Maternal–Newborn Nursing: Labor & Postpartum at Risk

Comprehensive vocabulary flashcards covering dysfunctional labor, operative delivery methods, intrapartum emergencies, postpartum hemorrhage, maternal infections, thromboembolism, and postpartum affective disorders from maternal-newborn nursing lecture notes.

Labor Dystocia

Labor that is abnormally slow, stalled, stopped, or prolonged beyond expected clinical timeframes, resulting from abnormalities in one or more of the 4 P's.

The 4 P's of Labor

The four interrelated mechanical and physiological factors governing labor progress: Powers (uterine contractions and pushing), Passenger (fetal presentation, size, and position), Passageway (maternal pelvis and birth canal), and Psyche (maternal psychological state and anxiety).

Powers (Dysfunctional Labor)

The labor component referring to uterine contractions and voluntary pushing efforts; dysfunction occurs when contractions are hypotonic, hypertonic but ineffective, or when maternal exhaustion prevents adequate expulsion.

Passenger (Dysfunctional Labor)

The labor component referring to the fetus; dystocia occurs due to macrosomia, malpresentation, malposition (such as persistent occiput posterior), or structural fetal anomalies.

Passageway (Dysfunctional Labor)

The labor component referring to the maternal bony pelvis, cervix, and soft tissues of the birth canal; dystocia occurs when the pelvic architecture is contracted or the cervix fails to dilate and efface.

Psyche (Dysfunctional Labor)

The labor component referring to maternal emotional state; excessive fear, pain, stress, or exhaustion triggers catecholamine release that inhibits effective myometrial contractions and stalls progress.

Latent Phase Labor Limits

The upper limit of normal duration for the latent phase of labor, defined as $< 20\text{ hours}$ in a nulliparous (primipara) patient and $< 14\text{ hours}$ in a multiparous patient.

Active Labor Progress Rates

The expected cervical dilation and descent once active labor begins at approximately $6\text{ cm}$; dilation should proceed at least $1.2\text{ cm/hr}$ in a primipara and $1.5\text{ cm/hr}$ in a multipara, while fetal descent proceeds at least $1\text{ cm/hr}$ in a primipara and $2\text{ cm/hr}$ in a multipara.

Shoulder Dystocia

An intrapartum obstetric emergency in which the anterior fetal shoulder becomes impacted behind the maternal symphysis pubis after the fetal head has delivered, halting delivery and risking fetal hypoxia.

Turtle Sign

The retraction of the delivered fetal head back against the maternal perineum, serving as the cardinal clinical indicator of shoulder dystocia.

McRoberts Maneuver

A first-line intervention for shoulder dystocia in which the maternal thighs are hyperflexed against the abdomen while placing the bed flat or in Trendelenburg position to widen the pelvic outlet and rotate the symphysis pubis.

Suprapubic Pressure

Direct manual pressure applied immediately above the maternal pubic bone toward the fetal face to dislodge the impacted anterior shoulder during shoulder dystocia; fundal pressure is strictly contraindicated.

Labor Induction

The deliberate pharmacological or mechanical stimulation of uterine contractions to initiate labor before it begins spontaneously.

Labor Augmentation

The process of stimulating uterine contractions with medication or procedures to reinforce labor that has initiated spontaneously but has failed to produce adequate cervical progress.

Bishop Score

A pre-induction cervical assessment scoring system across five parameters (dilation, effacement, station, consistency, and position) with a maximum of $13$ points; a score of $6\text{--}13$ indicates a favorable cervix, whereas $0\text{--}5$ indicates an unfavorable cervix.

Cytotec (Misoprostol)

A prostaglandin $E_1$ analogue administered vaginally or orally for cervical ripening (monitoring to prevent tachysystole with $> 3\text{ contractions in } 10\text{ minutes}$) and rectally at approximately $800\,\mu\text{g}$ to treat postpartum hemorrhage.

Cervidil (Dinoprostone)

A prostaglandin cervical ripening insert resembling a flat tampon with a retrieval string; it is kept refrigerated, must be placed within $1\text{ hour}$ of removal from refrigeration, and costs approximately $"\$2,500"$.

