OB Exam #2: Postpartum and Newborn Care

Dark red bleeding after delivery is known as

Lochia Rubra

Afterbirth pains are caused by

Uterine contractions during involution

Signs and symptoms of uterine infection contain all of the following

- Foul-smelling lochia

- Lower abdominal tenderness

- temperature at or above 100.4 F for 2 days or more

Postpartum patient who is pale, clammy, HR of 125 and peripad saturated in 10 minutes will have nurse FIRST:

Massage fundus

The nurse notes a boggy fundus, above umbilicus and deviated to the right. What is the next step?

check for full bladder

REEDA is the acronym to describe a laceration. This acronym describes...

Redness, Edema, Ecchymosis, Discharge, Approximation

During which phase with the mother relinquish her fantasy baby and accept the real baby?

Letting Go?

Rh immune globulin with be ordered postpartum if which situation occurs?

Mama Rh- and Baby Rh+

A patient has DIC Which of the complications is a risk factor to develop DIC

Preeclampsia

What are normal reflexes you might see in a newborn baby?

Blinking reflex, Grasping reflex, sucking reflex

A new parent is worried because their baby's hands and feet look slightly blue? What does this likely indicate?

Normal Circulation Adjustment

Why is it so important to always support a newborns head and neck when you are holding them?

Their neck muscles are weak

True or False; you should give a newborn baby a water bottle if they seem thirsty between feedings.

FALSE

What is the name for the soft spots on a baby's head that allow for brain growth?

Fontanelles

If a baby is crying with a loud, piercing sound and pulling their legs up, what might they be trying to tell you?

They have tummy pain

What are safe sleeping practices for newborns to reduce the risk of SIDS?

Keeping crib empty, placing baby on back, using a firm mattress

Why do newborns often cluster feed, meaning they want to eat very frequently for a few hours?

To boost milk supply

What is the dark, sticky first stool that a newborn baby passes called?

Meconium

A new dad is giving his baby a bath and notices a waxy, white substance in the baby's skin folds. What should he do?

Leave it its protective

Why is skin-to-skin contact so beneficial for both the newborn and the parents?

Calms the baby, regulates baby's temperature, promotes bonding

Who developed a score used at 1 and 5 mins after birth to assess a newborns health and transition?

Virginia APGAR

A baby seems to be startling easily at loud noises. What is the best way to help them feel secure?

Swaddle them snugly

What is the primary reason for burping a baby during and after their feeding sessions?

To release swallowed air

A parent notices their newborn has tiny, white bumps on their nose and face. What are these likely to be?

Milia

What is the fine, downy hair that can sometimes cover the body of a newborn baby called?

Lanugo

A baby is 3 days old and their skin is starting to look a little yellow. What is the most likely reason for this?

Normal newborn jaundice

On average, for how many hours a day does a typical newborn baby sleep?

16 Hours

Expected rate of fundal descent during postpartum uterine involution

Descends approximately 1 cm per day; non-palpable by 14 days postpartum.

Characteristics of Lochia Rubra

dark red or bight red blood with some clots. Similar to a period days 1-3

Characteristics of Lochia Serosa

Pinkish-brown, watery discharge occurring from days 4 to 10 postpartum.

Characteristics of Lochia Alba

Yellowish-white discharge occurring from days 11 to 21 (up to 6 weeks) postpartum.

Postpartum weight loss breakdown

10-13 lbs at delivery, 9 lbs over next 2 weeks, 5 lbs by 6 months.

Rubella vaccine postpartum patient education

Must avoid pregnancy for at least 30 days post-vaccination (live virus).

Timing and route for RhoGAM administration

Given within 72 hours postpartum via intramuscular (IM) injection after cord blood testing.

Definition and volume cutoff for Early Postpartum Hemorrhage

Cumulative blood loss >1000 mL occurring within 24 hours after birth.

Definition and characteristics of Late Postpartum Hemorrhage

Occurs 24 hours to 6 weeks postpartum; main signs include subinvolution and retained placenta.

Contraindication for Methergine (Methylergonovine)

Do not administer to patients with hypertension.

Contraindications for Hemabate (Carboprost)

Do not administer to patients with hypertension or asthma.

Preferred route and rationale for Cytotec (Misoprostol) in PPH

Rectally; vaginal route washes out with blood and oral absorption is too slow.

Function of the JADA device in postpartum management

Provides vacuum-induced hemorrhage control for abnormal uterine bleeding and PPH.

First-degree perineal laceration depth

Involves superficial vaginal mucosa or perineal skin (~1/4 inch).

Second-degree perineal laceration depth

Involves vaginal mucosa, perineal skin, and deeper fascia/muscles (~1/2 inch).

Third-degree perineal laceration depth

Extends into the anal sphincter muscle.

Fourth-degree perineal laceration depth

Extends through the anal sphincter and into the rectal mucosa.

Indication of continuous trickling bright red blood with a firm fundus

Suspect a cervical or vaginal laceration and notify provider immediately.

Clinical presentation of Mastitis

Local breast hardness, red streaks on the breast, and flu-like symptoms.

Postpartum Taking-In Phase characteristics

Days 1-2; mother exhibits passive, dependent behavior focused on basic food/sleep needs.

