OB NURSING BULLETS

Sexual intercourse OK anytime during pregnancy except for:

(+) PROM, pre-term labor, incompetent cervix and (+)
vaginal spotting
HUMAN CHORIONIC GONADOTROPIN
(HCG) responsible for a positive pregnancy test
FLUID RETENTION caused by elevated estrogen
and progesterone and also fatigue
OXYTOCIN produced by posterior pituitary gland
for uterine contractions
FUNDAL PRESSURE aids in placental delivery if
mother is anesthetized
GLOBULAR uterus in 3rd stage of labor
CORD TRACTION AND FUNDAL PRESSURE
DANGER inversion of uterus and avulsion of cord
AFTERCARE post PLACENTA DELIVERY
comfort, dry clothing, perineal pads and linens
CHECK 4TH STAGE OF LABOR q15 lochia,
fundus, hematoma
AVOID SEX if cervical mucus is clear and elastic (for
contraception)
INTRAFALLOPIAN TRANSFER for low sperm
count
IN-VITRO for tubal occlusion
ANOVULATION tx of Clomid or Parlodel
CERVICAL CAP (-) spermicide pre-intercourse, can
stay up to 24-48h, durable, contraindicated if with
abnormal pap smear
IUD doesnt protect against STDs
PROFUSE BLOOD LOSS saturation of peripad
within 15 minutes and with pain sensation
DISTENDED
BLADDER
inhibits
uterine
contraction with increased risk of blood loss
FOR IMPENDING HEMORRHAGIC SHOCK
massage fundus if boggy, elevate legs from hips, IV line,
oxygen at 8-10 l/min, stay with patient
PRE- LM void
FHR priority post rupture of membranes
FHR FREQUENCY beginning to beginning
ENDOMETRIOSIS growth of endometrial tissue
outside the uterus; dx: lap and biopsy
DANOCRINE menses stop, edema, weight gain,
anovulation
BBT drop 0.2 F pre ovulation, increase 0.4 F post
ovulation
MOST ACCURATE BBT READING
immediately after awakening and before arising
STRIAE GRAVIDARUM abdominal stretches

DIPPING descending but not at ischial spine

IMPENDING DELIVERY increase in bloody
show, rectal pressure, rupture of membranes, regular
and long contractions
RITGENS MANEUVER at crowning
FUNDAL HEIGHT AT UMBILICUS at 20 weeks
or 5 months gestation
HEMORRHAGE AND INFECTION most
important to check 24 postpartum
COMPLETE CERVICAL DILATATION
termination of first stage of labor
PLACENTAL DELIVERY end of third stage of
labor
VITAMIN K 1.0 mg for full terms, 0.5 mg for preterms
CLINIC VISITS 12 TO 24 MONTHS monthly
ROOMING IN for maternal-infant bonding
HCG PRIMARY FUNCTION maintain corpus
luteum during 1st trimester
DODERLEINS BACULLUS maintains acidic
vaginal pH
BTL no lifting activities post surgery
BSE SCHED 5-7 days post menstruation
MAMMOGRAPHY dx of breast CA; yearly for 40s,
biannual for 50y above
RADICAL MASTECTOMY removal of breast/s,
pectoral muscle, pectoral fascia, nodes
VITAL SIGNS most important 2 h postpartum
IUD INSERTION done during menstrual days 1-4
OVULATION PERIOD 24-48 hours pre-ovulation
to 48 hours post ovulation
OCPs prevent ovulation
CLOMID stimulates oogenesis
LIGHTENING - decrease in fundal height due to a
change in shape of the abdomen a few weeks before
onset of labor
HOME VISIT for continuity of care
ABORTION loss of fetus before viability (20 weeks)
INEVITABLE ABORTION with dilated cervix
THREATENED ABORTION closed cervix,
spotting and uterine cramping
HABITUAL ABORTION consecutive abortions
THREATENED ABORTION complete bed rest,
check vaginal bleeding and observe uterine contractions
OVULATION 14 days before menstruation (for a
28 day cycle); increased pH of cervical secretions, (+)
MITTLESCHMERZ; increase in BBT
PROLIFERATIVE LH surge from anterior
pituitary gland
AGE OF VIABILITY at 5th month or 20-24 weeks
OSSIFICATION OF BONES at 10th lunar month
FHT Doppler at 3 weeks, fetoscope at 18-20 weeks
MC DONALDS RULE fundic ht in cm x 8/7 =
aog
1

