Maternity and Newborn Nursing Reviewer

 The male sperm contributes an X or a Y chromosome; the female ovum contributes an X

chromosome.
 Fertilization produces a total of 46 chromosomes, including an XY combination (male) or
an XX combination (female).
 Organogenesis occurs during the first trimester of pregnancy, specifically, days 14 to 56
of gestation.
 Implantation in the uterus occurs 6 to 10 days after ovum fertilization.
 The chorion is the outermost extraembryonic membrane that gives rise to the placenta.
 The corpus luteum secretes large quantities of progesterone.
 From the 8th week of gestation through delivery, the developing cells are known as a
fetus.
 The union of a male and a female gamete produces a zygote, which divides into the
fertilized ovum.
 Spermatozoa (or their fragments) remain in the vagina for 72 hours after sexual
intercourse.
 If the ovum is fertilized by a spermatozoon carrying a Y chromosome, a male zygote is
formed.
 Implantation occurs when the cellular walls of the blastocyte implants itself in the
endometrium, usually 7 to 9 days after fertilization.
 Implantation occurs when the cellular walls of the blastocyte implants itself in the
endometrium, usually 7 to 9 days after fertilization.
 Heart development in the embryo begins at 2 to 4 weeks and is complete by the end of
the embryonic stage.

Menstruation
 If a patient misses a menstrual period while taking an oral contraceptive exactly as
prescribed, she should continue taking the contraceptive.
 The first menstrual flow is called menarche and may be anovulatory (infertile).

Breastfeeding
 When both breasts are used for breastfeeding, the infant usually doesn’t empty the
second breast. Therefore, the second breast should be used first at the next feeding.
 Stress, dehydration, and fatigue may reduce a breastfeeding mother’s milk supply.
 To help a mother break the suction of her breastfeeding infant, the nurse should teach her
to insert a finger at the corner of the infant’s mouth.
 Cow’s milk shouldn’t be given to infants younger than age one (1) because it has a low
linoleic acid content and its protein is difficult for infants to digest.
 A woman who is breastfeeding should rub a mild emollient cream or a few drops of breast
milk (or colostrum) on the nipples after each feeding. She should let the breasts air-dry to
prevent them from cracking.
 Breastfeeding mothers should increase their fluid intake to 2½ to 3 qt (2,500 to 3,000 ml)
daily.
 After feeding an infant with a cleft lip or palate, the nurse should rinse the infant’s mouth
with sterile water.
 Human immunodeficiency virus (HIV) has been cultured in breast milk and can be
transmitted by an HIV-positive mother who breast-feeds her infant.
 Colostrum, the precursor of milk, is the first secretion from the breasts after delivery.
 A mother should allow her infant to breastfeed until the infant is satisfied. The time may
vary from 5 to 20 minutes.
 Most drugs that a breastfeeding mother takes appear in breast milk.
 Prolactin stimulates and sustains milk production.
 Breastfeeding of a premature neonate born at 32 weeks gestation can be accomplished if
the mother expresses milk and feeds the neonate by gavage.
 A mother who has a positive human immunodeficiency virus test result shouldn’t
breastfeed her infant.
 Hot compresses can help to relieve breast tenderness after breastfeeding.
 Unlike formula, breast milk offers the benefit of maternal antibodies.

