures, and other birth-trauma anomalies.
74. Long, brittle fingernails are a sign of postmaturity.
75. Desquamation (skin peeling) is common in postmature neonates.
76. Neonates born to mothers who smoke average 6 oz (170 g) less than those of nonsmokers.
77. Jaundice in the first 24 hours is pathological jaundice and a sign of erythroblastosis fetalis.
78. Lanugo covers the fetus until about 20 weeks gestation, then disappears from the face, trunk, arms, and legs in that order.
79. Neonatal hypoglycemia causes temperature instability, hypotonia, jitteriness, and seizures; premature, postmature, small-for-gestational-age, and large-for-gestational-age neonates are at risk.
80. Neonates need about 50 to 55 cal per pound of body weight daily.
81. During FHR monitoring, variable decelerations indicate umbilical cord compression or prolapse.
82. A neonate whose mother has diabetes should be assessed for hyperinsulinism.
83. To assess jaundice, blanch the tip of the nose or the area just above the umbilicus.
84. Milia may appear as pinpoint spots over a neonate's nose.
85. Strabismus is a normal finding in a neonate.
86. Rubella in pregnancy, especially the first trimester, can cause spontaneous abortion, stillbirth, or fetal cardiac and other birth defects.
87. The Apgar score assesses vital functions at 1 minute and 5 minutes after delivery, scoring respiratory effort, heart rate, muscle tone, reflex irritability, and color.
88. Erythromycin at birth prevents ophthalmia neonatorum.
89. Normal neonatal blood glucose is 45 to 90 mg/dl.
90. Hepatitis B vaccine is usually given within 48 hours of birth.
91. Hepatitis B immune globulin is usually given within 12 hours of birth.
92. Boys born with hypospadias should not be circumcised at birth; the foreskin may be needed for reconstructive surgery.
93. In neonates, cold stress affects the circulatory, regulatory, and respiratory systems.
94. Fetal embodiment is a maternal developmental task of the second trimester; the mother may say she never sleeps because the fetus thumps whenever she tries.
95. Mongolian spots range from brown to blue depending on melanocyte depth and most often appear across the sacrum, buttocks, and legs.
96. Mongolian spots are common in non-white infants and usually disappear by age 2 to 3 years.
97. Vernix caseosa is a cheeselike substance that protects fetal skin in utero; it may be rubbed in or washed away within one or two baths.
98. Caput succedaneum is edema in and under the fetal scalp from labor; it resolves on its own, poses no danger, and does not cross the suture line.
99. Nevus flammeus (port-wine stain) is a diffuse pink to dark bluish-red lesion on the face or neck.
100. The Guthrie test (PKU screen) is most reliable between the second and sixth days after birth and after the neonate has ingested protein.
101. To assess sucking and swallowing coordination, observe the neonate's first breastfeeding or sterile-water bottle feeding.
102. To establish a milk supply, breastfeed at least every 4 hours; during the first month, breastfeed 8 to 12 times daily (demand feeding).
103. Wear gloves when handling the neonate until after the first bath to avoid contact with blood and body fluids.
104. If a breastfed infant is content with good skin turgor, adequate wet diapers, and normal weight gain, the milk supply is adequate.
105. In the supine position, the enlarged uterus impairs venous return from the lower body, causing supine hypotensive (inferior vena cava) syndrome.
106. Tocolytics for preterm labor include terbutaline (Brethine), ritodrine (Yutopar), and magnesium sulfate.
107. Hyperemesis gravidarum may require hospitalization for dehydration and starvation.
108. Diaphragmatic hernia is one of the most urgent neonatal surgical emergencies; by compressing the lungs and heart it can cause respiratory distress shortly after birth.
109. Complications of early pregnancy (up to 20 weeks gestation) include fetal loss and serious threats to maternal health.
110. If the neonate is stable, let the mother breastfeed within the first hour of life.
111. Check the neonate's temperature every 1 to 2 hours until it stays within normal limits.
112. At birth a neonate normally weighs 5 to 9 lb (2 to 4 kg), measures 18″ to 22″ (45.5 to 56 cm), has a head circumference of 13½″ to 14″ (34 to 35.5 cm), and a chest circumference 1″ (2.5 cm) less than the head.
113. Normal neonatal temperature ranges 98° to 99° F (36.7° to 37.2° C), apical pulse averages 120 to 160 beats/minute, and respirations are 40 to 60 breaths/minute.
114. The diamond-shaped anterior fontanel usually closes between ages 12 and 18 months; the triangular posterior fontanel closes by age 2 months.
115. A straight spine is normal; a tuft of hair over the spine is abnormal.
116. Prostaglandin gel may be applied to the vagina or cervix to ripen an unfavorable cervix before oxytocin (Pitocin) induction.
117. Supernumerary nipples occasionally appear along a line from each axilla through the normal nipple to the groin.
118. Meconium collects in the fetal intestines and forms the neonate's first feces, which are black and tarry.
119. Meconium in the amniotic fluid during labor signals possible fetal distress and the need to evaluate for meconium aspiration.
120. To assess the rooting reflex, touch the cheek or corner of the mouth; the neonate turns toward the stimulus, opens the mouth, and searches.
121. Harlequin sign is present when a side-lying neonate is red on the dependent side and pale on the upper side.
122. Because of the anti-insulin effect of placental hormones, insulin requirements rise during the third trimester.
123. Gestational age can be estimated by ultrasound measurement of maternal abdominal circumference, fetal femur length, and fetal head size; these are most accurate between 12 and 18 weeks gestation.
124. Skeletal abnormalities and ventricular septal defects are the most common disorders in infants of diabetic mothers; congenital malformation is three times higher than in infants of nondiabetic women.
125. Preeclampsia often shows puffiness around the eyes or hand edema ("I can't put my wedding ring on").
126. Kegel exercises contract and relax the perineal muscles, strengthening pelvic muscles and improving urine control postpartum.
127. Postpartum depression ranges from mild postpartum blues to intense suicidal depressive psychosis.
128. The preterm neonate may need gavage feedings because of a weak or uncoordinated suck or respiratory distress.
129. Acrocyanosis (blue, cool arms and legs) is normal in neonates because of immature peripheral circulation.
130. To prevent ophthalmia neonatorum (severe eye infection from maternal gonorrhea), instill one of three drugs as prescribed: tetracycline, silver nitrate, or erythromycin.
131. Neonatal PKU testing is mandatory in most states.
132. Place the neonate in a 30-degree Trendelenburg position to facilitate mucus drainage.
133. Suction the neonate's nose and mouth as needed with a bulb syringe or suction trap.
134. To prevent heat loss, keep the neonate under a radiant warmer during suctioning and delivery-room care, then wrap in a warmed blanket for transport.
135. The umbilical cord normally has two arteries and one vein.
136. Expose only one part of an infant's body at a time during care.
137. Lightening is settling of the fetal head into the brim of the pelvis.

