Maternal/Child Health (OB): The Basics

There is a lot of newly introduced vocabulary alongside a different conceptual view in the care of both the pregnant woman and the unborn child or newborn.

The content is organized into 3 main phases of peripartum care:
Antepartum (before the pregnancy)
Intrapartum (during pregnancy)
Postpartum (after pregnancy) 

Below is an abbreviated outline of the content typically covered in this course:

  • Fetal conception and development
    – Phases of the menstrual cycle
    – Process of fertilization
    – Fetal and Maternal changes
  • Risk factor and fetal assessment
    – Maternal and paternal psychosocial responses to pregnancy
    – Prenatal care: GTPAL, office visits, labs
    – Fundal height assessment
    – Anticipatory guidance for the first, second and third trimesters,
    – Fetal and maternal assessment methods: ultrasound, chorionic villi sampling (CVS), amniocentesis, electronic fetal monitoring, nonstress test (NST), contraction stress test (CST), biophysical profile (BPP), fetal pH blood sampling
  • Labor and Delivery
    – Leopold maneuvers – helps to determine fetal presentation, fetal position, fetal lie and fetal engagement
    – True vs False labor
    – The four stages of labor
    – The 3 phases of the first stage of labor: latent, active, transition
    – Analgesia and anesthesia – local, regional, peridural, intradural blocks
  • High risk pregnancies
    – Miscarriage/spontenous abortion – emergency!
    – Hydatiform Mole – developmental anomaly, “grape-like” clusters
    – Abruptio placentae – premature complete or partial detachment of the placenta from the uterine wall
    – Placenta previa – abnormal implantation of the placenta
    – Anemia
    – Ectopic pregnancy – abnormal implantation of fertilized egg outside of the uterus
    – Infection – TORCH (Toxoplasmosis, Other [HIV, Varicella, Parvo, Syphillis, Coxsackievirua], Rubella, Cytomegalovirus, Herpes simplex)
    – Preterm labor
    – Dystocia – difficult birthing
    – Preeclampsia, eclampsia
    – Hyperemesis gravidarum
    – Gestational diabetes
  • Postpartum
    – Normal postpartum changes of the uterus, cervix, breasts, CV, hematologic, integumentary, musculoskeletal system
    – Normal postpartum vital signs: high temp, low pulse, normal BP, rare changes in RR
    – Measuring fundal height – height decreases 1 cm per day
    – Assessing lochia (postpartum discharge) – rubra → serosa → alba
    – Assessing perineal area and episiotomies (incision of the posterior vaginal wall)
    – Examine breasts for tenderness, engorgement, breastfeeding techniques
    – Assist with mother-baby bonding
    – Assess urinary, bowel movements
    – Determine needs for RhoGAM, rubella vaccine, medications
  • Newborn care
    – APGAR assessment
    – The 5 symptoms of respiratory distress: retractions, tachypnea ( > 60), dusky color, expiratory grunt, flaring nares
    – Newborn prophylactic eye care with erythromycin ointment
    – Physical assessment: vitals, measurements, head-to-toe, reflexes
    – Primary concerns of: aspiration, infection, hypothermia, hypoglycemia, hemorrhagic disorders, hyperbilirubinemia
    – Assess elimination and feeding patterns
    – Screen for genetic disorders such as phenylketonuria (PKU) after breast milk/formula ingestion
    – Provide teaching about newborn care concerning bathing, diapering, crying and comfort

Under each area of content, familiarize yourself with the associated vocabulary, consider the type of care the mother and/or child should receive at this stage in pregnancy and what the nurse should be aware for in terms of possible complications.

Image source.
Content derived from HESI Comprehensive Review for NCLEX-RN Examination.

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