Neonatal Care

 The initial weight loss for a healthy neonate is 5% to 10% of birth weight.
 The normal hemoglobin value in neonates is 17 to 20 g/dl.
 The circumference of a neonate’s head is normally 2 to 3 cm greater than the
circumference of the chest.
 After delivery, the first nursing action is to establish the neonate’s airway.
 The specific gravity of a neonate’s urine is 1.003 to 1.030. A lower specific gravity
suggests overhydration; a higher one suggests dehydration.
 During the first hour after birth (the period of reactivity), the neonate is alert and
awake.
 The neonatal period extends from birth to day 28. It’s also called the first four (4)
weeks or first month of life.
 A low-birth-weight neonate weighs 2,500 g (5 lb 8 oz) or less at birth.
 A very-low-birth-weight neonate weighs 1,500 g (3 lb 5 oz) or less at birth.
 Administering high levels of oxygen to a premature neonate can cause blindness as a
result of retrolental fibroplasia.
 An Apgar score of 7 to 10 indicates no immediate distress, 4 to 6 indicates moderate
distress, and 0 to 3 indicates severe distress.
 To elicit Moro’s reflex, the nurse holds the neonate in both hands and suddenly, but
gently, drops the neonate’s head backward. Normally, the neonate abducts and extends
all extremities bilaterally and symmetrically, forms a C shape with the thumb and
forefinger, and first adducts and then flexes the extremities.
 An Apgar score of 7 to 10 indicates no immediate distress, 4 to 6 indicates moderate
distress, and 0 to 3 indicates severe distress.
 If jaundice is suspected in a neonate, the nurse should examine the infant under natural
window light. If natural light is unavailable, the nurse should examine the infant under a
white light.
 Vitamin K is administered to neonates to prevent hemorrhagic disorders because a
neonate’s intestine can’t synthesize vitamin K.
 Variability is any change in the fetal heart rate (FHR) from its normal rate of 120 to 160
beats/minute. Acceleration is increased FHR; deceleration is decreased FHR.
 Fetal alcohol syndrome presents in the first 24 hours after birth and produces lethargy,
seizures, poor sucking reflex, abdominal distention, and respiratory difficulty.
 In a neonate, the symptoms of heroin withdrawal may begin several hours to 4 days
after birth.
 In a neonate, the symptoms of methadone withdrawal may begin 7 days to several
weeks after birth.
 In a neonate, the cardinal signs of narcotic withdrawal include coarse, flapping
tremors; sleepiness; restlessness; prolonged, persistent, high-pitched cry; and irritability.
 The nurse should count a neonate’s respirations for one (1) full minute.
 Chlorpromazine (Thorazine) is used to treat neonates who are addicted to narcotics.
 The nurse should provide a dark, quiet environment for a neonate who is
experiencing narcotic withdrawal.
 Drugs used to treat withdrawal symptoms in neonates include phenobarbital (Luminal),
camphorated opium tincture (paregoric), and diazepam (Valium).
 In a premature neonate, signs of respiratory distress include nostril flaring, substernal
retractions, and inspiratory grunting.
 Respiratory distress syndrome (hyaline membrane disease) develops in premature
infants because their pulmonary alveoli lack surfactant.
 Whenever an infant is being put down to sleep, the parent or caregiver should position
the infant on the back. Remember the mnemonic “back to sleep.”
 The percentage of water in a neonate’s body is about 78% to 80%.
 To perform nasotracheal suctioning in an infant, the nurse positions the infant with his
neck slightly hyperextended in a “sniffing” position, with his chin up and his head tilted
back slightly.
 After birth, the neonate’s umbilical cord is tied 1″ (2.5 cm) from the abdominal wall
with a cotton cord, plastic clamp, or rubber band.
 When teaching parents to provide umbilical cord care, the nurse should teach them to
clean the umbilical area with a cotton ball saturated with alcohol after every diaper change
to prevent infection and promote drying.
 Ortolani’s sign (an audible click or palpable jerk that occurs with thigh abduction)
confirms congenital hip dislocation in a neonate.
 Cutis marmorata is mottling or purple discoloration of the skin. It’s a transient vasomotor
response that occurs primarily in the arms and legs of infants who are exposed to cold.
 The first immunization for a neonate is the hepatitis B vaccine, which is administered in
the nursery shortly after birth.
 Infants with Down syndrome typically have marked hypotonia, floppiness, slanted eyes,
excess skin on the back of the neck, flattened bridge of the nose, flat facial features,
spade-like hands, short and broad feet, small male genitalia, absence of Moro’s reflex, and
a simian crease on the hands.
 The nurse instills erythromycin in a neonate’s eyes primarily to prevent blindness caused by
gonorrhea or chlamydia.
 A fever in the first 24 hours postpartum is most likely caused by dehydration rather than
infection.
 Preterm neonates or neonates who can’t maintain a skin temperature of at least 97.6° F
(36.4° C) should receive care in an incubator (Isolette) or a radiant warmer. In a radiant
warmer, a heat-sensitive probe taped to the neonate’s skin activates the heater unit
automatically to maintain the desired temperature.
 Neonates who are delivered by cesarean birth have a higher incidence of respiratory
distress syndrome.
 When providing phototherapy to a neonate, the nurse should cover the neonate’s eyes
and genital area.
 The narcotic antagonist naloxone (Narcan) may be given to a neonate to correct
respiratory depression caused by narcotic administration to the mother during labor.
 In a neonate, symptoms of respiratory distress syndrome include expiratory grunting or
whining, sandpaper breath sounds, and seesaw retractions.
 Cerebral palsy presents as asymmetrical movement, irritability, and excessive, feeble crying
in a long, thin infant.
 The nurse should assess a breech-birth neonate for hydrocephalus, hematomas, fractures,
and other anomalies caused by birth trauma.
 In a neonate, long, brittle fingernails are a sign of postmaturity.
 Desquamation (skin peeling) is common in postmature neonates.
 The average birth weight of neonates born to mothers who smoke is 6 oz (170 g) less
than that of neonates born to nonsmoking mothers.
 Neonatal jaundice in the first 24 hours after birth is known as pathological jaundice and is a
sign of erythroblastosis fetalis.
 Lanugo covers the fetus’s body until about 20 weeks gestation. Then it begins to
disappear from the face, trunk, arms, and legs, in that order.
 In a neonate, hypoglycemia causes temperature instability, hypotonia, jitteriness, and
seizures. Premature, postmature, small-for-gestational-age, and large-for-gestational-age
neonates are susceptible to this disorder.
 Neonates typically need to consume 50 to 55 cal per pound of body weight daily.
 During fetal heart rate monitoring, variable decelerations indicate compression or prolapse
of the umbilical cord.
 A neonate whose mother has diabetes should be assessed for hyperinsulinism.
 The best technique for assessing jaundice in a neonate is to blanch the tip of the nose or
the area just above the umbilicus.
 Milia may occur as pinpoint spots over a neonate’s nose.
 Strabismus is a normal finding in a neonate.
 Respiratory distress syndrome develops in premature neonates because their alveoli lack
surfactant.
 Rubella infection in a pregnant patient, especially during the first trimester, can lead to
spontaneous abortion or stillbirth as well as fetal cardiac and other birth defects.