Prenatal Care

138. In a full-term neonate, skin creases cover two-thirds of the feet; preterm neonates have creases over less than two-thirds.
139. At 20 weeks gestation, the fundus is at the umbilicus.
140. At 36 weeks gestation, the fundus is at the lower border of the rib cage.
141. A premature neonate is born before the end of the 37th week of gestation.
142. Gravida is the number of pregnancies a woman has had, regardless of outcome.
143. Para is the number of pregnancies that reached viability, whether the fetus was delivered alive or stillborn; a fetus is viable at 20 weeks gestation.
144. A multipara has had 2 or more pregnancies that reached viability, regardless of whether the offspring were alive at birth.
145. Positive signs of pregnancy: ultrasound evidence, fetal heart tones, and fetal movement felt by the examiner (not usually present until 4 months gestation).
146. Quickening, a presumptive sign of pregnancy, occurs between 16 and 19 weeks gestation.
147. Goodell's sign is softening of the cervix.
148. Ovulation ceases during pregnancy.
149. Immunity to rubella is measured by a hemagglutination inhibition test (rubella titer), which identifies prior exposure and determines susceptibility; a titer greater than 1:8 indicates immunity.
150. For Naegele's rule, count back 3 months from the first day of the last menstrual period and add 7 days.
151. Weight gain in pregnancy averages 25 to 30 lb (11 to 13.5 kg).
152. Rubella is teratogenic in the first trimester, producing abnormalities in up to 40% of cases without interrupting the pregnancy.
153. At 12 weeks gestation, the fundus should be at the top of the symphysis pubis.
154. Chloasma, the mask of pregnancy, is pigmentation of a circumscribed area of skin, usually over the bridge of the nose and cheeks.
155. The gynecoid pelvis is most ideal for delivery; other types are platypelloid (flat), anthropoid (ape-like), and android (male-like).
156. There is no safe level of alcohol intake in pregnancy.
157. Linea nigra, a dark line from the umbilicus to the mons pubis, appears in pregnancy and fades afterward.
158. Culdoscopy visualizes the pelvic organs through the posterior vaginal fornix.
159. Teach a pregnant vegetarian to get protein from nuts, soybeans, and legumes.
160. A pregnant patient should take only prescribed prenatal vitamins; over-the-counter high-potency vitamins may harm the fetus.
161. High-sodium foods cause fluid retention, especially in pregnancy.
162. Adding fiber prevents constipation and hemorrhoids in pregnancy.
163. A pregnant woman should drink at least eight 8-oz glasses (about 2,000 ml) of water daily.
164. Cytomegalovirus is the leading cause of congenital viral infection.
165. Tocolytic therapy is indicated in premature labor but contraindicated in fetal death, fetal distress, or severe hemorrhage.
166. The biophysical profile uses ultrasonography to assess fetal well-being by measuring fetal breathing, gross body movements, fetal tone, reactive fetal heart rate (nonstress test), and amniotic fluid volume.
167. Pica, craving nonfood items such as dirt, crayons, chalk, glue, starch, or hair, may occur in pregnancy and endanger the fetus.
168. A pregnant patient should take folic acid for rapid cell division.
169. A woman taking clomiphene (Clomid) to induce ovulation should know multiple births are possible.
170. In the first trimester, avoid all drugs unless withholding them would harm the mother's health.
171. The FDA has five pregnancy drug categories by birth-defect risk: A, no evidence of risk; B, no risk in animals but no human studies; C, animal studies show an adverse effect but the drug may benefit women despite the risk; D, evidence of risk but benefits may outweigh it; and X, fetal anomalies noted and risks clearly outweigh benefits.
172. McDonald's sign, a probable sign of pregnancy, is ease in flexing the uterine body against the cervix.
173. Amenorrhea is a probable sign of pregnancy.
174. A partner should avoid forcing air into the vagina during oral sex because of air embolism risk.
175. Human chorionic gonadotropin in blood or urine is a probable sign of pregnancy.
176. Avoid radiography in pregnancy; if essential, perform it only after 36 weeks gestation.
177. A patient with ruptured membranes or vaginal bleeding should not have intercourse.
