NR602 / NR 602 Final Exam 2026 | Primary Care of the Childbearing & Childrearing Family | Chamberlain University | Questions & Answers with Detailed Rationales | Grade A | Women's Health & Pediatric Primary Care | FNP/PNP Prep PDF

INSTANT PDF DOWNLOAD — This is the comprehensive Final Exam preparation guide for NR602 / NR 602 - Primary Care of the Childbearing & Childrearing Family (2026 Update) at Chamberlain University, featuring questions and answers with detailed rationales. Designed for Family Nurse Practitioner (FNP) and Pediatric Nurse Practitioner (PNP) students, this resource consolidates the critical women's health, obstetrical, and pediatric primary care concepts required to master the NR602 Final Exam and excel in primary care of families across the childbearing and childrearing continuum. The guide is meticulously aligned with Chamberlain University curriculum, ACOG, AWHONN, AAP, Bright Futures, USPSTF guidelines, and current evidence-based primary care standards. This verified resource provides comprehensive coverage of key NR602 Primary Care Final Exam topics, including: Preconception and Prenatal Care (preconception counseling (folic acid 400-800 mcg daily (4 mg daily if prior neural tube defect pregnancy), optimize chronic disease management (diabetes (HbA1c 6.5%), hypertension (avoid ACE inhibitors/ARBs, switch to labetalol/nifedipine/methyldopa), thyroid (euthyroid, avoid methimazole first trimester—use propylthiouracil (PTU) first trimester then methimazole after), epilepsy (avoid valproate, topiramate—neural tube defects, cleft lip/palate; lamotrigine, levetiracetam safer), mental health disorders (avoid paroxetine (cardiac defects), benzodiazepines (cleft lip/palate); SSRIs safest (sertraline, fluoxetine, citalopram, escitalopram)), update immunizations (MMR (wait 4 weeks after vaccination before conception), varicella (wait 4 weeks), Tdap (given preconception or during pregnancy 27-36 weeks), HPV (complete series before pregnancy, not given in pregnancy), influenza (inactivated vaccine safe in any trimester), COVID-19 (recommended preconception and in pregnancy), hepatitis B, RSV (new vaccine recommended 32-36 weeks during RSV season (September-January) for prevention of infant RSV, or infant receives nirsevimab (Beyfortus) monoclonal antibody at birth)), genetic carrier screening (cystic fibrosis, spinal muscular atrophy (SMA), hemoglobinopathies (sickle cell, thalassemia), Tay-Sachs (Ashkenazi Jewish, French-Canadian, Cajun), Canavan disease (Ashkenazi Jewish), familial dysautonomia (Ashkenazi Jewish), Fragile X (family history, intellectual disability, premature ovarian insufficiency), spinal muscular atrophy (SMA) universal screening recommended by ACOG, cfDNA aneuploidy screening (NIPT) offered to all pregnancies regardless of age after 9-10 weeks gestation), prenatal visit schedule (every 4 weeks until 28 weeks, every 2 weeks from 28-36 weeks, weekly from 36 weeks to delivery, high-risk pregnancies more frequent), first trimester (dating ultrasound 8-12 weeks (crown-rump length (CRL) most accurate for dating), nuchal translucency (NT) screening 11-13 weeks 6 days (increased NT 3.0-3.5 mm associated with aneuploidy (trisomy 21,18,13, Turner) and structural anomalies (congenital heart disease, diaphragmatic hernia, omphalocele), combined first trimester screening (NT + PAPP-A + free beta-hCG) for trisomy 21 and 18, cell-free DNA (NIPT) for trisomy 21,18,13, sex chromosome aneuploidies (Turner, Klinefelter, triple X, XYY) and fetal sex, chorionic villus sampling (CVS) 10-13 weeks for diagnostic testing (karyotype, microarray, targeted mutation analysis), quad screen (maternal serum alpha-fetoprotein (MSAFP), hCG, unconjugated estriol (uE3), inhibin A) at 15-22 weeks for open neural tube defects (ONTD) and aneuploidy (trisomy 21,18), MSAFP alone for ONTD screening, anatomy ultrasound at 18-22 weeks (comprehensive fetal survey: head (ventricles, cerebellum, cisterna