 The Apgar score is used to assess the neonate’s vital functions. It’s obtained at 1 minute
and 5 minutes after delivery. The score is based on respiratory effort, heart
rate, muscletone, reflex irritability, and color.
 Erythromycin is given at birth to prevent ophthalmia neonatorum.
 In the neonate, the normal blood glucose level is 45 to 90 mg/dl.
 Hepatitis B vaccine is usually given within 48 hours of birth.
 Hepatitis B immune globulin is usually given within 12 hours of birth.
 Boys who are born with hypospadias shouldn’t be circumcised at birth because the foreskin
may be needed for constructive surgery.
 In neonates, cold stress affects the circulatory, regulatory, and respiratory systems.
 Fetal embodiment is a maternal developmental task that occurs in the second trimester.
During this stage, the mother may complain that she never gets to sleep because the
fetus always gives her a thump when she tries.
 Mongolian spots can range from brown to blue. Their color depends on how close
melanocytes are to the surface of the skin. They most commonly appear as patches across
the sacrum, buttocks, and legs.
 Mongolian spots are common in non-white infants and usually disappear by age 2 to 3
years.
 Vernix caseosa is a cheeselike substance that covers and protects the fetus’s skin in utero.
It may be rubbed into the neonate’s skin or washed away in one or two baths.
 Caput succedaneum is edema that develops in and under the fetal scalp during labor and
delivery. It resolves spontaneously and presents no danger to the neonate. The edema
doesn’t cross the suture line.
 Nevus flammeus, or port-wine stain, is a diffuse pink to dark bluish red lesion on a
neonate’s face or neck.
 The Guthrie test (a screening test for phenylketonuria) is most reliable if it’s done between
the second and sixth days after birth and is performed after the neonate has ingested
protein.
 To assess coordination of sucking and swallowing, the nurse should observe the neonate’s
first breastfeeding or sterile water bottle-feeding.
 To establish a milk supply pattern, the mother should breast-feed her infant at least every
4 hours. During the first month, she should breast-feed 8 to 12 times daily (demand
feeding).
 To avoid contact with blood and other body fluids, the nurse should wear gloves when
handling the neonate until after the first bath is given.
 If a breast-fed infant is content, has good skin turgor, an adequate number of wet
diapers, and normal weight gain, the mother’s milk supply is assumed to be adequate.
 In the supine position, a pregnant patient’s enlarged uterus impairs venous return from the
lower half of the body to the heart, resulting in supine hypotensive syndrome, or
inferior vena cava syndrome.
 Tocolytic agents used to treat preterm labor include terbutaline (Brethine), ritodrine
(Yutopar), and magnesium sulfate.
 A pregnant woman who has hyperemesis gravidarum may require hospitalization to treat
dehydration and starvation.
 Diaphragmatic hernia is one of the most urgent neonatal surgical emergencies. By
compressing and displacing the lungs and heart, this disorder can cause respiratory
distress shortly after birth.
 Common complications of early pregnancy (up to 20 weeks gestation) include fetal loss
and serious threats to maternal health.
 If the neonate is stable, the mother should be allowed to breast-feed within the neonate’s
first hour of life.
 The nurse should check the neonate’s temperature every 1 to 2 hours until it’s maintained
within normal limits.
 At birth, a neonate normally weighs 5 to 9 lb (2 to 4 kg), measures 18″ to 22″ (45.5 to 56
cm) in length, has a head circumference of 13½” to 14″ (34 to 35.5 cm), and has a chest
circumference that’s 1″ (2.5 cm) less than the head circumference.
 In the neonate, temperature normally ranges from 98° to 99° F (36.7° to 37.2° C), apical
pulse rate averages 120 to 160 beats/minute, and respirations are 40 to 60
breaths/minute.
 The diamond-shaped anterior fontanel usually closes between ages 12 and 18 months.
 The triangular posterior fontanel usually closes by age 2 months.
 In the neonate, a straight spine is normal. A tuft of hair over the spine is an abnormal
finding.
 Prostaglandin gel may be applied to the vagina or cervix to ripen an unfavorable cervix
before labor induction with oxytocin (Pitocin).
 Supernumerary nipples are occasionally seen on neonates. They usually appear along a
line that runs from each axilla, through the normal nipple area, and to the groin.
 Meconium is a material that collects in the fetus’s intestines and forms the neonate’s
first feces, which are black and tarry.
 The presence of meconium in the amniotic fluid during labor indicates possible fetal
distress and the need to evaluate the neonate for meconium aspiration.
 To assess a neonate’s rooting reflex, the nurse touches a finger to the cheek or the corner
of the mouth. Normally, the neonate turns his head toward the stimulus, opens his mouth,
and searches for the stimulus.
 Harlequin sign is present when a neonate who is lying on his side appears red on the
dependent side and pale on the upper side.
 Because of the anti-insulin effects of placental hormones, insulin requirements increase
during the third trimester.
 Gestational age can be estimated by ultrasound measurement of maternal abdominal
circumference, fetal femur length, and fetal head size. These measurements are most
accurate between 12 and 18 weeks gestation.
 Skeletal system abnormalities and ventricular septal defects are the most common
disorders of infants who are born to diabetic women. The incidence of congenital
malformation is three times higher in these infants than in those born to nondiabetic
women.
 Skeletal system abnormalities and ventricular septal defects are the most common
disorders of infants who are born to diabetic women. The incidence of congenital
malformation is three times higher in these infants than in those born to nondiabetic
women.
 The patient with preeclampsia usually has puffiness around the eyes or edema in the
hands (for example, “I can’t put my wedding ring on.”).
 Kegel exercises require contraction and relaxation of the perineal muscles. These exercises
help strengthen pelvic muscles and improve urine control in postpartum patients.
 Symptoms of postpartum depression range from mild postpartum blues to intense, suicidal,
depressive psychosis.
 The preterm neonate may require gavage feedings because of a weak sucking reflex,
uncoordinated sucking, or respiratory distress.
 Acrocyanosis (blueness and coolness of the arms and legs) is normal in neonates because
of their immature peripheral circulatory system.
 To prevent ophthalmia neonatorum (a severe eye infection caused by maternal
gonorrhea), the nurse may administer one of three drugs, as prescribed, in the neonate’s
eyes: tetracycline, silver nitrate, or erythromycin.
Neonatal testing for phenylketonuria is mandatory in most states.
 The nurse should place the neonate in a 30-degree Trendelenburg position to facilitate
mucus drainage.
 The nurse may suction the neonate’s nose and mouth as needed with a bulb syringe or
suction trap.
 To prevent heat loss, the nurse should place the neonate under a radiant warmer during
suctioning and initial delivery-room care, and then wrap the neonate in a warmed blanket
for transport to the nursery.
 The umbilical cord normally has two arteries and one vein.
 When providing care, the nurse should expose only one part of an infant’s body at a time.
 Lightening is settling of the fetal head into the brim of the pelvis.

