Maternity and Women's Health Care: High-Risk Antepartum, Intrapartum, Postpartum, and Neonatal Complications

Comprehensive vocabulary flashcards covering high-risk maternal, intrapartum, postpartum, and neonatal conditions based on Lowdermilk's Maternity and Women's Health Care (Chapters 29–37).

Gestational Diabetes Mellitus (GDM)

Any degree of glucose intolerance with onset or first recognition during pregnancy. When glycemic control is poor late in gestation, the fetus is at the greatest risk for macrosomia.

Diabetogenic Effect of Pregnancy

A physiological adaptation occurring in the second and third trimesters where placental hormones—such as estrogen, progesterone, and human placental lactogen (HPL)—act as insulin antagonists, inducing maternal insulin resistance to ensure an abundant glucose supply for fetal growth.

Glycosylated Hemoglobin A1c (HbA1c)

A laboratory blood test measuring maternal glycemic control over the preceding $4\text{ to }6\text{ weeks}$; values should remain at less than $7\%$ during pregnancy.

Maternal Phenylketonuria (PKU)

A maternal metabolic error where deficient phenylalanine breakdown results in toxic accumulation. Without strict dietary control, it can cause fetal microcephaly, congenital heart disease, cognitive impairment, and low birth weight; maternal PKU is also a contraindication to breastfeeding.

Hyperemesis Gravidarum

Severe, intractable nausea and vomiting during pregnancy resulting in weight loss, nutritional deprivation, and electrolyte imbalances; the primary initial clinical intervention is intravenous (IV) fluid and electrolyte replacement therapy.

Thyroid Storm

An acute, life-threatening crisis of severe hyperthyroidism triggered by stressors such as infection, birth, or surgery, clinically manifested by fever, restlessness, tachycardia, hypotension, vomiting, and stupor.

Cardiac Decompensation

The failure of the maternal heart to maintain adequate cardiac output under pregnancy hemodynamic demands, evidenced by dyspnea, moist cough, crackles, generalized edema, an irregular, weak, and rapid pulse, fatigue, and cyanosis of the lips and nailbeds.

15-methyl PGF2α (Carboprost Tromethamine / Hemabate)

A prostaglandin derivative used to manage postpartum hemorrhage via uterine contraction that is strictly contraindicated in patients with asthma due to its bronchoconstrictive properties.

Eisenmenger Syndrome

A severe cardiovascular condition characterized by pulmonary hypertension with right-to-left shunting in which pregnancy is strictly contraindicated due to high maternal mortality rates.

Bell Palsy

An acute, idiopathic, unilateral facial muscle weakness or paralysis that occurs $3\text{ to }5\text{ times}$ more frequently in pregnant women than nonpregnant women (peaking in the third trimester and puerperium) and is associated with an elevated risk of gestational hypertension.

Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)

A common, benign cutaneous eruption of pregnancy associated with increased maternal weight gain, twin gestations, and hypertension, managed symptomatically to relieve pruritus using antipruritic topicals, topical steroids, and oral antihistamines.

Sickle Cell Crisis

A recurrent vaso-occlusive episode triggered by hypoxia, dehydration, or acidosis in women with sickle cell anemia, characterized by fever, acute abdominal pain, and severe joint and extremity pain.

Postpartum Depression (PPD) with Psychotic Features

A psychiatric emergency occurring after childbirth characterized by delusions, hallucinations, and rapid mood cycling, where the primary clinical priority is protecting the safety of the mother and infant from potential self-harm or infanticide.

4 Ps Plus

A validated prenatal screening tool designed to quickly identify pregnant clients needing comprehensive substance abuse evaluation by screening across four domains: Parents, Partner, Past alcohol use, and Pregnancy substance consumption.

Methadone Maintenance

The standard of care pharmacotherapy for opioid addiction during pregnancy that decreases illicit narcotic use, enhances compliance with prenatal care, reduces criminal activity, and lowers transmission of blood-borne infections.

Terbutaline

A $\beta_2$-adrenergic agonist tocolytic administered to suppress uterine contractions; side effects include maternal and fetal tachycardia, maternal hyperglycemia, and cardiopulmonary decompensation (pulmonary edema presenting as dyspnea and crackles).

Magnesium Sulfate Toxicity

An excess serum concentration ($\ge 10\,\text{mg/dl}$, above the therapeutic range of $4\text{ to }7.5\,\text{mg/dl}$) that causes loss of deep tendon reflexes, oliguria, severe central nervous system depression, and respiratory arrest, requiring treatment with calcium gluconate.

Hypertonic Uterine Dysfunction

A primary dysfunctional labor pattern common in anxious primigravidas characterized by painful, uncoordinated, and frequent contractions (occurring every $2\text{ minutes}$ or less) that fail to produce normal cervical effacement or dilation.

Secondary Arrest of the Active Phase

An abnormal labor arrest pattern where cervical dilatation ceases completely for $2\text{ hours}$ or more during the active phase of labor despite previous progression.

Bishop Score

A pre-induction rating system used to assess cervical ripeness and determine readiness for labor induction, with scores of $9\text{ or higher}$ in nulliparas ($5\text{ or higher}$ in multiparas) indicating favorable outcomes.

Amniotomy

The artificial rupture of amniotic membranes (AROM) using an instrument to induce or augment labor, requiring immediate assessment of the fetal heart rate (FHR) to evaluate for umbilical cord compression or prolapse.