Cook's Balloon

A mechanical dual-balloon cervical ripening device inflated with approximately $80\text{ cc}$ of fluid in each balloon (one cervical, one vaginal) and taped under tension to the thigh; it is removed after $12\text{ hours}$ or once the cervix dilates to $5\text{ cm}$.

Amniotomy (AROM)

The surgical artificial rupture of amniotic membranes by a provider using an amnihook to stimulate or expedite uterine contractions during labor.

Oxytocin (Pitocin)

A synthetic uterotonic hormone administered IV on a dedicated primary infusion pump channel to induce or augment labor (titrated starting at $1\text{--}2\text{ milliunits/min}$ up to a max of $20\text{ milliunits/min}$) or as a rapid IV bolus to treat postpartum hemorrhage.

Uterine Tachysystole

Excessive uterine contraction frequency defined as greater than 5 contractions within a 10-minute window averaged over 30 minutes, risking impaired uteroplacental perfusion, late decelerations, and minimal variability.

Vacuum-Assisted Delivery

An operative vaginal delivery method using a soft suction cup applied to the fetal occiput with $50\text{--}60\text{ mmHg}$ negative pressure; restricted to a maximum of 3 pulls or pop-offs before proceeding to cesarean birth.

Forceps-Assisted Delivery

An operative vaginal delivery using paired curved metal blades applied to the fetal cheeks/face to guide delivery when the head is at least at $+2$ station but not yet crowning; restricted to 3 pulls and requires an emptied maternal bladder.

Cephalohematoma

A localized subperiosteal collection of blood over a neonatal skull bone that does not cross suture lines, frequently caused by vacuum extraction; monitored via 2 serial head circumference measurements taken within 2 hours.

Malignant Hyperthermia

An inherited, life-threatening pharmacogenetic skeletal muscle crisis triggered by volatile inhaled anesthetics or succinylcholine; marked by an early rise in end-tidal $\text{CO}_2$, generalized rigidity, and profound hyperthermia ($104\text{--}109^\circ\text{F}$).

Dantrolene

A skeletal muscle relaxant administered weight-based ($\text{mg/kg}$) as the definitive pharmacological antidote to arrest hypermetabolism in malignant hyperthermia.

TOLAC / VBAC

Trial of Labor After Cesarean (TOLAC) and Vaginal Birth After Cesarean (VBAC); a planned labor attempted by a woman with a single previous low-transverse uterine incision, requiring immediate surgical readiness due to the risk of uterine rupture.

Preterm Labor

The onset of regular uterine contractions producing cervical effacement and dilation occurring between $20\text{ weeks}$ and before the completion of $37\text{ weeks}$ of gestation ($< 37\text{ weeks}$).

Fetal Fibronectin (fFN)

A biological glycoprotein adhesive tested from cervicovaginal secretions between $24\text{ and } 34\text{ weeks}$ gestation to predict preterm delivery; requires no vaginal intercourse, lubrication, or cervical exams for $24\text{ hours}$ prior to prevent false positives.

Tocolytics

A class of pharmacologic medications (such as indomethacin, nifedipine, and terbutaline) administered up to $34\text{ weeks}$ of gestation to suppress uterine contractions and delay preterm delivery long enough to administer corticosteroids.

Magnesium Sulfate (Obstetric Use)

An intravenous continuous infusion administered in preterm labor strictly for fetal neuroprotection (reducing the incidence and severity of cerebral palsy) and also used to control seizures in amniotic fluid embolism.

Betamethasone (Celestone)

An antenatal corticosteroid administered intramuscularly in 2 doses given $12\text{--}24\text{ hours}$ apart to stimulate fetal lung surfactant production and reduce respiratory distress syndrome before preterm birth.

Postterm Pregnancy

A pregnancy extending beyond $42\text{ weeks}$ of gestation ($> 42\text{ weeks}$); managed with weekly nonstress tests, biophysical profiles (cesarean indicated if BPP $< 6$), kick counts, and induction due to placental aging and calcification.