Prenatal Care
 In a full-term neonate, skin creases appear over two-thirds of the neonate’s feet. Preterm
neonates have heel creases that cover less than two-thirds of the feet.
 At 20 weeks gestation, the fundus is at the level of the umbilicus.
 At 36 weeks gestation, the fundus is at the lower border of the rib cage.
 A premature neonate is one born before the end of the 37th week of gestation.
 Gravida is the number of pregnancies a woman has had, regardless of outcome.
 Para is the number of pregnancies that reached viability, regardless of whether the fetus
was delivered alive or stillborn. A fetus is considered viable at 20 weeks gestation.
 A multipara is a woman who has had two or more pregnancies that progressed to viability,
regardless of whether the offspring were alive at birth.
 Positive signs of pregnancy include ultrasound evidence, fetal heart tones, and fetal
movement felt by the examiner (not usually present until 4 months gestation
 Quickening, a presumptive sign of pregnancy, occurs between 16 and 19 weeks
gestation.
 Goodell’s sign is softening of the cervix.
 Quickening, a presumptive sign of pregnancy, occurs between 16 and 19 weeks
gestation.
 Ovulation ceases during pregnancy.
 Immunity to rubella can be measured by a hemagglutination inhibition test (rubella
titer). This test identifies exposure to rubella infection and determines susceptibility in
pregnant women. In a woman, a titer greater than 1:8 indicates immunity.
 To estimate the date of delivery using Naegele’s rule, the nurse counts backward three
(3) months from the first day of the last menstrual period and then adds seven (7) days to
this date.
 During pregnancy, weight gain averages 25 to 30 lb (11 to 13.5 kg).
 Rubella has a teratogenic effect on the fetus during the first trimester. It produces
abnormalities in up to 40% of cases without interrupting the pregnancy.
 At 12 weeks gestation, the fundus should be at the top of the symphysis pubis.
 Chloasma, the mask of pregnancy, is pigmentation of a circumscribed area of skin
(usually over the bridge of the nose and cheeks) that occurs in some pregnant women.
 The gynecoid pelvis is most ideal for delivery. Other types include platypelloid (flat),
anthropoid (ape-like), and android (malelike).
 Pregnant women should be advised that there is no safe level of alcohol intake.
 Linea nigra, a dark line that extends from the umbilicus to the mons pubis, commonly
appears during pregnancy and disappears after pregnancy.
 Culdoscopy is visualization of the pelvic organs through the posterior vaginal fornix.
 The nurse should teach a pregnant vegetarian to obtain protein from alternative sources,
such as nuts, soybeans, and legumes.
 The nurse should instruct a pregnant patient to take only prescribed prenatal vitamins
because over-the-counter high-potency vitamins may harm the fetus.
 High-sodium foods can cause fluid retention, especially in pregnant patients.
 A pregnant patient can avoid constipation and hemorrhoids by adding fiber to her diet.
 A pregnant woman should drink at least eight 8-oz glasses (about 2,000 ml) of water
daily.
 Cytomegalovirus is the leading cause of congenital viral infection.
 Tocolytic therapy is indicated in premature labor, but contraindicated in fetal death, fetal
distress, or severe hemorrhage.
 Through ultrasonography, the biophysical profile assesses fetal well-being by measuring
fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate
(nonstress test), and qualitative amniotic fluid volume.
 Pica is a craving to eat nonfood items, such as dirt, crayons, chalk, glue, starch, or hair. It
may occur during pregnancy and can endanger the fetus.
 A pregnant patient should take folic acid because this nutrient is required for rapid cell
division.
 A woman who is taking clomiphene (Clomid) to induce ovulation should be informed of the
possibility of multiple births with this drug.
 During the first trimester, a pregnant woman should avoid all drugs unless doing so would
adversely affect her health.
 The Food and Drug Administration has established the following five categories of drugs
based on their potential for causing birth defects: A, no evidence of risk; B, no risk found
in animals, but no studies have been done in women; C, animal studies have shown an
adverse effect, but the drug may be beneficial to women despite the potential risk; D,
evidence of risk, but its benefits may outweigh its risks; and X, fetal anomalies noted, and
the risks clearly outweigh the potential benefits.
 A probable sign of pregnancy, McDonald’s sign is characterized by an ease in flexing the
body of the uterus against the cervix.
 Amenorrhea is a probable sign of pregnancy.
 A pregnant woman’s partner should avoid introducing air into the vagina during oral sex
because of the possibility of air embolism.
 The presence of human chorionic gonadotropin in the blood or urine is a probable sign of
pregnancy.
 Radiography isn’t usually used in a pregnant woman because it may harm the developing
fetus. If radiography is essential, it should be performed only after 36 weeks gestation.
 A pregnant patient who has had rupture of the membranes or who is experiencing
vaginal bleeding shouldn’t engage in sexual intercourse.
 A pregnant staff member should not be assigned to work with a patient who has
cytomegalovirus infection because the virus can be transmitted to the fetus.
 A pregnant patient should take an iron supplement to help prevent anemia.
 Nausea and vomiting during the first trimester of pregnancy are caused by rising levels of
the hormone human chorionic gonadotropin.
 The duration of pregnancy averages 280 days, 40 weeks, 9 calendar months, or 10 lunar
months.
 Before performing a Leopold maneuver, the nurse should ask the patient to empty
her bladder.
 Pelvic-tilt exercises can help to prevent or relieve backache during pregnancy.
 The nurse must place identification bands on both the mother and the neonate before
they leave the delivery room.
 Dinoprostone (Cervidil) is used to ripen the cervix.
 Because women with diabetes have a higher incidence of birth anomalies than women
without diabetes, an alpha-fetoprotein level may be ordered at 15 to 17 weeks gestation.
 Painless vaginal bleeding during the last trimester of pregnancy may indicate placenta
previa.
 The hormone human chorionic gonadotropin is a marker for pregnancy.
 With advanced maternal age, a common genetic problem is Down syndrome.
