Pregnancy at Risk, Labor & Postpartum Complications – Review

A comprehensive set of question-and-answer flashcards covering endocrine, cardiac, respiratory, hematologic, infectious, obstetric, intrapartum, and postpartum complications in high-risk pregnancy, labor, and the puerperium. These cards reinforce key definitions, risk factors, medications, nursing interventions, and mnemonics for exam preparation.

What are the three main classifications of diabetes mellitus in pregnancy?

Type 1 (autoimmune β-cell destruction), Type 2 (insulin resistance), and Gestational Diabetes Mellitus (first diagnosed in pregnancy).

Which placental hormones contribute most to insulin resistance during pregnancy?

Human placental lactogen (hPL), progesterone, and cortisol.

What fasting blood-glucose target is recommended for pregnant patients with diabetes?

Fasting blood glucose < 95 mg/dL.

List two maternal complications associated with diabetes in pregnancy.

Examples: polyhydramnios, preeclampsia, infections (UTI/yeast), diabetic ketoacidosis, cesarean birth, postpartum hemorrhage.

Name two common fetal or neonatal risks of maternal diabetes.

Examples: congenital anomalies, macrosomia, shoulder dystocia, intrauterine growth restriction, respiratory distress syndrome, neonatal hypoglycemia, polycythemia, hyperbilirubinemia, stillbirth.

Why is insulin considered first-line therapy for hyperglycemia in pregnancy?

Because insulin does not cross the placenta and therefore does not directly affect the fetus.

Which oral hypoglycemic agent crosses the placenta and therefore requires newborn glucose monitoring?

Metformin.

What does the mnemonic “KISS” remind patients with gestational diabetes to do?

Keep BG in target, Insulin timing with meals, Snack between meals, Self-monitor BG and kick counts.

During which trimester is insulin dosage typically decreased for a Type 1 diabetic?

First trimester.

What functional cardiac class represents symptoms at rest and usually contraindicates pregnancy?

Class IV.

Which diuretic is commonly used for mitral stenosis in pregnancy and when should it be taken?

Furosemide; take in the morning to avoid nocturia.

What are two key signs of cardiac decompensation the nurse should report immediately?

Examples: dyspnea on exertion, night cough, generalized edema, cyanosis, palpitations, rapid respirations.

State the purpose of low-dose aspirin in certain pregnant patients with diabetes or cardiac disease.

To reduce the risk of preeclampsia.

Which asthma medications are considered safe for maintenance and rescue during pregnancy?

Budesonide (maintenance inhaled corticosteroid) and albuterol (short-acting beta-agonist rescue).

Which postpartum uterotonic drug should be avoided in asthmatic patients?

Carboprost (Hemabate).

Define iron-deficiency anemia in pregnancy by hemoglobin level in the first and third trimesters.

Hemoglobin < 11 g/dL.

What beverage enhances absorption of oral ferrous sulfate?

Orange juice (vitamin C).

List two common side effects of ferrous sulfate therapy.

Nausea, metallic taste, black stools, constipation.

Which mnemonic helps teach iron-supplement self-care?

“IRON”: Increase fiber/fluids, Rest stomach (take on empty if tolerated), Orange juice helps, No milk/tea/antacids near dose.

What daily dosage of folic acid is recommended to prevent neural tube defects?

At least 400 µg for low-risk women (higher if at risk).

Give two examples of “FOLIC” foods high in folate.

Fortified cereals, orange juice, leafy greens, iron-rich beans, corn/peas.

What is the first step in managing a sickle-cell pain crisis during pregnancy?

Hydration, followed by oxygen and pain management (the “HOP” approach).

Why is routine iron supplementation avoided in thalassemia major?

Because these patients often receive transfusions and risk iron overload; give iron only if specifically ordered.

Which antirheumatic drug must be stopped before conception in patients with rheumatoid arthritis?

Methotrexate.

Name the drug of choice to maintain remission in systemic lupus erythematosus (SLE) during pregnancy.

Hydroxychloroquine.

Explain the purpose of the “LUPUS” monitoring mnemonic.

Reminds nurses/patients to monitor Labs, Use meds, Plan Pregnancy in remission, Understand flare signs, and practice Sun protection.

Which infection in pregnancy requires IV penicillin G during labor to prevent neonatal sepsis?

Group B Streptococcus (GBS).

When should acyclovir or valacyclovir prophylaxis begin for a pregnant woman with recurrent genital herpes?

At 36 weeks’ gestation.

Which two interventions reduce vertical transmission of HIV during labor?

Administration of zidovudine (AZT) and avoiding invasive procedures such as scalp electrodes or artificial rupture of membranes.

State two common risks for pregnant adolescents.

Anemia, preterm birth, and poor prenatal care adherence.

What does the “MAP” mnemonic stand for when caring for adolescents or advanced-maternal-age clients?

Monitor for complications, Assess support systems, Provide tailored education.

Define hypertonic uterine dysfunction.