Umbilical Cord Prolapse

An obstetric emergency where the umbilical cord falls below the fetal presenting part; immediate management requires placing the mother in a knee-chest, Trendelenburg, or modified Sims position to relieve presenting part pressure on the cord.

Uterine Atony

Marked hypotonia and loss of muscular tone in the postpartum uterus; it is the leading cause of early postpartum hemorrhage and is managed initially with vigorous manual fundal massage.

Subinvolution of the Uterus

The failure of the uterus to return to its normal nonpregnant size and state following delivery; it is the most common cause of late secondary postpartum hemorrhage, frequently resulting from retained placental fragments or pelvic infection.

Puerperal Infection

Any clinical bacterial infection of the genital tract occurring within $28\text{ days}$ after birth or pregnancy loss, clinically defined by a maternal oral temperature of $38^\circ\text{C}\,(100.4^\circ\text{F})$ or higher on $2\text{ successive days}$ during the first $10\text{ postpartum days}$ (excluding the initial $24\text{ hours}$).

Placenta Accreta

An abnormal placental adherence disorder in which the chorionic villi slightly penetrate directly into the myometrium rather than attaching solely to the decidua basalis, preventing normal postpartum separation.

Desmopressin (DDAVP)

The primary initial pharmacological intervention for a client with von Willebrand disease (vWD) experiencing postpartum hemorrhage; it works by stimulating the endogenous release of factor VIII and von Willebrand factor from cellular storage sites.

Uterine Inversion

A rare, life-threatening obstetric emergency in which the uterus turns inside out and protrudes through the cervix into or outside of the introitus, rapidly causing severe pelvic pain and hypovolemic shock.

Respiratory Distress Syndrome (RDS)

A respiratory disorder seen primarily in preterm neonates caused by alveolar surfactant deficiency, resulting in atelectasis, poor gas exchange, and hypoxemia, which is treated with exogenous surfactant administration and ventilatory support.

Necrotizing Enterocolitis (NEC)

An acute inflammatory ischemic necrosis of the bowel mucosa in newborns, clinically identified by abdominal distention, gastric residual aspirates, lethargy, temperature instability, erythema of the abdominal wall, and grossly bloody stools.

Retinopathy of Prematurity (ROP)

A vasoproliferative eye disorder affecting the immature retinal vasculature of preterm infants, primarily linked to prolonged exposure to high levels of arterial oxygen tension (hyperoxia).

Periodic Breathing

A benign respiratory pattern typical of preterm neonates consisting of respiratory pauses lasting $5\text{ to }10\text{ seconds}$ followed by compensatory rapid respirations for $10\text{ to }15\text{ seconds}$, distinguished from true apnea which lasts $20\text{ seconds}$ or longer.

Kangaroo Care

A therapeutic practice involving direct skin-to-skin contact between a diapered preterm infant and the parent's bare chest, enhancing neonatal temperature regulation, behavioral organization, and parent-infant bonding.

Corrected Age

A developmental calculation for preterm infants derived by adding chronological postnatal age to gestational age at birth (or adjusting milestones based on weeks born early), maintained until approximately $2\text{ to }3\text{ years}$ of age.

Neonatal Hypoglycemia (Infant of Diabetic Mother)

An abrupt drop in blood glucose after delivery caused by high fetal insulin secretion (hyperinsulinemia) responding to maternal hyperglycemia, which persists immediately postpartum after the maternal transplacental glucose supply is abruptly halted.

Ophthalmia Neonatorum Prophylaxis

The routine topical application of erythromycin $0.5\%$ ophthalmic ointment into the eyes of all neonates shortly after delivery to prevent gonococcal conjunctivitis caused by Neisseria gonorrhoeae.

Toxoplasmosis

A zoonotic infection caused by the protozoan Toxoplasma gondii transmitted through cat feces or undercooked meats; maternal infection can lead to congenital fetal microcephaly, hydrocephalus, cerebral calcifications, and chorioretinitis.

Erythroblastosis Fetalis

A hemolytic disease of the fetus caused by maternal alloimmunization (typically Rh incompatibility), in which accelerated hemolysis leads the fetal bone marrow to compensate by releasing large quantities of immature red blood cells (erythroblasts) into the bloodstream.

Congenital Diaphragmatic Hernia

A congenital malformation where incomplete diaphragm development allows abdominal viscera to enter the thoracic cavity, leading to secondary pulmonary hypoplasia and severe respiratory distress at birth.

Myelomeningocele

A severe neural tube defect featuring a protruding sac along the spine containing cerebrospinal fluid, meninges, and neural tissue; the essential preoperative nursing goal is protecting the sac integrity with sterile, moist dressings to prevent rupture and CNS infection.

Developmental Dysplasia of the Hip (DDH)

A spectrum of congenital hip abnormalities in the newborn diagnosed by a positive Ortolani click, a positive Barlow test, or asymmetric gluteal skin folds; managed with corrective orthotic devices, whereas double or triple diapering is contraindicated.

Acute Distress Phase (Perinatal Loss)

The initial grief stage immediately following perinatal death characterized by shock, numbness, intense disbelief, and feelings of detachment, during which the parents face painful immediate decisions regarding seeing the baby, autopsy, and funeral plans.

Bittersweet Grief

A transient recurrence of poignant grief and sorrow experienced during the reorganization phase of bereavement, commonly evoked by reminders such as birthdays, anniversaries, or baby milestones.

Complicated Grief

An intense, prolonged bereavement reaction that fails to progress through normal grief stages over extended periods, causing functional impairment and distress that requires professional psychological referral.