Maternity Unit #3

REEDA

A memory trick used to assess wounds (like an episiotomy or lacerations) standing for Redness, Edema, Ecchymosis, Drainage, and Approximation of incision.

Hemorrhoids

Swollen veins in the rectum causing pain and minor bleeding, often treated with topical witch hazel for inflammation.

Homan's Sign

An exam used to check for DVT where the patient flexes the foot downward and upward while the leg is extended; calf pain indicates a positive sign.

COWS

A mnemonic for DVT signs: Calf pain/Cramping, One sided leg swelling, Warm red leg (blood pooling), and SOB & angina (indicating PE).

Postpartum WBC Count

While normal levels are $5,000\,-\,10,000$, leukocyte counts may increase up to $30,000$ postpartum; counts that do not decrease require action.

Endometritis

Inflammation or irritation of the lining of the uterus from an infection entering via the vagina; symptoms include foul-smelling lochia and fever $> 100.4^{\circ}F$.

Mastitis

Inflammation of breast tissue from poor breastfeeding technique, inadequate milk duct drainage, or infection; characterized by unilateral breast swelling and flu-like symptoms.

Thrombophlebitis

An inflammatory process that causes a blood clot to form and block one or more veins.

Calf (DVT Prevention Mnemonic)

Stands for Calf exercises, Ambulate, avoid Crossing legs/sitting for long periods, Leg compression stockings (SCDS), and increase Fluids.

Vaginal Hematoma

Blood accumulation under the skin from trauma to perineum tissues, causing severe pain, a feeling of fullness, and firm, midline uterus with continued bleeding.

Postpartum Hemorrhage (PPH) Definition

Blood loss $> 500\,mL$ after vaginal birth or blood loss $> 1000\,mL$ after C-section.

Uterine Atony

A boggy, soft uterus that fails to contract after birth; the most common cause of postpartum hemorrhage.

Macrosomia

A condition where the baby's weight is $> 8\,lbs\,13\,oz$, which can cause overdistention of the uterus.

Polyhydramnios

The presence of excessive amniotic fluid, which can contribute to uterine fatigue and atony.

Precipitous Labor

A quick labor lasting $3$ hours or less.

Placental Abruption

A condition where the placenta separates from the wall of the uterus while the baby is still inside.

Placenta Accreta

A condition where the placenta attaches to the uterus too firmly, potentially leading to retained fragments or fetal demise.

Hemorrhagic Shock Signs

Symptoms include tachycardia, hypotension, cold clammy skin, and long capillary refill time.

APGAR Score

A scale from $0-10$ used to describe newborn wellbeing after birth, typically assessed at $1$ minute and $5$ minutes post-delivery.

APGAR (A)

Appearance (skin color).

APGAR (P)

Pulse.

APGAR (G)

Grimace (reaction & reflection).

APGAR (A - Activity)

Activity (muscle tone).

APGAR (R)

Respiratory effort.

APGAR Score $0-3$

Indicates severe distress; requires full resuscitation.

APGAR Score $4-6$

Indicates moderate distress; requires interventions such as oxygen, suction, and stimulation of the baby.

APGAR Score $7-10$

Indicates adequate wellbeing; provide routine post-delivery care including warming the baby and encouraging feeding.

Full term infant

A newborn whose skin is opaque with the presence of vernix and other signs of maturity.

Preterm infant

A newborn with smooth, shiny, and gooey skin (lots of vernix) that is translucent and extremely flexible.

Post term infant

A larger, chunky, and non-flexible baby with skin that is dry, cracked, and peeled on the hands and feet.

NB Assessment Phase 1

Stabilization, which includes the APGAR score.

NB Assessment Phase 2

Infant physical exam.

NB Assessment Phase 3

Routine care.

Baby blues

A short-term condition lasting $10$ days or less characterized by crying, sadness, fatigue, and exhaustion; usually resolves on its own.

Post Partum Depression

A condition that stops the mother's ability to function, occurring for $2-8$ weeks with onset within $4$ weeks of delivery; symptoms include debilitating anxiety, panic, and apathy.

Post Partum Psychosis

A rare and severe condition where the mother loses touch with reality, occurring within $2-3$ weeks of delivery; history of bipolar disorder is a risk factor.

Fetal demise

A stillborn infant that died before or during delivery.

BUBBLE HE

An acronym for postpartum assessment: Breast, Uterus, Bladder, Bowels, Lochia, Episiotomy (though the transcript focuses on the first five).

Normal Fundus

A fundus that is firm, midline, and level to the umbilicus (belly button), indicating the uterus is contracting to normal size.

Displaced Fundus

A fundus that is not midline, often caused by a full bladder; interventions include having the patient void every $2$ hours or using an in & out catheter.

Uterine atony

A soft or boggy fundus that increases the risk for hemorrhaging; requires fundal massage or oxytocin infusion.

Bladder Distention Intervention

Allow the patient to void frequently and apply ice to the perineum in the first $24$ hours to reduce pain and swelling.

Postpartum Bowel Care

Prevent constipation and straining to protect lacerations or episiotomies using stool softeners, laxatives, increased fluids, fiber, and movement.