 Methergine stimulates uterine contractions.
 The administration of folic acid during the early stages of gestation may prevent neural
tube defects.
 A clinical manifestation of a prolapsed umbilical cord is variable decelerations.
 The nurse should keep the sac of meningomyelocele moist with normal saline solution.
 If fundal height is at least 2 cm less than expected, the cause may be growth retardation,
missed abortion, transverse lie, or false pregnancy.
 Fundal height that exceeds expectations by more than 2 cm may be caused by multiple
gestation, polyhydramnios, uterine myomata, or a large baby.
 A major developmental task for a woman during the first trimester of pregnancy is
accepting the pregnancy.
 A pregnant patient with vaginal bleeding shouldn’t have a pelvic examination.
 In the early stages of pregnancy, the finding of glucose in the urine may be related to the
increased shunting of glucose to the developing placenta, without a corresponding
increase in the reabsorption capability of the kidneys.
 A patient who has premature rupture of the membranes is at significant risk for infection if
labor doesn’t begin within 24 hours.
 Infants of diabetic mothers are susceptible to macrosomia as a result of increased insulin
production in the fetus.
 To prevent heat loss in the neonate, the nurse should bathe one part of his body at a time
and keep the rest of the body covered
 A patient who has a cesarean delivery is at greater risk for infection than the patient who
gives birth vaginally.
 The occurrence of thrush in the neonate is probably caused by contact with the organism
during delivery through the birth canal.
 Maternal serum alpha-fetoprotein is detectable at 7 weeks of gestation and peaks in the
third trimester. High levels detected between the 16th and 18th weeks are associated with
neural tube defects. Low levels are associated with Down syndrome.
 An arrest of descent occurs when the fetus doesn’t descend through the pelvic cavity
during labor. It’s commonly associated with cephalopelvic disproportion, and cesarean
delivery may be required.
 A late sign of preeclampsia is epigastric pain as a result of severe liver edema.
 In the patient with preeclampsia, blood pressure returns to normal during the puerperal
period.
 To obtain an estriol level, urine is collected for 24 hours.
 An estriol level is used to assess fetal well-being and maternal renal functioning as well as
to monitor a pregnancy that’s complicated by diabetes.
 The period between contractions is referred to as the interval, or resting phase. During
this phase, the uterus and placenta fill with blood and allow for the exchange of oxygen,
carbon dioxide, and nutrients.
 In a patient who has hypertonic contractions, the uterus doesn’t have an opportunity to
relax and there is no interval between contractions. As a result, the fetus may experience
hypoxia or rapid delivery may occur.
 Two qualities of the myometrium are elasticity, which allows it to stretch yet maintain its
tone, and contractility, which allows it to shorten and lengthen in a synchronized pattern.
 During crowning, the presenting part of the fetus remains visible during the interval
between contractions.
 Uterine atony is failure of the uterus to remain firmly contracted.
 The major cause of uterine atony is a full bladder.
 If the mother wishes to breast-feed, the neonate should be nursed as soon as possible
after delivery.
 A smacking sound, milk dripping from the side of the mouth, and sucking noises all
indicate improper placement of the infant’s mouth over the nipple.
 Before feeding is initiated, an infant should be burped to expel air from the stomach.
 Most authorities strongly encourage the continuation of breastfeeding on both the affected
and the unaffected breast of patients with mastitis.
 Neonates are nearsighted and focus on items that are held 10″ to 12″ (25 to 30.5 cm)
away.
 In a neonate, low-set ears are associated with chromosomal abnormalities such as Down
syndrome.
 Meconium is usually passed in the first 24 hours; however, passage may take up to 72
hours.
 Obstetric data can be described by using 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 (if a child has died, further explanation is needed to clarify the
discrepancy in numbers).
 Parity doesn’t refer to the number of infants delivered, only the number of deliveries.
 Women who are carrying more than one fetus should be encouraged to gain 35 to 45 lb
(15.5 to 20.5 kg) during pregnancy.
 The recommended amount of iron supplement for the pregnant patient is 30 to 60 mg
daily.
 Drinking six alcoholic beverages a day or a single episode of binge drinking in the first
trimester can cause fetal alcohol syndrome.
 Chorionic villus sampling is performed at 8 to 12 weeks of pregnancy for early
identification of genetic defects.
 In percutaneous umbilical blood sampling, a blood sample is obtained from the umbilical
cord to detect anemia, genetic defects, and blood incompatibility as well as to assess the
need for blood transfusions.
 Hemodilution of pregnancy is the increase in blood volume that occurs during pregnancy.
The increased volume consists of plasma and causes an imbalance between the ratio of
red blood cells to plasma and a resultant decrease in hematocrit.
 Visualization in pregnancy is a process in which the mother imagines what the child she’s
carrying is like and becomes acquainted with it.
 Mean arterial pressure of greater than 100 mm Hg after 20 weeks of pregnancy is
considered hypertension.
 Laden’s sign, an early indication of pregnancy, causes softening of a spot on the anterior
portion of the uterus, just above the uterocervical juncture.
 During pregnancy, the abdominal line from the symphysis pubis to the umbilicus changes
from linea alba to linea nigra.
 The treatment for supine hypotension syndrome (a condition that sometimes occurs in
pregnancy) is to have the patient lie on her left side.
 A contributing factor in dependent edema in the pregnant patient is the increase of
femoral venous pressure from 10 mm Hg (normal) to 18 mm Hg (high).
 Hyperpigmentation of the pregnant patient’s face, formerly called chloasma and now
referred to as melasma, fades after delivery.
 The hormone relaxin, which is 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 facilitate passage of the fetus during delivery.
 Progesterone maintains the integrity of the pregnancy by inhibiting uterine motility.

