Maternity Final Exam Study Guide
Birth Rate: number of live births in 1 year / 1000 population
Infant Mortality Rate Maternal Mortality Rate
Number of deaths of infants younger than 1 Number of maternal deaths from births and
year of age per 1000 live births complications of pregnancy, childbirth and
puerperium (first 42 days after termination of
pregnancy) per 100,000 live births
Professional Negligence or Malpractice
Duty - owed duty to patient
Breach of Duty - did not carry out duty
Foreseeability - harm was foreseeable
Causation- relationship of cause and effect between one event or action and the result.
Injury of harm- liability of causing harm.
Facts About Consent
● Legally, the person performing surgery/procedure is responsible to inform
● Nurse may clarify information, witness client’s signature, and cosign consent form
● Consent form may be signed by an emancipated minor
● Consent may be obtained by fax or phone with witness
● Consent documents protect the surgeon and health care facility
Ethical Principles
Autonomy: patient can make independent decisions/ support patient decisions.
Fidelity: be honest and faithful to promises
Justice: fairness; care given equitably, fairly, and justly
Paternalism: people in positions of authority restricting freedom in supposed best interest of
the patient without consent
Nonmaleficence: non-harming or inflicting the least harm possible; avoiding risk
Beneficence: act of promoting good and doing what is best for the patient
Veracity: truth; do not withhold truth from patients
,Maternity Final Exam Study Guide
Involution
Definition: process of the uterus returning to its nearly prepregnant size, shape, and location
Involution takes 6-8 weeks
Uterine Atony → Boggy/Soft uterus
● Concerned about postpartum hemorrhage
● Massage the fundus
Fundus deviated from midline
● Empty bladder
Factors Affecting Involution
Faster Involution Slower Involution
● Breastfeeding ● Multiple gestations
● Normal labor/delivery ● C section
● Early ambulation ● Polyhydramnios
● Complete expulsion of placenta ● Retained placenta
● Full bladder
● Multiple fetuses
● Prolonged Labor
Lochia
Postpartum uterine discharge classified according to appearances/contents
Rubra First 1-3 days, RED
Blood & debris
Normal: heavy menstrual period
Abnormal: saturating a pad in 15 min/less
Serosa Days 3-10
Pale serosanguinous to light brown
Old blood, WBCs, serum, tissue, debris
Alba Days 10-14
creamy yellow/white, usually gone by 2 weeks, can last 6 weeks
NORMAL: clots size of grapes or smaller
ABNORMAL: clots size of plum or larger
,Maternity Final Exam Study Guide
Physiologic Adaptations
● Cardiac output elevated transiently
● Diuresis and diaphoresis
● WBC (leukocytosis) increase (can increase up to 30,000)
● Fibrinogen (risk for clots) increase
● Risk of urinary retention
● Proteinuria
● Prolactin for lactation
● Constipation
Rhogam + Rubella Shots
● Mom Rh negative, infant Rh positive
● Rhogam at 28 weeks and 72 hours postpartum
● Negative COOMBS test
● If mom is negative indirect COOMBs then you need to give Rhogam
● If mom is indirect COOMBs positive, she’s already sensitized and does not need
Rhogam
Hep B
Baby receives Hep B vaccine and Hep B immunoglobulin / HBIG
Postpartum Assessment
● BUBBLEHEB
● After pains
○ Occur within first few days, more common with multiparous women
○ Apply warm blanket to abdomen, ibuprofen, encourage patient to empty
bladder
● Void within 4 hours after birth
● Ice packs (first 24 hours) and sitz baths (after 24 hours) for episiotomy
● Vital signs
, Maternity Final Exam Study Guide
Postpartum Hemorrhage
Definition: blood loss greater than 500 mL vaginal and greater than 1,000 mL C-Section
● Early/Primary
○ Occurs during first 24 hours after birth
● Late/Delayed/Secondary
○ May occur from 24 hours to 12 weeks post delivery
Causes:
● Tone: uterine atony
● Tissue: retained placental fragments
● Trauma: lower genital lacerations (1st-4th degree lacerations)
● Thrombin disorders: disseminated intravascular coagulation (DIC)
● RIsk factors:
○ Multiple babies/pregnancies, large baby, twins, pitocin, difficult labor, C
section, assistive device
S/Sx PPH:
● Saturation of peripad within 15 min
● Boggy fundus after massage
● Tachycardia (late sign)
● Decrease in BP (late sign)
Interventions:
● Massage fundus until firm - do not overmassage
● Increase IV fluid
● Increase oxytocin, additional uterotonics
● Methergine
● Surgical interventions
● Weigh pads to estimate blood loss
Hematoma
Definition: collection of blood within connective tissues of vagina or perineal area related to a
vessel that ruptures and continues to bleed
S/Sx Hematoma:
● Severe pain in vaginal/perineal area
● Tachycardia, hypotension
Interventions:
● Large hematomas surgically drained
● Apply ice for first 24 hours
● Monitor for decrease BP and increase pulse → indicate shock
● Administer analgesics for pain
Birth Rate: number of live births in 1 year / 1000 population
Infant Mortality Rate Maternal Mortality Rate
Number of deaths of infants younger than 1 Number of maternal deaths from births and
year of age per 1000 live births complications of pregnancy, childbirth and
puerperium (first 42 days after termination of
pregnancy) per 100,000 live births
Professional Negligence or Malpractice
Duty - owed duty to patient
Breach of Duty - did not carry out duty
Foreseeability - harm was foreseeable
Causation- relationship of cause and effect between one event or action and the result.