Lochia

The inner lining of the uterus that sloughs off after birth; assessment includes amount, color, odor, and presence of clots.

Excessive postpartum bleeding

Saturating $1$ pad every $15$ minutes; an abnormal finding that must be reported.

Lochia Rubra

Red discharge occurring during the first few days ($3-4$ days) after birth.

Lochia Serosa

Pink/brown discharge occurring during the second phase, lasting from day $4$ to day $10$.

Lochia Alba

White/clear discharge occurring during the third phase, lasting from day $10$ to day $28$ before discharge ceases.

Puerperium

The postpartum period which lasts approximately $6$ weeks.

4th Trimester

Another term for the postpartum period.

Taking-in phase

Rubin’s first phase of postpartum adaptation.

Taking-hold phase

The postpartum phase in which the mother becomes interested in learning infant care.

Letting-go phase

The phase in which parents accept lifestyle changes related to the newborn.

Engrossment

Intense interest shown by a new father toward the infant.

Involution

The process by which the uterus returns to its prepregnant state.

Subinvolution

Failure of the uterus to return to its prepregnant size.

Fundal Descent

Process where the uterine fundus descends approximately $1$ cm per day postpartum.

Boggy Uterus

A soft uterus that places the patient at risk for postpartum hemorrhage and requires massage.

Lochia Rubra

Lochia that is bright red and mostly blood.

Lochia Serosa

Pink or brown-tinged lochia occurring around days $3-10$.

Lochia Alba

White or yellow-white lochia occurring after day $10$.

REEDA

An acronym standing for Redness, edema, ecchymosis, discharge, and approximation, used to assess the perineum.

Prolactin

The hormone responsible for milk production.

Oxytocin

The hormone responsible for milk let-down.

Football hold

A breastfeeding position (along with side-lying) that is best for a mother recovering from a cesarean birth.

Uterine Atony

Failure of the uterus to contract effectively after delivery.

Tachycardia

Usually the first sign of hypovolemic shock postpartum.

Cervical Laceration

Indicated by bright red bleeding occurring even when the fundus is firm.

Homans’ sign

A positive sign that may indicate thrombophlebitis.

Vaginal Birth Blood Loss

A normal loss of approximately $500$ mL.

Cesarean Birth Blood Loss

A normal loss of approximately $1000$ mL.

Postpartum Chills

Commonly caused by the release of epinephrine.

Colace (DSS)

A common stool softener prescribed postpartum.

RhoGAM

Medication given within $72$ hours to an Rh-negative mother who delivers an Rh-positive infant.

Rubella Titer

A measurement less than $1:8$ requires immunization postpartum.

Vitamin K

The antidote for warfarin (Coumadin) overdose.

Naloxone (Narcan)

Used to reverse opioid-induced respiratory depression.

Postpartum Psychosis

A psychological state characterized by loss of reality and severe mental status changes.

Postpartum Blues

Temporary mood swings and tearfulness after birth.

Evaporative Heat Loss

Heat loss from evaporation of moisture on the newborn’s skin.

Conduction Heat Loss

Heat loss from direct contact with a cold surface.

Convection Heat Loss

Heat loss from drafts.

Radiation Heat Loss

Heat loss from nearby cold surfaces without direct contact.

Newborn Hypoglycemia

A blood glucose level below $45$ mg/dL, sometimes indicated by a high-pitched cry.

Meconium

Newborn stool usually passed within the first $12$ hours of life.

Lanugo

Fine hair commonly seen on preterm newborns.

Vernix

The creamy white protective substance on newborn skin.

Ballard Assessment

The gestational age tool commonly used after birth.

Hohmann's sign

An assessment for deep vein thrombosis where the patient feels pain in the calf when the toes are dorsiflexed.

Subinvolution

The failure of the uterus to return to its pre-pregnant state after $6$ weeks.

Involution

The process of the reproductive organs changing back to their pre-pregnancy size and state.

Fundal assessment

The physical palpation of the uterine fundus to determine its height and firmness, ideally located at the level of the umbilicus postpartum.

Boggy

A term describing a uterus that feels soft or spongy rather than firm, indicating a risk for hemorrhage.

Fundal massage

A technique where the nurse rubs or pushes on the fundus to encourage it to contract and stop bleeding.

Retained placenta

A condition where a piece of the placenta remains attached to the uterus, receiving blood flow from the mother and causing postpartum hemorrhage.

Afterbirth pains

Postpartum uterine contractions that help push out extra clots; they are often felt more intensely by breastfeeding mothers due to oxytocin release.

Lochia

Postpartum vaginal discharge consisting of endometrial tissue, blood, and lymph; it changes from bright red (rubra) to pinkish (serosa) and finally clear/mucus (alba).

Colostrum

The first milk produced immediately after birth, often called liquid gold because it is high in vitamins and antibodies to help the baby fight infection.

Mastitis

An inflammation or infection of the mammary gland, typically in one breast, characterized by redness, heat, pain, and fever up to $104^{\circ}$.

REEDA

An acronym used to assess an episiotomy or laceration site: Redness, Edema, Ecchymosis, Discharge, and Approximation.