Labor and Delivery

 During labor, to relieve supine hypotension manifested by nausea and vomiting and
paleness, turn the patient on her left side.
 During the transition phase of the first stage of labor, the cervix is dilated 8 to 10 cm and
contractions usually occur 2 to 3 minutes apart and last for 60 seconds.
 The first stage of labor begins with the onset of labor and ends with full cervical dilation
at 10 cm.
 The second stage of labor begins with full cervical dilation and ends with the neonate’s
birth.
 The third stage of labor begins after the neonate’s birth and ends with expulsion of the
placenta.
 The fourth stage of labor (postpartum stabilization) lasts up to 4 hours after the placenta
is delivered. This time is needed to stabilize the mother’s physical and emotional state
after the stress of childbirth.
 Unlike false labor, true labor produces regular rhythmic contractions, abdominal
discomfort, progressive descent of the fetus, bloody show, and progressive effacement
and dilation of the cervix.
 When used to describe the degree of fetal descent during labor, floating means the
presenting part is not engaged in the pelvic inlet, but is freely movable (ballotable) above
the pelvic inlet.
 When used to describe the degree of fetal descent, engagement means when the largest
diameter of the presenting part has passed through the pelvic inlet.
 Fetal stations indicate the location of the presenting part in relation to the ischial spine.
It’s described as –1, –2, –3, –4, or –5 to indicate the number of centimeters above the
level of the ischial spine; station –5 is at the pelvic inlet.
 Fetal stations are also described as +1, +2, +3, +4, or +5 to indicate the number of
centimeters it is below the level of the ischial spine; station 0 is at the level of the ischial
spine.
 Any vaginal bleeding during pregnancy should be considered a complication until proven
otherwise.
 During delivery, if the umbilical cord can’t be loosened and slipped from around the
neonate’s neck, it should be clamped with two clamps and cut between the clamps.
 During the first stage of labor, the side-lying position usually provides the greatest
degree of comfort, although the patient may assume any comfortable position.
 Fetal stations are also described as +1, +2, +3, +4, or +5 to indicate the number of
centimeters it is below the level of the ischial spine; station 0 is at the level of the ischial
spine.
 Fetal stations indicate the location of the presenting part in relation to the ischial spine.
It’s described as –1, –2, –3, –4, or –5 to indicate the number of centimeters above the
level of the ischial spine; station –5 is at the pelvic inlet.
 When used to describe the degree of fetal descent, engagement means when the largest
diameter of the presenting part has passed through the pelvic inlet.
 Amniotomy is artificial rupture of the amniotic membranes.
 The three phases of a uterine contraction are increment, acme, and decrement.
 The intensity of a labor contraction can be assessed by the indentability of the uterine
wall at the contraction’s peak. Intensity is graded as mild (uterine muscle is somewhat
tense), moderate (uterine muscle is moderately tense), or strong (uterine muscle is
boardlike).
 The frequency of uterine contractions, which is measured in minutes, is the time from
the beginning of one contraction to the beginning of the next.
 Before internal fetal monitoring can be performed, a pregnant patient’s cervix must be
dilated at least 2 cm, the amniotic membranes must be ruptured, and the presenting part
of the fetus (scalp or buttocks) must be at station –1 or lower, so that a small electrode
can be attached.
 Teenage mothers are more likely to have low-birth-weight neonates because they seek
prenatal care late in pregnancy (as a result of denial) and are more likely than older
mothers to have nutritional deficiencies.
 The narrowest diameter of the pelvic inlet is the anteroposterior (diagonal conjugate).
 During labor, the resting phase between contractions is at least 30 seconds.
 The length of the uterus increases from 2½” (6.3 cm) before pregnancy to 12½” (32 cm)
at term.
 To estimate the true conjugate (the smallest inlet measurement of the pelvis), deduct 1.5
cm from the diagonal conjugate (usually 12 cm). A true conjugate of 10.5 cm enables the
fetal head (usually 10 cm) to pass.
 The smallest outlet measurement of the pelvis is the intertuberous diameter, which is the
transverse diameter between the ischial tuberosities.
 Electronic fetal monitoring is used to assess fetal well-being during labor. If compromised
fetal status is suspected, fetal blood pH may be evaluated by obtaining a scalp sample.
 In an emergency delivery, enough pressure should be applied to the emerging fetus’s
head to guide the descent and prevent a rapid change in pressure within the molded fetal
skull.
 Massaging the uterus helps to stimulate contractions after the placenta is delivered.
 When a patient is admitted to the unit in active labor, the nurse’s first action is to listenfor
fetal heart tones.
 Nitrazine paper is used to test the pH of vaginal discharge to determine the presence of
amniotic fluid.
 A pregnant patient normally gains 2 to 5 lb (1 to 2.5 kg) during the first trimester and
slightly less than 1 lb (0.5 kg) per week during the last two trimesters.
 Precipitate labor lasts for approximately 3 hours and ends with delivery of the neonate.
 As emergency treatment for excessive uterine bleeding, 0.2 mg of methylergonovine
(Methergine) is injected I.V. over 1 minute while the patient’s blood pressure and uterine
contractions are monitored.
 Braxton Hicks contractions are usually felt in the abdomen and don’t cause cervical
change. True labor contractions are felt in the front of the abdomen and back and lead to
progressive cervical dilation and effacement.
 If a fetus has late decelerations (a sign of fetal hypoxia), the nurse should instruct the
mother to lie on her left side and then administer 8 to 10 L of oxygen per minute by mask
or cannula. The nurse should notify the physician. The side-lying position removes
pressure on the inferior vena cava.
 Oxytocin (Pitocin) promotes lactation and uterine contractions.
 Because oxytocin (Pitocin) stimulates powerful uterine contractions during labor, it must
be administered under close observation to help prevent maternal and fetal distress.
 Molding is the process by which the fetal head changes shape to facilitate movement
through the birth canal.
 If a woman suddenly becomes hypotensive during labor, the nurse should increase the
infusion rate of I.V. fluids as prescribed.
 During fetal heart monitoring, early deceleration is caused by compression of the head
during labor.
 After the placenta is delivered, the nurse may add oxytocin (Pitocin) to the patient’s I.V.
solution, as prescribed, to promote postpartum involution of the uterus and stimulate
lactation.
 If needed, cervical suturing is usually done between 14 and 18 weeks gestation to
reinforce an incompetent cervix and maintain pregnancy. The suturing is typically removed
by 35 weeks gestation.
 The Food and Drug Administration has established the following five categories of drugs
based on their potential for causing birth defects: A, no evidence of risk; B, no risk found
in animals, but no studies have been done in women; C, animal studies have shown an
adverse effect, but the drug may be beneficial to women despite the potential risk; D,
evidence of risk, but its benefits may outweigh its risks; and X, fetal anomalies noted, and
the risks clearly outweigh the potential benefits.
 The mechanics of delivery are engagement, descent and flexion, internal rotation,
extension, external rotation, restitution, and expulsion.
 The duration of a contraction is timed from the moment that the uterine muscle begins to
tense to the moment that it reaches full relaxation. It’s measured in seconds.
 Fetal demise is death of the fetus after viability.
 The most common method of inducing labor after artificial rupture of the membranes is
oxytocin (Pitocin) infusion.
 After the amniotic membranes rupture, the initial nursing action is to assess the fetal heart
rate.
 The most common reasons for cesarean birth are malpresentation, fetal distress,
cephalopelvic disproportion, pregnancy-induced hypertension, previous cesarean birth,
and inadequate progress in labor.
 Amniocentesis increases the risk of spontaneous abortion, trauma to the fetus or placenta,
premature labor, infection, and Rh sensitization of the fetus.
 After amniocentesis, abdominal cramping or spontaneous vaginal bleeding may indicate
complications.
 To prevent her from developing Rh antibodies, an Rh-negative primigravida should receive
Rho(D) immune globulin (RhoGAM) after delivering an Rh-positive neonate.
 When informed that a patient’s amniotic membrane has broken, the nurse should check
fetal heart tones and then maternal vital signs.
 Crowning is the appearance of the fetus’s head when its largest diameter is encircled by
the vulvovaginal ring.
 Subinvolution may occur if the bladder is distended after delivery.
 For an extramural delivery (one that takes place outside of a normal delivery center), the
priorities for care of the neonate include maintaining a patent airway, supporting efforts to
breathe, monitoring vital signs, and maintaining adequate body temperature.
 The administration of oxytocin (Pitocin) is stopped if the contractions are 90 seconds or
longer.
 If a pregnant patient’s rubella titer is less than 1:8, she should be immunized after
delivery.
 During the transition phase of labor, the woman usually is irritable and restless.
 Maternal hypotension is a complication of spinal block.
 The mother’s Rh factor should be determined before an amniocentesis is performed.
 With early maternal age, cephalopelvic disproportion commonly occurs.
 Spontaneous rupture of the membranes increases the risk of a prolapsed umbilical cord.