PRENATAL CHECKUPS 1-7 mo once a month,

8th mo 2/month, 9th q wk
PREGNANCY AS A MATURATIONAL CRISIS
due to hormonal and physiological changes occurring
PROM prone to infections
TAKING HOLD PHASE focus is the infant
POST PARTUM BLUES 4-5 days post partum
ZYGOTE cell that results from the fertilization of
the ovum by a sperm
MITOSIS cell division of the fertilized ovum
OVULATION rupture of the ovum from the
graafian follicle
MORULA mulberry-like ball of cell that results from
cleavage
FUNDUS where zygote normally implants
IMPLANTATION 7-10 days post fertilization
EFFACEMENT cervix becomes thinner
GDM carbohydrate intolerance induced by
pregnancy
ADVERSE EFFECTS OF GDM morbidity
common in newborn, infant may inherit a predisposing
to DM, higher perinatal death
GDM NURSING INTERVENTIONS liberal
exercise, acceptable diet at 30-35 kcal/kg of IDBW/day,
insulin as ordered, CBG monitoring
GLUCOSE 18.02 mg/dl = 1 mmol
BREAST ENGORGEMENT doesnt last for
greater than 24 hours
MEFENAMIC ACID anti-inflammatory
PASSAGEWAY structure of maternal pelvis
NITRAZINE PAPER TEST urine vs. amniotic
fluid; yellow vs blue
PROM check temperature
NONPREGNANT UTERUS lined by
endometrium
VULVA externally visible structure of the female
reproductive system extending from the symphysis
pubis to the perineum
AMPULLA fertilization site
ISTHMUS site of sterilization
VAS DEFERENS conduit for spermatozoa
EJACULATORY DUCT seminal fluid
LEYDIGS CELLS synthesize testosterone
PROGESTERONE increased activity of
endometrial glands during luteal phase; increased basal
metabolism, increased placental growth, development
of acinar cells in the breast
ROUND LIGAMENT (+) hypertrophy during
pregnancy
SPERM MOTILITY best criterion for sperm
quality
HYSTEROSAPINGOGRAPHY introduction of
radiopaque material into uterus and fallopian tubes to
assess for tubal patency

TETANIC CONTRACTIONS brought about by

the overstimulation by oxytocin
DYSTOCIA due to mechanical factors
POSTPARTUM HEMORRHAGE greater than
500 ml of blood loss
CORTEX OF OVARIES where developing
follicles and the graafian follicles are found
LABIA MINORA forms the frenulum and prepuce
of the clitoris
FOURCHETTE formed by the labia minora
tapering and extending posteriorly
RUGAE thick folds of membranous stratified
epithelium on the internal vaginal wall capable of
stretching during the birth process to accommodate
delivery of fetus
EXTERNAL OS location where squamocolumnar
junction is, pap smear location
MYOMETRIUM largest portion of uterus
CORPUS upper triangular portion of uterus
LH testosterone production
ESTROGEN secreted by graafian follicle associated
with spinnbarkeit and ferning
AUTOSOMAL RECESSIVE cystic fibrosis, taysachs disease, sickle-cell anemia
CHORIONIC VILLI SAMPLING detects trisomy
21, cystic fibrosis and tay sachs
MATERNAL AGE indication for chorionic villi
sampling
RHOGAM essential post-CVS or RH (-) mom;
refrain from sex 48h post-CVS
NEEDLE INSERTION SITE most important
factor affecting amniocentesis
MORNING AFTER PILL prevent implantation of
the fertilized ovum; taken within 12h post-intercourse,
(+) slight nausea post-2d; not given to those with hx
contraindications to OCPs
COMBINED OCPs inhibit FSH and LH
production
ESTROGEN causes sodium retention
PARITY indication for IUD use
HX OF PRETERM LABOR contraindication for
IUD use
HYSTEROSALPINGOGRAM done 2-6 days after
menses
COVADES SYNDROME way in which an
expectant father can explore his feelings
RhOGAM should be administered within 72h;
destroys fetal RBCs to prevent antibody formation
LEUPROLIDE tx for endometriosis
AMPICILLIN safest antibiotic for pyelonephritis
HYPOTONIC DYSTOCIA monitor contractions
MAGNESIUM TOXICITY first sign is
disappearance of knee-jerk reflex
IUD SIDE EFFECT excessive menstrual flow
2