178. A pregnant staff member should not care for a patient with cytomegalovirus; the virus can reach the fetus.
179. A pregnant patient should take an iron supplement to prevent anemia.
180. First-trimester nausea and vomiting are caused by rising human chorionic gonadotropin.
181. Pregnancy averages 280 days, 40 weeks, 9 calendar months, or 10 lunar months.
182. Before a Leopold maneuver, have the patient empty her bladder.
183. Pelvic-tilt exercises help prevent or relieve backache in pregnancy.
184. Place identification bands on both mother and neonate before they leave the delivery room.
185. Dinoprostone (Cervidil) ripens the cervix.
186. Because diabetic women have more birth anomalies, an alpha-fetoprotein level may be ordered at 15 to 17 weeks gestation.
187. Painless vaginal bleeding in the last trimester may indicate placenta previa.
188. Human chorionic gonadotropin is a marker for pregnancy.
189. With advanced maternal age, Down syndrome is a common genetic problem.
190. Methergine stimulates uterine contractions.
191. Folic acid in early gestation may prevent neural tube defects.
192. A prolapsed umbilical cord shows as variable decelerations.
193. Keep a meningomyelocele sac moist with normal saline solution.
194. Fundal height at least 2 cm less than expected may mean growth retardation, missed abortion, transverse lie, or false pregnancy.
195. Fundal height more than 2 cm above expected may mean multiple gestation, polyhydramnios, uterine myomata, or a large baby.
196. A major first-trimester developmental task is accepting the pregnancy.
197. A pregnant patient with vaginal bleeding should not have a pelvic exam.
198. Early in pregnancy, glucose in the urine may reflect increased shunting of glucose to the placenta without matching renal reabsorption.
199. A patient with premature rupture of membranes is at significant infection risk if labor doesn't begin within 24 hours.
200. Infants of diabetic mothers are prone to macrosomia from increased fetal insulin production.
201. To prevent neonatal heat loss, bathe one body part at a time and keep the rest covered.
202. A cesarean delivery carries greater infection risk than vaginal birth.
203. Neonatal thrush is usually acquired from the organism during delivery through the birth canal.
204. Maternal serum alpha-fetoprotein is detectable at 7 weeks gestation and peaks in the third trimester; high levels between the 16th and 18th weeks suggest neural tube defects, low levels suggest Down syndrome.
205. Arrest of descent is failure of the fetus to descend through the pelvic cavity in labor; it is commonly associated with cephalopelvic disproportion and may require cesarean delivery.
206. A late sign of preeclampsia is epigastric pain from severe liver edema.
207. In preeclampsia, blood pressure returns to normal during the puerperal period.
208. For an estriol level, collect urine for 24 hours.
209. An estriol level assesses fetal well-being and maternal renal function and monitors a diabetes-complicated pregnancy.
210. The interval (resting phase) between contractions lets the uterus and placenta fill with blood for exchange of oxygen, carbon dioxide, and nutrients.
211. With hypertonic contractions the uterus can't relax and there is no interval, so the fetus may become hypoxic or delivery may be rapid.
212. The myometrium has elasticity (stretch while keeping tone) and contractility (synchronized shortening and lengthening).
213. During crowning, the presenting part stays visible between contractions.
214. Uterine atony is failure of the uterus to stay firmly contracted.
215. The major cause of uterine atony is a full bladder.
216. If the mother wants to breastfeed, nurse the neonate as soon as possible after delivery.
217. A smacking sound, milk dripping from the mouth, and sucking noises all signal improper latch.
218. Burp an infant before feeding to expel stomach air.
219. Continue breastfeeding on both the affected and unaffected breast in mastitis.
220. Neonates are nearsighted and focus on items held 10″ to 12″ (25 to 30.5 cm) away.
221. Low-set ears are associated with chromosomal abnormalities such as Down syndrome.
222. Meconium usually passes within the first 24 hours but may take up to 72 hours.
223. Obstetric data use the F/TPAL system:

