Obstetric Nursing

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Maternity nursing across the childbearing year: pregnancy physiology, prenatal care, fetal heart rate interpretation, labor and birth, obstetric medications, hypertensive and bleeding complications, postpartum recovery and newborn transition.

How is the estimated due date calculated with Naegele rule?
Take the first day of the last menstrual period, subtract 3 months, add 7 days, and add one year.
What does the GTPAL system record?
Gravida is the number of pregnancies, and the four numbers are term births, preterm births, abortions or losses before 20 weeks, and living children.
Presumptive, probable and positive signs of pregnancy
Presumptive signs are what the woman feels, such as amenorrhea, nausea and fatigue; probable signs are what an examiner observes, such as Goodell, Chadwick and Hegar signs and a positive pregnancy test; positive signs are direct evidence of a fetus.
Why does physiologic anemia of pregnancy occur?
Plasma volume rises more than red cell mass, so the hematocrit falls even though the total number of red cells has increased.
What is supine hypotensive syndrome and how is it prevented?
The heavy uterus compresses the vena cava when the woman lies flat, reducing venous return and causing dizziness, pallor and hypotension; it is prevented by positioning on the side or wedging one hip.
What are the fundal height landmarks in pregnancy?
The fundus reaches the symphysis pubis at about 12 weeks and the umbilicus at about 20 weeks, and after 20 weeks the measurement in centimeters roughly matches the weeks of gestation.
When is quickening usually felt?
Around 18 to 20 weeks in a first pregnancy and often a few weeks earlier in later pregnancies.
What weight gain is recommended in pregnancy?
It depends on the prepregnancy body mass index, with roughly 25 to 35 pounds recommended for a woman starting at a normal weight.
How does cardiac output change during pregnancy?
It rises by roughly 30 to 50 percent, peaking in the second trimester, with an increased heart rate and a decreased systemic vascular resistance.
Why is shortness of breath common in late pregnancy?
The enlarging uterus elevates the diaphragm and progesterone increases the depth of breathing, so mild breathlessness is expected while the respiratory rate stays normal.
Which gastrointestinal changes are expected in pregnancy?
Heartburn from relaxation of the lower esophageal sphincter and delayed gastric emptying, and constipation from slowed transit and iron supplements.
Why is urinary tract infection more consequential in pregnancy?
Smooth muscle relaxation and ureteral compression cause urinary stasis, so infection ascends more readily and untreated bacteriuria is linked to pyelonephritis and preterm labor.
What is the usual schedule of prenatal visits in an uncomplicated pregnancy?
About every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, and weekly thereafter until birth.
Which nutrients matter most in pregnancy and which foods are avoided?
Folic acid, iron, calcium and protein are emphasized; alcohol is avoided entirely, along with unpasteurized dairy, deli meats unless heated, raw fish and high mercury fish.
Which danger signs should a pregnant woman report immediately?
Vaginal bleeding, leaking fluid, severe or persistent headache, visual changes, right upper quadrant or epigastric pain, sudden swelling of the face and hands, decreased fetal movement, painful urination, fever, and regular contractions before term.
When and why is group B streptococcus screening performed?
A vaginal and rectal culture is collected late in the third trimester, and a positive result means intravenous antibiotics in labor to prevent newborn infection.
When is gestational diabetes screening usually done?
Between about 24 and 28 weeks, and earlier when risk factors are present.
How is an Rh negative pregnant woman managed?
With an antibody screen, Rho D immune globulin at about 28 weeks, after any event that could cause fetomaternal bleeding, and again after birth if the newborn is Rh positive.
How is nausea and vomiting of pregnancy managed before medication?
With small frequent dry carbohydrate snacks, eating before rising, avoiding triggers and strong smells, separating fluids from solids, and ginger or vitamin B6 as advised.
What is fetal movement counting and when is it reported?
The woman counts fetal movements daily at a consistent time and reports a decrease from her baby's usual pattern.
What does an amniocentesis involve and what are the nursing responsibilities?
Ultrasound guided withdrawal of amniotic fluid for genetic or maturity testing; the nurse obtains consent support, monitors the fetal heart rate before and after, and observes for contractions, bleeding and leaking fluid.
Which vaccines are given and avoided in pregnancy?
Inactivated influenza vaccine and the tetanus, diphtheria and acellular pertussis vaccine are recommended in pregnancy, while live vaccines such as measles, mumps and rubella and varicella are deferred until after birth.
What exercise and travel advice fits a normal pregnancy?
Moderate activity most days is encouraged with avoidance of contact sports, overheating and supine exercise late in pregnancy; travel is generally acceptable with frequent walking and hydration.
Why is prenatal dental care encouraged?
Gingival tissue is more vascular and inflamed in pregnancy, and untreated dental infection is a health risk; routine dental care is safe.
What is a nonstress test and what makes it reactive?
External monitoring of the fetal heart rate for accelerations with movement; a reactive result at term is two accelerations of at least 15 beats per minute lasting at least 15 seconds in 20 minutes.
What is a normal baseline fetal heart rate?
Between 110 and 160 beats per minute, assessed over a 10 minute window excluding accelerations and decelerations.
What does moderate variability indicate?
Fluctuation of the baseline by about 6 to 25 beats per minute, which reliably indicates adequate fetal oxygenation of the central nervous system.
What causes early decelerations?
Head compression during a contraction; they mirror the contraction, are gradual, and are benign.
What causes variable decelerations?
Umbilical cord compression, producing abrupt drops that vary in shape and timing relative to contractions.
What causes late decelerations?
Uteroplacental insufficiency, producing gradual decelerations that begin after the contraction starts and return to baseline after it ends.