IUD COMMON PROBLEM spontaneous

expulsion of device
IUD provides contraception by setting up a nonspecific inflammatory cell reaction in the endometrium
OVULATION occurs when LH is high
OCPs causes breakthrough bleeding
POST COITAL TEST best timed within 1-2 days
of presumed ovulation
TUBAL DEFECTS are most often related to past
infections
INFERTILITY inability to become pregnant after a
year of trying
SIMS HUHNER (POST COITAL TEST)
determine the number, motility and activity of sperm
HYATIDIFORM MOLE be alert for unusual
uterine enlargement
ECTOPIC PREGNANCIES sudden lower right or
left abdominal pain radiating to the shoulders
TUBAL RUPTURE sudden knifelike, lower
quadrant pain
GERM PLASMA DEFECTS causes most
spontaneous abortions
INCOMPLETE ABORTION fetus is expelled but
part of the placenta and membranes are not
FUNIS umbilical cord
AMNION inner membrane that encloses the fluid
medium for the embryo
FETUS 8th week to birth
12th WEEK uterus becomes an abdominal organ
QUICKENING first fetal movement felt by the
mother
GREATEST WEIGHT GAIN in third trimester;
2nd trimester: height and length
PLACENTA chief source of estrogen and
progesterone after the first 3 months
DUCTUS VENOSUS has the highest oxygen
content
DIAGONAL CONJUGATE A-P diameter of
pelvic inlet
BLOOD VOLUME INCREASE 30-50% is
normal
CHADWICKS SX purplish discoloration of vaginal
mucosa
PHYSIOLOGIC ANEMIA result of increased
plasma volume of the mother
CHORIONIC GONADOTROPIN causes nausea
and vomiting
PITUITARY GLAND increase in melanotropin
hormone causing dark nipples and linea nigra
RH DETERMINATION - routinely performed on
expectant mothers to predict whether the fetus is at
risk for acute hemolytic anemia
LEUKORRHEA caused by elevated estrogen

TX FOR FLUID RETENTION - adequate fluids

and elevation of lower extremities
FULL BLADDER pre UTZ
NORMAL AMNIOTIC FLUID clear, almost
colorless, containing little white specks
RESTRICT MOVEMENT when an external fetal
monitor is being used
EARLY DECELERATION FHT decreases just
before acme due to head compression
LATE DECELERATION FHT decreases just
after acme caused by uteroplacental insufficiency; may
lead to distress
VARIABLE DECELARATION due to cord
compression
LOCATION
OF
FUNDUS
AFTER
PLACENTAL DELIVERY halfway between the
symphysis pubis and the umbilicus
SLOW DEEP BREATHING alleviates discomfort
during contractions
PANTING during crowning
OCCIPUT POSTERIOR causes low back pain
APPLICATION OF BACK PRESSURE during
contractions to increase comfort
NPO during second stage of labor because
undigested food and fluid may cause nausea and
vomiting, limiting the choice of anesthesia
TRANSITIONAL
PHASE

help
client
retain/remain in control
POSITIONING DURING DELIVERY legs
elevated simultaneously to prevent trauma to the
uterine ligaments
UTERINE TETANY observe carefully for this
during the induction of labor
PUSH WITH GLOTTIS OPEN when fully
dilated but (-) crowning
EPISIOTOMY is done to prevent lacerations
PUERPERAL INFECTIONS 2 most important
predisposing factors to its development is hemorrhage
and trauma during birth
PROLACTIN - stimulates secretion of milk from the
mammary glands
SITZ BATH promotes vasodilation, relieves
hemorrhoids
INFANT FEEDING on demand; baby will soon
develop a feeding schedule
CLOSURE OF FORAMEN OVALE after birth is
caused by an increase in the pulmonary blood flow
DUCTUS ARTERIOSUS becomes the ligamentum
arteriosum
HEART RATE primary critical observation in apgar
scoring
MECONIUM CHECK Q SHIFT to keep limit
development of hyperbilirubinemia
ASSYMETRICAL MORO REFLEX associated
with brachial plexus, cervical or humerus injuries
3