Postpartum Care
 Lochia rubra is the vaginal discharge of almost pure blood that occurs during the first few
days after childbirth.
 Lochia serosa is the serous vaginal discharge that occurs 4 to 7 days after childbirth.
 Lochia alba is the vaginal discharge of decreased blood and increased leukocytes that’s the
final stage of lochia. It occurs 7 to 10 days after childbirth.
 After delivery, a multiparous woman is more susceptible to bleeding than a primiparous
woman because her uterine muscles may be overstretched and may not contract
efficiently.
 The nurse should suggest ambulation to a postpartum patient who has gas pain and
flatulence.
 Methylergonovine (Methergine) is an oxytocic agent used to prevent and treat postpartum
hemorrhage caused by uterine atony or subinvolution.
 After a stillbirth, the mother should be allowed to hold the neonate to help her come to
terms with the death.
 If a woman receives a spinal block before delivery, the nurse should monitor the patient’s
blood pressure closely.
 A postpartum patient may resume sexual intercourse after the perineal or uterine wounds
heal (usually within 4 weeks after delivery).
 If a pregnant patient’s test results are negative for glucose but positive for acetone, the
nurse should assess the patient’s diet for inadequate caloric intake.
 Direct antiglobulin (direct Coombs’) test is used to detect maternal antibodies attached to
red blood cells in the neonate.
 Before discharging a patient who has had an abortion, the nurse should instruct her to
report bright red clots, bleeding that lasts longer than 7 days, or signs of infection, such as
a temperature of greater than 100° F (37.8° C), foul-smelling vaginal discharge, severe
uterine cramping, nausea, or vomiting.
 The fundus of a postpartum patient is massaged to stimulate contraction of the uterus and
prevent hemorrhage.
 Laceration of the vagina, cervix, or perineum produces bright red bleeding that often
comes in spurts. The bleeding is continuous, even when the fundus is firm.
 To avoid puncturing the placenta, a vaginal examination should not be performed on a
pregnant patient who is bleeding.
 A patient who has postpartum hemorrhage caused by uterine atony should be given
oxytocin as prescribed.
 After delivery, if the fundus is boggy and deviated to the right side, the patient should
empty her bladder.
 In the early postpartum period, the fundus should be midline at the umbilicus.