Uterine Rupture

A catastrophic intrapartum emergency where the myometrium tears open; characterized clinically by sudden severe abdominal tearing pain, loss of fetal station, cessation of contractions, and fetal bradycardia.

Umbilical Cord Prolapse

An acute obstetric emergency where the umbilical cord descends alongside or below the presenting fetal part into the vagina, leading to cord compression and fetal hypoxia manifested by sudden severe or repetitive variable decelerations.

Amniotic Fluid Embolism (AFE)

An unpreventable intrapartum emergency where amniotic fluid and fetal cells enter maternal circulation, triggering an anaphylactoid reaction marked by acute dyspnea, cyanosis, hypotension, cardiovascular collapse, DIC, and seizures.

Fetal Demise

Fetal death occurring after $20\text{ weeks}$ of gestation prior to complete expulsion or extraction from the mother, necessitating supportive psychological care, coroner reporting, and memory-making.

Postpartum Hemorrhage (PPH)

Cumulative blood loss exceeding $500\text{ mL}$ following vaginal birth or exceeding $1000\text{ mL}$ following cesarean birth, or saturation of a perineal pad within $30\text{ minutes}$, accompanied by signs of hypovolemia.

Uterine Atony

The failure of the myometrium to contract and retract into a firm state following delivery; clinically recognized by a boggy, soft fundus and representing the leading cause of postpartum hemorrhage.

Methergine (Methylergonovine)

An ergot alkaloid uterotonic medication administered to stimulate intense uterine contractions during postpartum hemorrhage; contraindicated in patients with hypertension or preeclampsia.

Hemabate (Carboprost Tromethamine)

A prostaglandin $F_{2\alpha}$ uterotonic agent administered intramuscularly to control severe postpartum hemorrhage; contraindicated in patients with asthma due to its bronchoconstrictive effects.

Tranexamic Acid (TXA)

An antifibrinolytic drug administered intravenously to treat postpartum hemorrhage by blocking clot degradation; reserved as a late/last-line pharmacologic option due to the risk of thromboembolic events (PE, DVT, stroke, MI).

Bakri Balloon

An intrauterine silicone tamponade balloon filled with sterile fluid to apply direct pressure against bleeding myometrial sinuses during postpartum hemorrhage; fundal massage is stopped once placed.

Mastitis

An infection of the lactating breast tissue/milk ducts, typically unilateral and wedge-shaped in the upper outer quadrant; characterized by erythema, heat, flu-like symptoms, and fever, treated with cephalexin and uninterrupted nursing or pumping.

Metritis (Endometritis)

An infectious polymicrobial inflammation of the uterine lining (endometrium/decidua); manifested by high fever, abdominal uterine tenderness, and foul-smelling lochia, requiring broad-spectrum IV antibiotics.

REEDA Scale

An acronym and assessment tool utilized to systematically evaluate perineal lacerations, episiotomies, or surgical incisions for Redness, Edema, Ecchymosis, Discharge, and Approximation.

Deep Vein Thrombosis (DVT)

A vascular thromboembolic disorder presenting postpartum with unilateral lower-extremity calf warmth, edema, erythema, and increased circumference; confirmed by Doppler ultrasound and managed with anticoagulants to prevent pulmonary embolism.

Postpartum Blues

A transient, self-limiting emotional state characterized by tearfulness, irritability, mood swings, and anxiety occurring in $50\text{--}85\%$ of mothers within the first 2 weeks postpartum; not classified as a psychiatric disorder.

Postpartum Depression

A non-psychotic depressive disorder affecting approximately $13\%$ of mothers occurring anytime in the first year postpartum; characterized by persistent guilt, anhedonia, sleep disturbances, fatigue, and potential suicidal ideation.

Postpartum Psychosis

A rare ($0.01\%$) psychiatric emergency emerging within the first 3 months postpartum; characterized by auditory hallucinations, delusions, rapid cycling, cognitive confusion, and severe risk of infanticide or suicide.

Edinburgh Postnatal Depression Scale

A standardized clinical screening questionnaire utilized during the prenatal visit, post-delivery hospital stay, and postpartum office visit to identify women at risk for maternal affective disorders.