• F/T: full-term delivery at 38 weeks or longer
• P: preterm delivery between 20 and 37 weeks
• A: abortion or loss of fetus before 20 weeks
• L: number of children living (a death needs further explanation to clarify the numbers)

224. Parity refers to the number of deliveries, not the number of infants delivered.
225. Women carrying more than one fetus should gain 35 to 45 lb (15.5 to 20.5 kg) during pregnancy.
226. The recommended iron supplement in pregnancy is 30 to 60 mg daily.
227. Six alcoholic drinks a day, or one binge in the first trimester, can cause fetal alcohol syndrome.
228. Chorionic villus sampling is done at 8 to 12 weeks of pregnancy for early identification of genetic defects.
229. In percutaneous umbilical blood sampling, a sample from the cord detects anemia, genetic defects, and blood incompatibility and assesses the need for transfusion.
230. Hemodilution of pregnancy is the rise in blood volume; the added plasma lowers the red-cell-to-plasma ratio and drops the hematocrit.
231. Visualization in pregnancy is the mother imagining and getting acquainted with the child she is carrying.
232. Mean arterial pressure greater than 100 mm Hg after 20 weeks of pregnancy is hypertension.
233. Laden's sign, an early indication of pregnancy, is softening of a spot on the anterior uterus just above the uterocervical junction.
234. In pregnancy, the abdominal line from the symphysis pubis to the umbilicus changes from linea alba to linea nigra.
235. Treat supine hypotension syndrome by having the patient lie on her left side.
236. A contributor to dependent edema in pregnancy is the rise in femoral venous pressure from 10 mm Hg (normal) to 18 mm Hg (high).
237. Facial hyperpigmentation, once called chloasma and now melasma, fades after delivery.
238. Relaxin, secreted first by the corpus luteum and later by the placenta, relaxes the connective tissue and cartilage of the symphysis pubis and the sacroiliac joint to ease fetal passage.
239. Progesterone maintains the pregnancy by inhibiting uterine motility.