magna, cavum septum pellucidum), face (lips/nose for cleft), spine (ossification, alignment), heart (four-chamber, outflow tracts, aortic arch), chest (lungs, diaphragm), abdomen (stomach, liver, kidneys (presence, size, echogenicity, pyelectasis), bladder, abdominal wall (umbilical cord insertion), extremities (long bones, hands, feet, digits), placenta (location (prevue, low-lying), appearance, cord insertion), amniotic fluid volume (polyhydramnios (AFI 24 cm or DVP 8 cm), oligohydramnios (AFI 5 cm or DVP 2 cm)), cervical length (transvaginal if indicated, short cervix 25 mm increased risk preterm birth), fetal growth (biometry: biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), estimated fetal weight (EFW), growth percentiles, interval growth for at-risk pregnancies), gestational diabetes screening (glucose challenge test (GCT) 1-hour 50g glucose load 24-28 weeks (abnormal ≥130-140 mg/dL, sensitivity 80-90%), if abnormal, diagnostic 3-hour 100g oral glucose tolerance test (OGTT) (Carpenter-Coustan criteria: fasting ≥95 mg/dL, 1-hour ≥180, 2-hour ≥155, 3-hour ≥140—2 or more elevated diagnoses GDM), or one-step method (75g OGTT fasting, 1-hour, 2-hour per IADPSG criteria: fasting ≥92, 1-hour ≥180, 2-hour ≥153—≥1 elevated diagnoses GDM), GDM management (medical nutrition therapy (MNT), blood glucose monitoring fasting (95 mg/dL) and 1-hour postprandial (140 mg/dL) or 2-hour (120 mg/dL), pharmacologic treatment if glucose goals not met after 1-2 weeks of MNT: insulin (first-line, does not cross placenta, NPH, regular, aspart, lispro, detemir, glargine) or metformin (crosses placenta, may be used if patient refuses insulin or cannot afford, but may increase risk of preterm birth and neonatal hypoglycemia compared to insulin, not FDA-approved for GDM), glyburide (crosses placenta, higher risk of neonatal hypoglycemia and macrosomia compared to insulin, not recommended as first-line), fetal surveillance for GDM (ultrasound for fetal growth (macrosomia (EFW g), polyhydramnios), antenatal testing (NST, BPP) starting at 32-36 weeks if medication-controlled or with other risk factors, timing of delivery (well-controlled GDM: 39-40 weeks, medication-controlled: 39 weeks, poorly controlled or macrosomia: 38-39 weeks), postpartum glucose screening (75g OGTT 4-12 weeks postpartum, then every 1-3 years thereafter, 50% develop type 2 DM within 10 years), Group B Streptococcus (GBS) screening (rectovaginal culture at 36-37 6/7 weeks, intrapartum penicillin G or ampicillin prophylaxis for positive culture, risk factors for GBS prophylaxis without culture (previous infant with GBS disease, GBS bacteriuria in current pregnancy, unknown GBS status and 37 weeks, prolonged rupture of membranes ≥18 hours, intrapartum fever ≥100.4°F (38°C)), penicillin allergy (cefazolin if non-anaphylactic, clindamycin or vancomycin if anaphylactic and susceptibility testing confirms sensitivity, otherwise vancomycin)), Obstetrical Complications (preterm labor (cervical dilation and effacement with regular contractions between 20-37 weeks, risk factors (prior preterm birth, short cervix (25 mm), multifetal gestation, polyhydramnios, uterine anomaly, cervical insufficiency, infection (bacterial vaginosis, trichomoniasis, gonorrhea, chlamydia, UTI, periodontitis), smoking, substance use, low maternal weight, extremes of age (18 or 35), African American race, low socioeconomic status, stress, physical labor, short interpregnancy interval (6 months), bleeding (abruption, prevue), diagnosis (transvaginal ultrasound cervical length (25 mm), fetal fibronectin (fFN) (negative predictive value high, positive predictive value low, between 22-34 weeks, avoid if cervical dilation 3 cm, bleeding, intercourse within 24 hours, digital exam within 24 hours—can cause false positive), tocolysis (nifedipine (first-line, 20 mg PO load then 10-20 mg q6-8h, side effects: hypotension, headache, flushing, maternal tachycardia, pulmonary edema rare), indomethacin (≤48 hours, 32 weeks, side effects: constriction of ductus arteriosus, oligohydramnios, necrotizing enterocolitis (NEC) in preterm infant, avoid 32 weeks), magnesium sulfate (for fetal neuroprotection if 32 weeks, reduces cerebral palsy risk, also tocolytic, monitor respiratory rate, deep tendon reflexes, urine output—toxicity: loss of patellar reflex, respiratory depression, cardiac arrest, calcium gluconate antidote), terbutaline (no longer used for maintenance tocolysis, subcutaneous use only for acute treatment up to 48 hours, Black Box Warning for maternal death), betamethasone (corticosteroid for fetal lung maturation if 24-34 weeks (some up to 36 weeks), two doses 12-24 hours apart IM, reduces RDS, IVH, NEC, death, rescue course if 14 days since prior course and 34 weeks), antenatal magnesium sulfate for fetal neuroprotection (32 weeks, 4-6g IV load then 1-2g/hour for 12-24 hours, reduces cerebral palsy by 30-40%), preterm premature rupture of membranes (PPROM) (rupture of membranes before 37 weeks, management depends on gestational age (24 weeks: counsel regarding extreme prematurity, pulmonary hypoplasia, chorioamnionitis risk; 24-33 weeks: expectant management (hospitalization, monitoring for infection, fetal heart rate, contractions, steroids, antibiotics (latency antibiotics: ampicillin + erythromycin or azithromycin for 7 days or until 34 weeks, reduces chorioamnionitis, prolongs latency, reduces neonatal infection), GBS prophylaxis if GBS positive, tocolysis considered if 32 weeks, magnesium sulfate for neuroprotection if 32 weeks; 34-36 weeks: active management (induction or C-section if favorable/unfavorable cervix, no steroids if 34 weeks, antibiotics as indicated for GBS prophylaxis, delivery after 34 weeks reduces chorioamnionitis risk compared to expectant management)), chorioamnionitis (intra-amniotic infection, clinical diagnosis (maternal fever ≥100.4°F (38°C) plus ≥2 of: maternal tachycardia (100 bpm), fetal tachycardia (160 bpm), uterine tenderness, purulent/foul amniotic fluid, leukocytosis (15,000-18,000/mm³)), treatment (IV antibiotics (ampicillin + gentamicin, plus clindamycin or metronidazole for anaerobic coverage if C-section), expedite delivery (induction or C-section), neonatal sepsis evaluation), hypertensive disorders of pregnancy (chronic hypertension (preexisting before pregnancy or before 20 weeks, persists 12 weeks postpartum), gestational hypertension (new onset BP ≥140/90 after 20 weeks without proteinuria or other end-organ dysfunction, resolves postpartum, increased risk of progression to preeclampsia (15-50%)), preeclampsia (new onset hypertension (≥140/90) after 20 weeks with proteinuria (≥300 mg/24h, protein:creatinine ratio ≥0.3, dipstick ≥1+ if quantitative not available) OR new onset hypertension without proteinuria but with end-organ dysfunction (thrombocytopenia (platelets 100,000), renal insufficiency (creatinine 1.1 mg/dL or doubling of baseline), impaired liver function (elevated LFTs (AST, ALT) to 2x upper limit normal), pulmonary edema, cerebral or visual symptoms (severe headache, blurred vision, scotomata, hyperreflexia, clonus)), severe preeclampsia (BP ≥160/110 on two occasions at least 4 hours apart while on bed rest OR any of: thrombocytopenia (platelets 100,000), impaired liver function (elevated LFTs 2x normal, severe persistent RUQ/epigastric pain), progressive renal insufficiency (creatinine 1.1 or doubling), pulmonary edema, new-onset cerebral/visual disturbances, eclampsia (seizures), management: severe preeclampsia at ≥34 weeks or unstable maternal/fetal condition: delivery (IV magnesium sulfate for seizure prophylaxis (4-6g IV load then 1-2g/hour, monitor DTRs, respiratory rate, urine output, calcium gluconate at bedside), antihypertensives for severe range (labetalol 20-80mg IV q10-20min, hydralazine 5-10mg IV q20-30min, nifedipine 10-20mg PO q30min), delivery (induction or C-section depending on gestational age, cervical