Pregnancy Complications
 An ectopic pregnancy is one that implants abnormally, outside the uterus.
 A habitual aborter is a woman who has had three or more consecutive spontaneous
abortions.
 Threatened abortion occurs when bleeding is present without cervical dilation.
 A complete abortion occurs when all products of conception are expelled.
 Hydramnios (polyhydramnios) is excessive amniotic fluid of more than 2,000 ml in the
third trimester.
 In an incomplete abortion, the fetus is expelled, but parts of the placenta and
membrane remain in the uterus.
 When a pregnant patient has undiagnosed vaginal bleeding, vaginal examination
should be avoided until ultrasonography rules out placenta previa.
 A patient with a ruptured ectopic pregnancy commonly has sharp pain in the lower
abdomen, with spotting and cramping. She may have abdominal rigidity; rapid, shallow
respirations; tachycardia; and shock.
 A 16-year-old girl who is pregnant is at risk for having a low-birth-weight neonate.
 A rubella vaccine shouldn’t be given to a pregnant woman. The vaccine can be
administered after delivery, but the patient should be instructed to avoid becoming
pregnant for 3 months.
Nonstress Test
 A nonstress test is considered nonreactive (positive) if fewer than two fetal heart rate
accelerations of at least 15 beats/minute occur in 20 minutes.
 A nonstress test is considered reactive (negative) if two or more fetal heart rate
accelerations of 15 beats/minute above baseline occur in 20 minutes.
 A nonstress test is usually performed to assess fetal well-being in a pregnant patient
with a prolonged pregnancy (42 weeks or more), diabetes, a history of poor pregnancy
outcomes, or pregnancy-induced hypertension.

Placental Abnormalities
 Placenta previa is abnormally low implantation of the placenta so that it encroaches on
or covers the cervical os.
 In complete (total) placenta previa, the placenta completely covers the cervical os.
 In partial (incomplete or marginal) placenta previa, the placenta covers only a
portion of the cervical os.
 Abruptio placentae is premature separation of a normally implanted placenta. It may be
partial or complete, and usually causes abdominal pain, vaginal bleeding, and a boardlike
abdomen.
 In placenta previa, bleeding is painless and seldom fatal on the first occasion, but it
becomes heavier with each subsequent episode.
 Nursing interventions for a patient with placenta previa include positioning the patient
on her left side for maximum fetal perfusion, monitoring fetal heart tones, and
administering I.V. fluids and oxygen, as ordered.
 Treatment for abruptio placentae is usually immediate cesarean delivery.
 A classic difference between abruptio placentae and placenta previa is the degree of pain.
Abruptio placentae causes pain, whereas placenta previa causes painless bleeding.
 Because a major role of the placenta is to function as a fetal lung, any condition that
interrupts normal blood flow to or from the placenta increases fetal partial pressure of
arterial carbon dioxide and decreases fetal pH.

Preeclampsia

 Pregnancy-induced hypertension is a leading cause of maternal death in the United

States.
 Pregnancy-induced hypertension (preeclampsia) is an increase 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 accompanied by edema and albuminuria after 20 weeks gestation.
 The classic triad of symptoms of preeclampsia are hypertension, edema, and proteinuria.
Additional symptoms of severe preeclampsia include hyperreflexia, cerebral and vision
disturbances, and epigastric pain.
 After administering magnesium sulfate to a pregnant patient for hypertension
or preterm labor, the nurse should monitor the respiratory rate and deep tendon reflexes.
 Eclampsia is the occurrence of seizures that aren’t caused by a cerebral disorder in a
patient who has pregnancy-induced hypertension.
 In a patient with preeclampsia, epigastric pain is a late symptom and requires immediate
medical intervention.
 In a pregnant patient, preeclampsia may progress to eclampsia, which is characterized by
seizures and may lead to coma.
 HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is an unusual
variation of pregnancy-induced hypertension.

Contraceptives

 The failure rate of a contraceptive is determined by the experience of 100 women for
1 year. It’s expressed as pregnancies per 100 woman-years.
 Before providing a specimen for a sperm count, the patient should avoid ejaculation for 48
to 72 hours.
 If a patient misses two consecutive menstrual periods while taking an oral contraceptive,
she should discontinue the contraceptive and take a pregnancy test.
 If a patient who is taking an oral contraceptive misses a dose, she should take the pill as
soon as she remembers or take two at the next scheduled interval and continue with the
normal schedule.
 If a patient who is taking an oral contraceptive misses two consecutive doses, she should
double the dose for 2 days and then resume her normal schedule. She also should use an
additional birth control method for 1 week.