Labor and Delivery

240. During labor, relieve supine hypotension (nausea, vomiting, paleness) by turning the patient on her left side.
241. In the transition phase of the first stage of labor, the cervix is dilated 8 to 10 cm and contractions occur 2 to 3 minutes apart, lasting 60 seconds.
242. The first stage of labor runs from onset to full cervical dilation at 10 cm.
243. The second stage of labor runs from full dilation to the neonate's birth.
244. The third stage of labor runs from birth to expulsion of the placenta.
245. The fourth stage of labor (postpartum stabilization) lasts up to 4 hours after the placenta delivers, stabilizing the mother after childbirth.
246. Unlike false labor, true labor produces regular rhythmic contractions, abdominal discomfort, progressive fetal descent, bloody show, and progressive effacement and dilation.
247. Floating means the presenting part is not engaged in the pelvic inlet but is freely movable (ballotable) above it.
248. Engagement means the largest diameter of the presenting part has passed through the pelvic inlet.
249. Fetal stations describe the presenting part relative to the ischial spine: -1, -2, -3, -4, or -5 cm above the spine; station -5 is at the pelvic inlet.
250. Fetal stations are also described as +1, +2, +3, +4, or +5 cm below the ischial spine; station 0 is at the level of the spine.
251. Any vaginal bleeding during pregnancy is a complication until proven otherwise.
252. If the cord can't be slipped from around the neonate's neck during delivery, clamp it with two clamps and cut between them.
253. In the first stage of labor, the side-lying position usually gives the most comfort, though any comfortable position is fine.
254. Amniotomy is artificial rupture of the amniotic membranes.
255. The three phases of a uterine contraction are increment, acme, and decrement.
256. Contraction intensity is graded by indentability of the uterine wall at peak: mild (somewhat tense), moderate, or strong (boardlike).
257. Contraction frequency, measured in minutes, is the time from the start of one contraction to the start of the next.
258. Before internal fetal monitoring, the cervix must be dilated at least 2 cm, the membranes ruptured, and the presenting part at station -1 or lower so the electrode can attach.
259. Teenage mothers are more likely to have low-birth-weight neonates because they seek prenatal care late and tend to have nutritional deficiencies.
260. The narrowest diameter of the pelvic inlet is the anteroposterior (diagonal conjugate).
261. During labor, the resting phase between contractions is at least 30 seconds.
262. The uterus grows from 2½″ (6.3 cm) before pregnancy to 12½″ (32 cm) at term.
263. To estimate the true conjugate (smallest inlet measurement), deduct 1.5 cm from the diagonal conjugate (usually 12 cm); a true conjugate of 10.5 cm lets the fetal head (usually 10 cm) pass.
264. The smallest outlet measurement is the intertuberous (transverse) diameter between the ischial tuberosities.
265. Electronic fetal monitoring assesses fetal well-being in labor; if status is questioned, fetal scalp blood pH may be sampled.
266. In an emergency delivery, apply enough pressure to the emerging head to guide descent and prevent a rapid pressure change in the molded skull.
267. Massaging the uterus stimulates contractions after the placenta delivers.
268. When a patient arrives in active labor, the nurse's first action is to listen for fetal heart tones.
269. Nitrazine paper tests the pH of vaginal discharge to detect amniotic fluid.
270. A pregnant patient normally gains 2 to 5 lb (1 to 2.5 kg) in the first trimester and slightly under 1 lb (0.5 kg) per week in the last two trimesters.
271. Precipitate labor lasts about 3 hours and ends with delivery.
272. For excessive uterine bleeding, 0.2 mg of methylergonovine (Methergine) is injected I.V. over 1 minute while blood pressure and contractions are monitored.
273. Braxton Hicks contractions are felt in the abdomen and cause no cervical change; true contractions are felt in the front of the abdomen and back and cause progressive dilation and effacement.
274. For late decelerations (fetal hypoxia), turn the mother to her left side, give 8 to 10 L of oxygen per minute by mask or cannula, and notify the physician; the left side-lying position relieves pressure on the inferior vena cava.
275. Oxytocin (Pitocin) promotes lactation and uterine contractions.
276. Because oxytocin (Pitocin) drives powerful contractions during labor, give it under close observation to prevent maternal and fetal distress.
277. Molding is the fetal head changing shape to move through the birth canal.
278. If a woman becomes hypotensive during labor, increase the I.V. fluid rate as prescribed.
279. During fetal heart monitoring, early deceleration is caused by head compression during labor.
280. After the placenta delivers, oxytocin (Pitocin) may be added to the I.V. as prescribed to promote involution and stimulate lactation.
281. Cervical suturing to reinforce an incompetent cervix is usually done between 14 and 18 weeks gestation and removed by 35 weeks.
282. The mechanics of delivery: engagement, descent and flexion, internal rotation, extension, external rotation, restitution, and expulsion.
283. Contraction duration is timed from when the uterine muscle begins to tense to full relaxation, measured in seconds.
284. Fetal demise is death of the fetus after viability.
285. The most common method of inducing labor after artificial rupture of membranes is oxytocin (Pitocin) infusion.
286. After the membranes rupture, the first nursing action is to assess the fetal heart rate.
287. Common reasons for cesarean birth: malpresentation, fetal distress, cephalopelvic disproportion, pregnancy-induced hypertension, previous cesarean, and inadequate labor progress.
288. Amniocentesis raises the risk of spontaneous abortion, fetal or placental trauma, premature labor, infection, and Rh sensitization of the fetus.
289. After amniocentesis, abdominal cramping or spontaneous vaginal bleeding may signal complications.
290. To prevent Rh antibody formation, an Rh-negative primigravida should receive Rho(D) immune globulin (RhoGAM) after delivering an Rh-positive neonate.
291. When a patient's membranes have broken, check fetal heart tones first, then maternal vital signs.
292. Crowning is the appearance of the fetal head when its largest diameter is encircled by the vulvovaginal ring.
293. Subinvolution may occur if the bladder is distended after delivery.
294. For an extramural delivery (outside a normal delivery center), neonatal priorities are a patent airway, supported breathing, monitored vital signs, and adequate body temperature.
295. Stop oxytocin (Pitocin) if contractions last 90 seconds or longer.
296. If a patient's rubella titer is less than 1:8, immunize her after delivery.
297. During the transition phase, the woman is usually irritable and restless.
298. Maternal hypotension is a complication of spinal block.
299. Determine the mother's Rh factor before amniocentesis.
300. With early maternal age, cephalopelvic disproportion is common.
301. Spontaneous rupture of membranes raises the risk of a prolapsed umbilical cord.