status, fetal presentation, prior uterine scars); severe preeclampsia at 34 weeks: expectant management if stable (hospitalization, daily labs, BP monitoring, fetal monitoring, steroids for fetal lung maturity, magnesium sulfate for seizure prophylaxis, antihypertensives as needed, delivery at 34 weeks or earlier if deterioration), mild preeclampsia without severe features at ≥37 weeks: delivery, at 34-37 weeks: delivery vs expectant management (controversial, some recommend delivery at 37 weeks, some at 34 weeks if cervix favorable, delivery reduces maternal complications but increases neonatal respiratory morbidity), chronic hypertension in pregnancy (treat to BP 160/105 or 140/90 depending on guidelines (ACOG recommends 160/105, USPSTF recommends 140/90), avoid ACE inhibitors, ARBs, direct renin inhibitors, spironolactone, eplerenone (fetotoxic—renal dysgenesis, oligohydramnios, intrauterine growth restriction, skull hypoplasia, neonatal renal failure, death), first-line: labetalol, nifedipine, methyldopa (not first-line due to side effects but safe), beta-blockers (atenolol associated with intrauterine growth restriction, avoid if possible), low-dose aspirin 81 mg daily starting 12-28 weeks (optimally 16 weeks) for preeclampsia prevention in high-risk (history of preeclampsia, multifetal gestation, chronic hypertension, type 1 or 2 diabetes, renal disease, autoimmune disease) or moderate-risk (first pregnancy, obesity (BMI 30), family history of preeclampsia, African American race, low socioeconomic status, age 35, prior low birthweight or SGA, prior adverse pregnancy outcome, interpregnancy interval 10 years), HELLP syndrome (Hemolysis (LDH 600, elevated bilirubin, schistocytes, anemia), Elevated Liver enzymes (AST/ALT 2x normal, often 500-1000), Low Platelets (100,000), often presents with epigastric/RUQ pain, nausea, vomiting, malaise, can occur without hypertension/proteinuria, may develop postpartum (up to 48 hours, but can be up to 7 days), management: delivery (after maternal stabilization, platelet transfusion if 50,000 for vaginal delivery or 100,000 for C-section, corticosteroids for fetal lung maturity if 34 weeks, magnesium sulfate for seizure prophylaxis, antihypertensives for BP 160/110, plasma exchange for severe thrombocytopenia/hemolysis if no improvement postpartum, monitoring for DIC, acute renal failure, pulmonary edema, hepatic rupture (rare but catastrophic—RUQ pain, shock, hemoperitoneum—emergency surgery)), postpartum preeclampsia (new onset hypertension with proteinuria or end-organ dysfunction within 48 hours to 6 weeks postpartum, often presents with severe headache, visual changes, epigastric pain, nausea, management: antihypertensives, magnesium sulfate for severe features (BP ≥160/110, cerebral/visual symptoms, epigastric pain, thrombocytopenia, elevated LFTs), avoid NSAIDs for pain (may worsen hypertension), labetalol, nifedipine, enalapril (ACE inhibitors safe postpartum even if breastfeeding), captopril), placental abruption (premature separation of placenta, risk factors (prior abruption, chronic hypertension, preeclampsia, preterm premature rupture of membranes, chorioamnionitis, multifetal gestation, polyhydramnios, trauma, smoking, cocaine use, thrombophilias, uterine anomalies, fibroids, advanced maternal age), classic triad (vaginal bleeding (80%, may be concealed (20%) with no visible bleeding but abdominal pain, uterine tenderness, back pain, frequent contractions, tetanic contractions, hypertonus, nonreassuring fetal heart rate (late decelerations, bradycardia, variable decelerations, sinusoidal pattern), hypovolemic shock, DIC (especially with large abruption, consumption of clotting factors, fibrinogen 200 mg/dL, elevated PT/PTT, low platelets), diagnosis (clinical, ultrasound may show retroplacental clot (sensitivity only 25-50%), management (hemodynamic stabilization (IV fluids, blood products), continuous fetal monitoring, delivery (C-section if