Injury of harm- liability of causing harm.
Facts About Consent
● Legally, the person performing surgery/procedure is responsible to inform
● Nurse may clarify information, witness client’s signature, and cosign consent form
● Consent form may be signed by an emancipated minor
● Consent may be obtained by fax or phone with witness
● Consent documents protect the surgeon and health care facility
Ethical Principles
Autonomy: patient can make independent decisions/ support patient decisions.
Fidelity: be honest and faithful to promises
Justice: fairness; care given equitably, fairly, and justly
Paternalism: people in positions of authority restricting freedom in supposed best interest of
the patient without consent
Nonmaleficence: non-harming or inflicting the least harm possible; avoiding risk
Beneficence: act of promoting good and doing what is best for the patient
Veracity: truth; do not withhold truth from patients
,Maternity Final Exam Study Guide
Involution
Definition: process of the uterus returning to its nearly prepregnant size, shape, and location
Involution takes 6-8 weeks
Uterine Atony → Boggy/Soft uterus
● Concerned about postpartum hemorrhage
● Massage the fundus
Fundus deviated from midline
● Empty bladder
Factors Affecting Involution
Faster Involution Slower Involution
● Breastfeeding ● Multiple gestations
● Normal labor/delivery ● C section
● Early ambulation ● Polyhydramnios
● Complete expulsion of placenta ● Retained placenta
● Full bladder
● Multiple fetuses
● Prolonged Labor
Lochia
Postpartum uterine discharge classified according to appearances/contents
Rubra First 1-3 days, RED
Blood & debris
Normal: heavy menstrual period
Abnormal: saturating a pad in 15 min/less
Serosa Days 3-10
Pale serosanguinous to light brown
Old blood, WBCs, serum, tissue, debris
Alba Days 10-14
creamy yellow/white, usually gone by 2 weeks, can last 6 weeks
NORMAL: clots size of grapes or smaller
ABNORMAL: clots size of plum or larger
,Maternity Final Exam Study Guide
Physiologic Adaptations
● Cardiac output elevated transiently
● Diuresis and diaphoresis
● WBC (leukocytosis) increase (can increase up to 30,000)
● Fibrinogen (risk for clots) increase
● Risk of urinary retention
● Proteinuria
● Prolactin for lactation
● Constipation
Rhogam + Rubella Shots
● Mom Rh negative, infant Rh positive
● Rhogam at 28 weeks and 72 hours postpartum
● Negative COOMBS test
● If mom is negative indirect COOMBs then you need to give Rhogam
● If mom is indirect COOMBs positive, she’s already sensitized and does not need
Rhogam
Hep B
Baby receives Hep B vaccine and Hep B immunoglobulin / HBIG
Postpartum Assessment
● BUBBLEHEB
● After pains
○ Occur within first few days, more common with multiparous women
○ Apply warm blanket to abdomen, ibuprofen, encourage patient to empty
bladder
● Void within 4 hours after birth
● Ice packs (first 24 hours) and sitz baths (after 24 hours) for episiotomy
● Vital signs
, Maternity Final Exam Study Guide
Postpartum Hemorrhage
Definition: blood loss greater than 500 mL vaginal and greater than 1,000 mL C-Section
● Early/Primary
○ Occurs during first 24 hours after birth
● Late/Delayed/Secondary
○ May occur from 24 hours to 12 weeks post delivery
Causes:
● Tone: uterine atony
● Tissue: retained placental fragments
● Trauma: lower genital lacerations (1st-4th degree lacerations)
● Thrombin disorders: disseminated intravascular coagulation (DIC)
● RIsk factors:
○ Multiple babies/pregnancies, large baby, twins, pitocin, difficult labor, C
section, assistive device
S/Sx PPH:
● Saturation of peripad within 15 min
● Boggy fundus after massage
● Tachycardia (late sign)
● Decrease in BP (late sign)
Interventions:
● Massage fundus until firm - do not overmassage
● Increase IV fluid
● Increase oxytocin, additional uterotonics
● Methergine
● Surgical interventions
● Weigh pads to estimate blood loss
Hematoma
Definition: collection of blood within connective tissues of vagina or perineal area related to a
vessel that ruptures and continues to bleed
S/Sx Hematoma:
● Severe pain in vaginal/perineal area
● Tachycardia, hypotension
Interventions:
● Large hematomas surgically drained
● Apply ice for first 24 hours
● Monitor for decrease BP and increase pulse → indicate shock
● Administer analgesics for pain