Postpartum Care

302. Lochia rubra is nearly pure blood in the first few days after childbirth.
303. Lochia serosa is the serous discharge 4 to 7 days after childbirth.
304. Lochia alba, the final stage, is decreased blood with increased leukocytes, 7 to 10 days after childbirth.
305. After delivery, a multiparous woman bleeds more easily than a primiparous one because overstretched uterine muscles may not contract well.
306. Suggest ambulation for a postpartum patient with gas pain and flatulence.
307. Methylergonovine (Methergine), an oxytocic, prevents and treats postpartum hemorrhage from uterine atony or subinvolution.
308. After a stillbirth, let the mother hold the neonate to help her come to terms with the death.
309. After a spinal block before delivery, monitor blood pressure closely.
310. A postpartum patient may resume intercourse after the perineal or uterine wounds heal, usually within 4 weeks of delivery.
311. If a pregnant patient's results are negative for glucose but positive for acetone, assess the diet for inadequate caloric intake.
312. The direct antiglobulin (direct Coombs') test detects maternal antibodies attached to red blood cells in the neonate.
313. Before discharge after an abortion, tell the patient to report bright-red clots, bleeding longer than 7 days, or signs of infection such as a temperature greater than 100° F (37.8° C), foul-smelling vaginal discharge, severe uterine cramping, nausea, or vomiting.
314. Massage the fundus to stimulate uterine contraction and prevent hemorrhage.
315. Laceration of the vagina, cervix, or perineum produces bright-red bleeding that often spurts and continues even when the fundus is firm.
316. To avoid puncturing the placenta, do not perform a vaginal exam on a bleeding pregnant patient.
317. Postpartum hemorrhage from uterine atony should be treated with oxytocin as prescribed.
318. After delivery, if the fundus is boggy and deviated to the right, have the patient empty her bladder.
319. In the early postpartum period, the fundus should be midline at the umbilicus.