fetal distress, unstable mother, severe abruption, viable fetus; vaginal delivery may be attempted if abruption mild, reassuring fetal status, cervix favorable, stable mother), DIC management (cryoprecipitate, platelets, fresh frozen plasma, fibrinogen concentrate, tranexamic acid (TXA) if bleeding refractory, recombinant factor VIIa for life-threatening bleeding after standard measures), postpartum hemorrhage (PPH) risk increased), placenta prevue (implantation of placenta over or near internal cervical os, risk factors (prior C-section (increases risk of placenta accreta spectrum with prevue), prior prevue, multifetal gestation, advanced maternal age, smoking, cocaine, uterine surgery, Asherman's syndrome), presentation (painless bright red vaginal bleeding in second or third trimester (classic), may have uterine irritability (contractions but not painful), malpresentation (breech, transverse), diagnosis (transvaginal ultrasound (preferred, safe), avoid digital cervical exam until prevue ruled out (can cause catastrophic hemorrhage), management (no intercourse, pelvic rest, no digital exams, hospitalize at 34-36 weeks for monitoring if persistent prevue at term, C-section delivery (usually 36-37 weeks if stable, earlier if bleeding), massive hemorrhage protocol (blood products, interventional radiology for uterine artery embolization, hysterectomy if uncontrolled bleeding), placenta accreta spectrum (PAS) (placenta accreta (chorionic villi attach to myometrium), increta (invade into myometrium), percreta (invade through serosa into adjacent organs (bladder, bowel)), risk factors (placenta prevue with prior C-section (risk increases with number of prior C-sections: 1 prior C-section 3%, 2 prior 11%, 3 prior 40%, 4 prior 61%, 5 prior 67%), prior uterine surgery, Asherman's syndrome, uterine irradiation, diagnosis (ultrasound (loss of retroplacental clear zone, myometrial thinning 1mm, placental lacunae (Swiss cheese appearance), bridging vessels, bladder wall interruption, abnormal Doppler), MRI for deep invasion, management (multidisciplinary team (MFM, gynecologic oncology, interventional radiology, anesthesia, blood bank, neonatology), scheduled C-section hysterectomy (usually 34-35 weeks), leave placenta in situ if percreta with bladder invasion (adjuvant methotrexate, UAE, delayed hysterectomy), massive hemorrhage preparedness (cell saver, interventional radiology, 10+ units PRBC, FFP, platelets, cryoprecipitate, fibrinogen concentrate, recombinant factor VIIa, TXA), internal iliac artery balloon catheters, uterine artery embolization), Labor and Delivery (stages of labor: first stage (latent phase (0-6 cm, slow cervical change, usually longest part of labor for nulliparas, may last 20+ hours, expectant management, therapeutic rest (morphine, secobarbital, zolpidem, diphenhydramine) if latent phase prolonged with reassuring fetal status and no infection, active phase (≥6 cm to 10 cm, more rapid cervical change, nulliparas ≥1.2 cm/hour, multiparas ≥1.5 cm/hour, if slower, consider inadequate contractions (augment with oxytocin) or CPD (cephalopelvic disproportion), second stage (complete dilation to delivery of infant, nulliparas up to 3 hours with epidural (2 hours without), multiparas up to 2 hours with epidural (1 hour without), passive descent vs active pushing (delayed pushing may reduce fatigue but may prolong second stage, no difference in neonatal outcomes, consider fetal position, station, maternal urge, epidural effects), prolonged second stage associated with increased operative vaginal delivery, C-section, maternal fatigue, perineal trauma, postpartum hemorrhage, chorioamnionitis, neonatal acidemia, third stage (delivery to placental expulsion, normally within 30 minutes, active management (oxytocin 10 units IM or IV after delivery of anterior shoulder, controlled cord traction, uterine massage) reduces PPH risk by 60%, fourth stage (1-4 hours postpartum, maternal recovery, monitoring