Frequent, painful, uncoordinated contractions in the latent phase with high resting tone and minimal cervical change.

Which maneuver is first applied for shoulder dystocia?

McRoberts positioning (legs flexed to abdomen).

What two main criteria confirm a diagnosis of preterm labor?

Regular contractions (4 in 20 min or 8 in 60 min) plus cervical change (effacement or dilation).

List the three first-line tocolytics remembered by “NIM.”

Nifedipine, Indomethacin, Magnesium sulfate.

Why is indomethacin limited to use before 32 weeks’ gestation?

Risk of premature closure of the fetal ductus arteriosus and oligohydramnios after 32 weeks.

What corticosteroid and dosing are used to accelerate fetal lung maturity in threatened preterm birth?

Betamethasone 12 mg IM, two doses 24 hours apart.

At how many weeks is a pregnancy considered post-term?

42 weeks.

Which antenatal tests are commonly ordered in a post-term pregnancy?

Non-stress test (NST) and biophysical profile (BPP).

Describe the priority nursing action when umbilical-cord prolapse is detected.

Place patient in knee-chest or Trendelenburg and use a gloved hand to elevate the presenting part off the cord while preparing for emergency cesarean birth.

List two classic signs of placental abruption.

Painful dark vaginal bleeding and a rigid/board-like uterus; late fetal heart rate decelerations are also common.

What immediate sign often signals uterine rupture during a trial of labor after cesarean (TOLAC)?

Sudden tearing abdominal pain with loss of fetal station and fetal distress on the monitor.

Which life-threatening obstetric emergency presents with sudden dyspnea, hypotension, and DIC?

Amniotic fluid embolism.

What is the minimal Bishop score generally considered favorable for induction of labor in nulliparous women?

8 or higher (some sources state ≥ 6 for multiparas and ≥ 8 for nulliparas).

Why must oxytocin always be administered via an IV pump during induction?

To allow precise titration and rapid discontinuation if tachysystole or fetal distress occurs.

What is the purpose of an amnioinfusion?

To increase intrauterine fluid volume and relieve umbilical-cord compression, especially with variable decelerations.

Before applying vacuum or forceps, what simple maternal intervention should the nurse perform?

Ensure the bladder is emptied (straight catheter if necessary).

Which uterine scar type is considered safe for a trial of labor after cesarean (VBAC)?

Low transverse uterine incision.

Define primary postpartum hemorrhage.

Blood loss > 1,000 mL (or any loss causing hemodynamic instability) occurring within the first 24 hours after birth.

Name the four primary causes of postpartum hemorrhage remembered by the ‘4 Ts’.

Tone (uterine atony), Tissue (retained placenta), Trauma (lacerations/hematomas), Thrombin (coagulopathy).

Which uterotonic is contraindicated in hypertensive patients?

Methylergonovine (Methergine).

What medication is used within 3 hours of PPH onset as an antifibrinolytic?

Tranexamic acid (TXA).

List two hallmark signs of endometritis.

Fever > 38 °C, foul-smelling lochia, and uterine tenderness.

How should a mother with mastitis be counseled regarding breastfeeding?

Continue breastfeeding or pumping to empty the breasts fully while on antibiotics.

Differentiate ‘baby blues’ from postpartum depression in terms of duration.

'Baby blues' resolve within 2 weeks, whereas postpartum depression persists longer than 2 weeks and affects daily function.

Which selective serotonin reuptake inhibitor (SSRI) is commonly prescribed for postpartum depression and when is it best taken?

Sertraline; usually taken in the morning to reduce insomnia.

Identify two classic signs of a deep-vein thrombosis (DVT) in the postpartum client.

Unilateral leg pain/swelling and warmth/redness (remember ‘RED HOT’).

Why is warfarin avoided during pregnancy but acceptable postpartum for some clients?

It crosses the placenta and is teratogenic, but postpartum it does not affect the infant if breastfeeding precautions are followed.

What does the mnemonic ‘HELPERR’ guide in shoulder dystocia management?

Help, Evaluate for episiotomy, Legs McRoberts, Pressure suprapubic, Enter maneuvers, Remove posterior arm, Roll to hands-and-knees.

Name the TORCH infections and one fetal risk for each.

Toxoplasmosis (hydrocephalus), Other – syphilis (congenital syphilis), Rubella (congenital rubella syndrome), CMV (hearing loss), Herpes (neonatal encephalitis).

Which postpartum condition involves a uterus that remains enlarged with prolonged lochia?

Subinvolution of the uterus.

What drug class and monitoring parameter are essential for acute treatment of pulmonary embolism postpartum?

IV unfractionated heparin; monitor aPTT and signs of bleeding.

For preeclampsia prophylaxis, at what gestational age is low-dose aspirin usually started?

Between 12 and 16 weeks’ gestation in high-risk women.

Which fetal condition is common with maternal diabetes due to excess insulin production in the fetus?

Macrosomia (birth weight > 4,000 g).