STERILE INFANT INTESTINES lack bacteria

necessary for the synthesis of prothrombin
PKU SCREENING measures protein metabolism
NORMAL REGURGITATION in infants is
caused by an underdeveloped cardiac sphincter
AMNIOCENTESIS done to detect presence of
neural tube defects
PREMATURITY contraindication for oxytocin
challenge test
UTEROPLACENTAL INSUFFICIENCY (+)
CST
PREGNANT ADOLESCENT emphasize
importance of consistent care
PERINATAL MORTALITY is 2-3 times greater in
multiple gestation than in single gestation
HYPOTONIC UTERINE DYSTOCIA is
oftentimes caused by multiple gestation
PYELONEPHRITIS observe for signs of PTL;
antibiotic tx should be administered until urine is
sterile2 (-) C/S
CONCEALED
HEMORRHAGE
causes
abdominal pain associated with abruption placenta
DIC/HYPOFIBRINOGENEMIA

causes
bleeding following sever abruptio placenta
ABRUPTIO PLACENTA is most likely to occur in
women with pregnancy induced hypertension
PLACENTA PREVIA painless vaginal bleeding
PAIN MEDS are kept at minimum during PTL to
prevent respiratory depression
ATONY OF THE UTERUS due to overstretching
is commonly caused by multiple gestation
OVERDISTENED BLADDER/HYDRAMNIOS
may cause uterine atony
POSTPARTAL HEMORRHAGE rarely occurs as
a complication of uncomplicated gestational
hypertension
PIH BP elevation of 30/15 mmHg from baseline on
2 occasions 6 hours apart
EPIGASTRIC PAIN subjective symptom of an
impending seizure
ROLLING OF EYES TO ONE SIDE WITH A
FIXED STATE objective sign of an impending
seizure
DANGER OF SEIZURE ends in 48h postpartum
in a woman with eclampsia
CORD COMPRESSION - birth hazard associated
with breech delivery
GRAVIDOCARDIAC PT - cardiac acceleration in
the last half of pregnancy; most compromised during
the first 48 hours after delivery; forceps delivery
GDM DIET balanced, to meet the increased dietary
needs with insulin adjusted as necessary
RENAL AGENESIS - funis with only two vessels
DRUG WITHDRAWAL IN INFANT - irritability
and nasal congestion

NEONATAL MORBIDITY - with low apgar score

at 5 minutes post delivery
HIV/AIDS INFANT microcephalic, craniofacial
features, persistent diarrhea
CHLAMYDIA
INFECTIONS

purulent
conjunctivitis and pneumonia in infant
RETROLENTAL FIBROPLASIA caused by high
oxygen concentration administered in premature
infants
SYPHILIS asymptomatic newborn, VDRL test
HIP DYSPLASIA asymmetric gluteal folds
ERBS PALSY complication of breech delivery;
flaccid arm with elbows extended; ROM exercises
PRECIPITATE DELIVERY increased risk for
intracranial hemorrhage and elevated ICP
PATHOLOGIC JAUNDICE appearance of
jaundice during the first 24 hours
DECREASED INFANT GFR inability of the
infant to concentrate urine and conserve water
RESPIRATORY DISTRESS most common
preterm complication
INFANT HYPOGLYCEMIA SX - tremors, periods
of apnea, cyanosis and poor sucking
LARGER DM NEWBORNS due to increased
somatotropin and increased glucose utilization
UTERINE AND OVARIAN ARTERIES main
blood supply of the uterus
ENDOMETRIOSIS is characterized by painful
menstruation and backache
RETROCOELE is brought about by overstretching
of perineal supporting tissues as a result of childbirth
COLUMNOSQUAMOUS JUNCTION OF THE
INTERNALAND EXTERNAL OS common site
of cervical CA growth
DIETHYLSTILBESTROL management for
infertility
RADIUM REACTION pain and elevated
temperature
DOXORUBICIN inhibits RNA synthesis by
binding DNA
ESTROGEN RECEPTOR PROTEIN (ERP)
evaluates potential response to hormone therapy
BILATERAL OOPHORECTOMY surgical
menopause
CESSATION OF MENSES is due to the inability
of the ovary to respond to gonadotropic hormone
BARTHOLOMEWS RULE via location of
fundus
HAASES RUELE first 5 months: month2 = aog;
second half: month x 5 = aog
NAGELES RULE LMP minus 3m +7d + 1y =
EDC
DECIDUA BASALIS placenta