👶 Lecture 10–11
Maternity & Neonatology
Pregnancy weight, fundal height, labor stages, fetal monitoring, OB meds.
Pregnancy Basics
📅
Naegele's Rule: First day of LMP + 7 days − 3 months = Estimated Due Date
⚖️
Weight Gain Trick: Weeks gestation − 9 = ideal pounds
±1–2 lbs = WNL | ±3 lbs = assess | ±4+ lbs = BPP on fetus
±1–2 lbs = WNL | ±3 lbs = assess | ±4+ lbs = BPP on fetus
📌
Prenatal visits: Monthly until wk 28 → biweekly wks 28–36 → weekly after wk 36 → deliver by wk 42
✅
Positive signs of pregnancy: Fetal skeleton on X-ray, fetus on ultrasound, fetal heart auscultated, EXAMINER palpates fetal movement
📌 Fetal Heart 8–12 wks | Quickening 16–20 wks
FIRST? → Earliest | MOST LIKELY? → Middle | BY? → Latest number
Labor Stages
| Stage/Phase | Dilation | Contractions | #1 Priority |
|---|---|---|---|
| Phase 1 – Latent | 0–4 cm | 5–30 min, 15–30 sec | Support |
| Phase 2 – Active | 5–7 cm | 3–5 min, 30–60 sec | Pain management |
| Phase 3 – Transition | 8–10 cm | 2–3 min, 60–90 sec | Breathe + check dilation |
| Stage 2 – Baby | 10 cm | Pushing | Clear AIRWAY (#1) |
| Stage 3 – Placenta | After | Final contractions | Check intact + 3-vessel cord (AVA) |
| Stage 4 – Recovery | 2 hours | Uterus clamping | V/S → Fundus → Peri pads → Roll (q15 min) |
🚨
STOP PITOCIN FIRST if running, then LION! Contractions: no longer than 90 sec, no closer than 2 min!
⚠️
Fetal Monitor: Starts with "L" = BAD → do LION | Variable decel = PUSH + POSITION (prolapsed cord) | Early decel = normal
Postpartum & OB Meds
💫 BUBBLE HEAD — Postpartum Assessment
Breasts | Uterus (firm, midline ⭐) | Bladder | Bowel | Lochia (Rubra→Serosa→Alba ⭐) | Episiotomy | Hgb | Extremities (DVT ⭐) | Affect | Discomforts
📌
Boggy + MIDLINE → MASSAGE | Boggy + NOT midline → CATHETERIZE (full bladder displacing uterus)
| Drug | Action | Key Side Effect |
|---|---|---|
| Terbutaline | Stops labor (tocolytic) | Maternal tachycardia |
| Mag Sulfate | Stops labor + seizure prevention | Everything DOWN. If RR <12 or reflexes 0–1+ → decrease dose |
| Pitocin | Strengthens labor | Uterine hyperstimulation → STOP IT FIRST |
| Methergine | After delivery | HTN (contracts vessels) |
| Betamethasone | Lung maturity (to MOM IM) | Raises glucose |
| Surfactant | Lung surfactant (to BABY, transtracheal) | Given AFTER birth |
📖 Notes for Dummies
🧠 Think of it this way…
Maternity nursing sounds complicated but it follows a logical pattern. Pregnancy → Labor → Delivery → Recovery. Each phase has a #1 priority. Know those priorities and you'll handle most NCLEX maternity questions correctly.
📊
Labor stages in plain English:
Stage 1 = Cervix opens up (3 phases — latent, active, transition)
Stage 2 = Baby comes out
Stage 3 = Placenta comes out
Stage 4 = Recovery for 2 hours
Stage 1 = Cervix opens up (3 phases — latent, active, transition)
Stage 2 = Baby comes out
Stage 3 = Placenta comes out
Stage 4 = Recovery for 2 hours
🚨
OB emergency rule — LION:
L = Left side | I = IV | O = Oxygen | N = Notify HCP
Works for: low FHR, late decels, tetany, maternal HTN, vena cava syndrome, uterine rupture
ALWAYS stop Pitocin FIRST before LION!
L = Left side | I = IV | O = Oxygen | N = Notify HCP
Works for: low FHR, late decels, tetany, maternal HTN, vena cava syndrome, uterine rupture
ALWAYS stop Pitocin FIRST before LION!
🪢
Prolapsed cord emergency:
Variable decelerations = cord is being compressed. PUSH the baby's head off the cord + POSITION (knee-chest or Trendelenburg). Prep for C-section.
Variable decelerations = cord is being compressed. PUSH the baby's head off the cord + POSITION (knee-chest or Trendelenburg). Prep for C-section.
🫃
Postpartum check — BUBBLE HEAD:
Most important 3: Uterus (firm, midline), Lochia (normal color/amount), Extremities (check for DVT)
Boggy fundus + midline = massage it. Not midline = catheterize first!
Most important 3: Uterus (firm, midline), Lochia (normal color/amount), Extremities (check for DVT)
Boggy fundus + midline = massage it. Not midline = catheterize first!
📝 Key numbers to memorize:
Active labor contractions: 3–5 min apart, last 30–60 sec
Stop Pitocin: contractions >90 sec or <2 min apart
Excessive bleeding postpartum: pad saturated in <15 minutes
Lochia order: Red (Rubra) → Pink (Serosa) → White (Alba)
Active labor contractions: 3–5 min apart, last 30–60 sec
Stop Pitocin: contractions >90 sec or <2 min apart
Excessive bleeding postpartum: pad saturated in <15 minutes
Lochia order: Red (Rubra) → Pink (Serosa) → White (Alba)