Describe the key nursing teaching for nifedipine when used as a tocolytic.

Take orally; monitor maternal blood pressure and for dizziness or flushing.

What is the priority nursing assessment when giving magnesium sulfate for preterm labor?

Check deep tendon reflexes and respiratory rate (hold if RR < 12/min).

Which pelvic type is considered most favorable for vaginal birth?

Gynecoid pelvis.

State one common maternal complication of precipitous labor.

Postpartum hemorrhage due to uterine atony or lacerations.

Why is bladder emptying important in the management of dystocia?

A full bladder can obstruct fetal descent and contribute to soft-tissue dystocia.

What perinatal risk is increased with multiple gestation due to uterine overdistention?

Preterm labor/birth.

When caring for a client with peripartum cardiomyopathy, which inotrope may be ordered and what must be assessed before each dose?

Digoxin; assess apical pulse (hold if < 60 bpm) and monitor for toxicity (visual halos, nausea).

Explain the rationale for avoiding ergot derivatives postpartum in women with asthma.

Ergot derivatives (e.g., methylergometrine) can cause bronchospasm and exacerbate asthma.

Which postpartum mood disorder is considered a psychiatric emergency and why?

Postpartum psychosis; risk of suicide or infanticide due to hallucinations and severe confusion.

What teaching should be given regarding duloxetine or pregabalin use in pregnant women with fibromyalgia?

These cross the placenta; risks vs benefits must be reviewed, and non-pharmacologic pain control encouraged.

How is neonatal varicella exposure managed if the mother develops chickenpox near delivery?

Administer Varizig (varicella-zoster immune globulin) to the newborn.

What antenatal surveillance is recommended for women with advanced maternal age to detect chromosomal abnormalities early?

Early genetic screening such as first-trimester screening, quad screen, or amniocentesis.

List two potential neonatal effects of maternal opioid use during pregnancy.

Neonatal abstinence syndrome (NAS) and low birth weight.

Which posture helps relieve back pressure and assist rotation in cases of occiput-posterior fetal position?

Hands-and-knees (all-fours) maternal positioning.

Why must blood products often be cross-matched quickly during placental abruption?

Because significant maternal blood loss may occur rapidly, requiring transfusion.

What symptom differentiates placental abruption from placenta previa?

Placental abruption typically presents with PAINful bleeding, whereas placenta previa bleeding is usually painless.

Which infection screening test is done at 35–37 weeks’ gestation to prevent neonatal sepsis?

Group B Streptococcus (GBS) vaginal-rectal culture.

What is the antidote for magnesium-sulfate toxicity?

Calcium gluconate 1 g IV over 3–5 minutes.

Which two vital signs are most critical to monitor for postpartum hemorrhage detection?

Heart rate and blood pressure (tachycardia and hypotension indicate hypovolemia).

State one key instruction when taking warfarin postpartum regarding diet.

Maintain consistent intake of vitamin K-rich foods (green leafy vegetables) to avoid INR fluctuations.

What neonatal complication results from maternal nicotine use in pregnancy?

Low birth weight (LBW) and increased risk of sudden infant death syndrome (SIDS).

Why should pregnant patients with asthma avoid carboprost for postpartum hemorrhage control?

Carboprost can cause bronchospasm and worsen asthma.

Which maternal positioning helps improve maternal cardiac output and uteroplacental perfusion in late pregnancy?

Left side-lying lateral position.

What routine prenatal supplement contains 27 mg of elemental iron?

Standard prenatal vitamin.

Identify two nursing priorities after cesarean birth.

Assess fundal firmness/lochia and monitor the incision for bleeding or infection.

What fetal assessment is essential after amniotomy (AROM)?

Immediate fetal heart rate check to detect cord prolapse or compression.

Which drug is given intramuscularly for syphilis treatment during pregnancy?

Benzathine penicillin G.

In the event of a cord prolapse, why is a sterile-gloved hand kept in the vagina until delivery?

To maintain upward pressure on the presenting part and prevent cord compression until cesarean delivery.

What is the minimum urinary output per hour that should be maintained in a patient receiving magnesium sulfate?

At least 30 mL/hour.

Name two common side effects of nifedipine used as a tocolytic.

Hypotension, dizziness, flushing, and headache.

Explain why a Bishop score is used before labor induction.

To evaluate cervical favorability and predict the likelihood of successful induction.

Which uterotonic drug may cause severe diarrhea as a side effect?

Carboprost (Hemabate).

What dietary instruction helps manage constipation associated with iron therapy?

Increase fluids and fiber and consider stool softeners as needed.

Which lab values are monitored to detect HELLP syndrome in SLE patients?

Platelet count, liver enzymes (AST/ALT), and hemolysis indicators (LDH).

What mental-health screening tool is commonly used postpartum to detect depression?

Edinburgh Postnatal Depression Scale (EPDS).

Why is misoprostol effective for postpartum hemorrhage when given rectally?

Rectal administration allows rapid absorption and is useful when oral intake is not possible.