for PPH (fundus firmness (should be midline at umbilicus or lower, deviated fundus suggests full bladder), vaginal bleeding (normal lochia rubra (moderate, no clots 2-3 cm), abnormal: heavy (1 pad/hour), large clots (2-3 cm), boggy fundus (uterine atony), retained placental fragments, genital tract laceration, uterine rupture, inversion), vital signs (BP, pulse, respiratory rate, temperature), uterine tone, bladder distention (can cause uterine atony, displaced fundus, catheterize if unable to void, if postpartum 6 hours unable to void, suspect urinary retention, straight catheter or indwelling catheter), pain management, breastfeeding support), Postpartum Care (normal postpartum physiological changes: uterine involution (fundus descends ~1 cm/day, nonpalpable by 2 weeks postpartum, lochia rubra (red, bloody) for 3-4 days, serosa (pink/brown) 4-10 days, alba (white/yellow) 10-28 days, persistent rubra or return to rubra suggests retained products of conception (RPOC) or endometritis), cardiovascular (increased cardiac output (CO) and stroke volume, decreased systemic vascular resistance, orthostatic hypotension, diuresis (first 2-5 days, up to 3 L/day), risk of thromboembolism (pregnancy hypercoagulable state persists up to 6 weeks postpartum), respiratory (diaphragm descends, increased tidal volume, decreased residual volume, functional residual capacity returns to prepregnancy within 1-2 weeks, dyspnea may be normal first few days but rule out pulmonary embolism, peripartum cardiomyopathy), endocrine (prolactin increases with nipple stimulation, suppresses ovulation (lactational amenorrhea method (LAM) effective if 6 months postpartum, exclusively breastfeeding (no supplements, no pacifiers), and amenorrheic, failure rate 2%), first ovulation may occur as early as 27 days postpartum in non-breastfeeding, 6 months in breastfeeding, menstrual period returns by 12 weeks in 70% of non-breastfeeding, 6 months in 40% of breastfeeding), thyroid (postpartum thyroiditis (transient thyrotoxicosis (1-4 months) then hypothyroidism (4-8 months), may cause depression, anxiety, fatigue, weight changes, screen TSH if symptoms), postpartum depression screening (Edinburgh Postnatal Depression Scale (EPDS) at 2-6 weeks postpartum, 10-13 indicates risk, refer for evaluation, treat with psychotherapy (CBT, IPT) and/or SSRIs (sertraline, fluoxetine, paroxetine (lowest breastmilk levels), citalopram, escitalopram), all compatible with breastfeeding, postpartum psychosis (emergency, 1-2/1000 deliveries, onset within 2 weeks (often first 48-72 hours), risk factors (bipolar disorder, prior postpartum psychosis, family history), symptoms (delusions (often bizarre, religious, grandiose, paranoid, infanticidal, suicidal), hallucinations (auditory commanding to harm self/baby), disorganization, mania, confusion, agitation, insomnia, rapid mood swings, treatment (hospitalization, antipsychotic (risperidone, olanzapine, quetiapine, haloperidol, aripiprazole), lithium (mood stabilization, but requires monitoring of baby (lethargy, feeding difficulties, hypotonia, nephrogenic diabetes insipidus, hypothyroidism, cardiac arrhythmias), breastfeeding compatible with monitoring), benzodiazepine (lorazepam, clonazepam) for agitation/insomnia, ECT if refractory, risk of infanticide 4%, suicide 5%), postpartum hemorrhage (PPH) (early (24 hours) vs late (24 hours to 12 weeks), causes (4 Ts: Tone (uterine atony) (70%), Trauma (lacerations, episiotomy, uterine rupture, uterine inversion, hematoma) (20%), Tissue (retained placenta, placental fragments, invasive placenta (accreta/increta/percreta)) (10%), Thrombin (coagulopathy (DIC, von Willebrand, ITP, factor deficiency, anticoagulation)) (1%), management: uterine atony (fundal massage (two-handed bimanual compression), oxytocin (10-40 units in 1L IV fluid at 125-250 mL/hour or 10 units IM, first-line, no maximum dose but water intoxication risk with large volumes of hypotonic