Postpartum Taking-Hold Phase characteristics

Mother shifts focus to newborn care, gains independence, and seeks self-care education.

Timeframe differentiating Postpartum Blues from Postpartum Depression

Symptoms lasting longer than 2 weeks require formal evaluation for depression/psychosis.

Breast Assessment Technique

Use the back of the hand while listening to lung sounds.

Postpartum Bowel Sounds

Expected to be hypoactive.

Postpartum Voiding Timeframe

Patient should void within 6 to 8 hours post-birth.

C-Section Bladder Management

Foley catheter typically remains in place for the first 24 hours.

REEDA Scale Components

Redness, Edema, Ecchymosis, Drainage (pus, not lochia), Approximation.

Postpartum Pain Management & Bleeding

Avoid NSAIDs if active bleeding is present; Percocet is acceptable while breastfeeding.

Postpartum DVT Assessment (Legs)

Evaluate legs for symmetry, swelling, redness, and heat.

Edinburgh Postnatal Depression Scale Timing

Administered to all patients prior to discharge.

Prerequisites for RhoGAM Administration

Wait for cord blood collection and lab results prior to IM administration.

How do we assess a postpartum assessment?

BUBBLE HE

Define BUBBLEHE

Breast

Uterus

Bladder

Bowels

Lochia

Episiotomy

Homans sign/DVT Check

Emotional

Superficial Venous Thrombosis (SVT) characteristics & location

Associated with varicose veins, limited to calf area; presents with swelling, redness, tenderness, warmth.

Deep Vein Thrombosis (DVT) clinical presentation & diagnosis

Asymptomatic in 75% of affected patients; diagnosed via venous ultrasonography.

Pulmonary Embolism (PE) definition

Critical complication where clot fragments dislodge to pulmonary vasculature; can cause rapid mortality.

Maternal & lifestyle risk factors for Thrombosis

Inactivity/bed rest, obesity, C-section birth, sepsis, smoking, maternal age >35, high parity.

Intrapartum risk factors for Thrombosis

Prolonged labor, prolonged time in stirrups during 2nd stage, forceps use, C-section.

Medical & history risk factors for Thrombosis

History of thrombosis, varicose veins, diabetes mellitus, dehydration, family history, antiphospholipid syndrome, inherited thrombophilias.

Normal newborn respiration rate & assessment

30-60/min; count for a full minute due to irregular breathing.

Normal newborn apical pulse rate & assessment

120-160/min; count for a full minute.

Normal newborn axillary temperature range

36.5-37.3°C (97.7-99.5°F); preferred over the rectal route.

Characteristics of newborn acrocyanosis

Blue hands and feet with a pink body; common shortly after birth.

Clinical significance of central cyanosis in a newborn

Blue lips, tongue, or body; requires immediate clinical assessment.

Proper sequence for bulb syringe suctioning in newborns

Suction the mouth before the nose, only when necessary.

Purpose of newborn Vitamin K injection

Helps prevent vitamin K deficiency bleeding.

Purpose of newborn Erythromycin eye ointment

Helps prevent gonococcal eye infections.

When is the APGAR score evaluated in a newborn?

At 1 and 5 minutes after birth.

What are the 5 categories of the APGAR score?

Appearance, Pulse, Grimace, Activity, and Respiration.

APGAR score — Appearance assesses...

Color

APGAR score — Pulse assesses...

Heart rate

APGAR score — Grimace assesses...

Response to stimulation

APGAR score — Activity assesses...

Muscle tone

APGAR score — Respiration assesses...

Breathing effort

An APGAR score of 7-10 indicates...

Reassuring condition

An APGAR score of 4-6 indicates...

Needs support and reassessment

An APGAR score of 0-3 indicates...

Severe difficulty

Priority intervention if a newborn requires breathing support at birth

Provide breathing support immediately rather than waiting for the APGAR score.

Why newborns lose heat easily

Thin skin, minimal insulating fat, and large body surface area relative to size.

Evaporation heat loss in newborns

Heat loss occurring when wet skin dries after birth or a bath.

Conduction heat loss in newborns

Heat loss from direct skin contact with a cold object or scale.

Convection heat loss in newborns

Heat loss caused by cool air currents or drafts passing over the baby.

Radiation heat loss in newborns

Heat loss to a nearby cool surface without direct contact, such as a window.

Primary mechanism of newborn heat production

Metabolizing brown fat (which is decreased in preterm infants).

Risks and effects of cold stress in newborns

Depletes oxygen and glucose; increases risk for respiratory distress, hypoglycemia, and acidosis.

Nursing interventions to prevent newborn heat loss

Dry promptly, utilize skin-to-skin contact or radiant warmers, and monitor temperature.

Thermoregulation protocol for extremely preterm infants

Place in plastic wrap without drying first under a radiant warmer.

Anterior fontanel characteristics

Larger, diamond-shaped soft spot on the newborn head.

Posterior fontanel characteristics

Smaller, triangular soft spot on the newborn head.

Caput succedaneum

Scalp swelling that crosses suture lines; usually resolves in days.

Cephalhematoma

Blood collection over one skull bone that does not cross suture lines.

Key newborn physical checks

Facial symmetry, palate, clavicles, arm movement, and the umbilical cord.

Purpose of the New Ballard Score

Estimates gestational age using six muscle-tone tests and six physical features.