Pregnancy Complications

320. An ectopic pregnancy implants abnormally, outside the uterus.
321. A habitual aborter has had 3 or more consecutive spontaneous abortions.
322. Threatened abortion is bleeding without cervical dilation.
323. A complete abortion expels all products of conception.
324. Hydramnios (polyhydramnios) is excessive amniotic fluid, more than 2,000 ml in the third trimester.
325. In an incomplete abortion, the fetus is expelled but parts of the placenta and membrane remain in the uterus.
326. With undiagnosed vaginal bleeding, avoid a vaginal exam until ultrasonography rules out placenta previa.
327. A ruptured ectopic pregnancy causes sharp lower-abdominal pain with spotting and cramping, and may bring abdominal rigidity; rapid, shallow respirations; tachycardia; and shock.
328. A 16-year-old who is pregnant is at risk for a low-birth-weight neonate.
329. Don't give rubella vaccine to a pregnant woman; give it after delivery and tell her to avoid pregnancy for 3 months.

Nonstress Test

330. A nonstress test is nonreactive (positive) if fewer than 2 fetal heart rate accelerations of at least 15 beats/minute occur in 20 minutes.
331. A nonstress test is reactive (negative) if 2 or more fetal heart rate accelerations of 15 beats/minute above baseline occur in 20 minutes.
332. A nonstress test assesses fetal well-being in a prolonged pregnancy (42 weeks or more), diabetes, a history of poor pregnancy outcomes, or pregnancy-induced hypertension.

Placental Abnormalities

333. Placenta previa is abnormally low implantation so the placenta encroaches on or covers the cervical os.
334. In complete (total) placenta previa, the placenta fully covers the cervical os.
335. In partial (incomplete or marginal) placenta previa, the placenta covers only part of the cervical os.
336. Abruptio placentae is premature separation of a normally implanted placenta; partial or complete, it usually causes abdominal pain, vaginal bleeding, and a boardlike abdomen.
337. In placenta previa, bleeding is painless and seldom fatal on the first occasion but becomes heavier with each subsequent episode.
338. For placenta previa, position the patient on her left side for maximum fetal perfusion, monitor fetal heart tones, and give I.V. fluids and oxygen as ordered.
339. Treatment for abruptio placentae is usually immediate cesarean delivery.
340. The classic difference: abruptio placentae causes pain, whereas placenta previa causes painless bleeding.
341. Because the placenta acts as a fetal lung, anything that interrupts blood flow to or from it raises fetal partial pressure of arterial carbon dioxide and lowers fetal pH.

Preeclampsia

342. Pregnancy-induced hypertension is a leading cause of maternal death in the United States.
343. Pregnancy-induced hypertension (preeclampsia) is a rise in blood pressure of 30/15 mm Hg over baseline, or blood pressure of 140/95 mmHg on two occasions at least 6 hours apart, with edema and albuminuria after 20 weeks gestation.
344. The classic triad of preeclampsia is hypertension, edema, and proteinuria; severe disease adds hyperreflexia, cerebral and vision disturbances, and epigastric pain.
345. After giving magnesium sulfate for hypertension or preterm labor, monitor respiratory rate and deep tendon reflexes.
346. Eclampsia is seizures not caused by a cerebral disorder in a patient with pregnancy-induced hypertension.
347. In preeclampsia, epigastric pain is a late symptom needing immediate medical intervention.
348. Preeclampsia may progress to eclampsia, marked by seizures and possible coma.
349. HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome is an unusual variant of pregnancy-induced hypertension.

Contraceptives

350. A contraceptive's failure rate is based on the experience of 100 women for 1 year, expressed as pregnancies per 100 woman-years.
351. Before providing a sperm count specimen, the patient should avoid ejaculation for 48 to 72 hours.
352. If a patient misses two consecutive periods on an oral contraceptive, she should stop it and take a pregnancy test.
353. If a patient on an oral contraceptive misses a dose, she should take it as soon as she remembers, or take two at the next scheduled interval and continue normally.
354. If a patient misses two consecutive doses, she should double the dose for 2 days, resume the normal schedule, and use a backup birth control method for 1 week.