fluid), methylergonovine (Methergine) 0.2 mg IM q2-4h (contraindicated in hypertension, preeclampsia, cardiovascular disease), carboprost (Hemabate) 250 mcg IM q15-90min (max 8 doses, contraindicated in asthma, active cardiac/pulmonary disease, renal/liver disease), misoprostol (800-1000 mcg rectal or sublingual, use if no IV access or other agents unavailable, side effects: fever, chills, diarrhea, nausea, vomiting), tranexamic acid (TXA) 1g IV over 10 minutes, repeat once if bleeding continues after 30 minutes, reduces mortality if given within 3 hours of delivery (WOMAN trial)), intrauterine balloon tamponade (Bakri balloon, condom catheter), uterine artery embolization (UAE) for stable patient with continued bleeding, uterine compression sutures (B-Lynch, Hayman, Cho square, compression brace), uterine artery ligation (O'Leary), internal iliac artery ligation (last resort before hysterectomy), hysterectomy (for uncontrolled bleeding, invasive placenta, uterine rupture, failed conservative measures), genital tract lacerations (inspect cervix, vagina, perineum, repair with absorbable suture, vaginal packing for deep sulcus tears, retroperitoneal hematoma (broad ligament, pelvic sidewall, may present with hypotension, tachycardia, falling Hgb, pain, mass on exam, requires surgical exploration, UAE, or embolization), retained placenta (manual removal under anesthesia, curettage, if invasive placenta (accreta/increta/percreta), do not attempt manual removal (catastrophic hemorrhage), prepare for hysterectomy, consider leaving placenta in situ if stable and patient desires future fertility (adjuvant methotrexate, UAE, delayed hysterectomy), coagulopathy (DIC from abruption, severe preeclampsia/HELLP, amniotic fluid embolism, sepsis, massive transfusion, obtain labs (CBC, PT/PTT/INR, fibrinogen (critical 200 mg/dL, replacement goal 200), D-dimer (not useful postpartum), peripheral smear (schistocytes), TEG/ROTEM if available, replace with FFP, cryoprecipitate (fibrinogen source), platelets (goal 50,000), fibrinogen concentrate, prothrombin complex concentrate (PCC), recombinant factor VIIa (off-label, last resort), Newborn Care (transition to extrauterine life: initiation of breathing (chemical (hypoxia, hypercapnia, acidosis), mechanical (chest compression during vaginal delivery), thermal (cool environment stimulates respiratory center), sensory (touch, light, sound, pain)), pulmonary transition (fluid clearance (vaginal delivery (thoracic compression), C-section (delayed clearance, higher risk TTN (transient tachypnea of newborn)), surfactant release (term infant, preterm at risk RDS), pulmonary vasodilation (increased oxygen, decreased PVR, closure of ductus arteriosus functional closure by 24 hours, anatomic closure 2-3 weeks, patent ductus arteriosus (PDA) in preterm associated with pulmonary overcirculation, volume overload, heart failure, may close with indomethacin or ibuprofen, surgery if medical therapy fails), cardiovascular transition (closure of foramen ovale (functional closure within first breaths, anatomic closure months), ductus venosus closure (functional within hours, anatomic 3-7 days), umbilical vessels (clamp and ligation, delayed cord clamping 30-60 seconds recommended in term and preterm (increases hemoglobin, iron stores, improves neonatal outcomes, may increase risk of polycythemia, hyperbilirubinemia but benefits outweigh risks), thermoregulation (newborn heat loss mechanisms (conduction (to cold surfaces), convection (to cool air currents), radiation (to cold objects not in direct contact), evaporation (from wet skin after birth), neutral thermal environment (axillary temperature 36.5-37.5°C (97.7-99.5°F)), prevention (dry immediately after birth, warm blankets, radiant warmer, skin-to-skin contact with mother, hat to reduce heat loss from head (25-30% of heat loss), warm humidified oxygen if needed, delay first bath until temperature stable (at least 2 hours, ideally 24 hours),