OB Exam 3 Study Guide

What is uterine involution?

The contraction of uterine muscle fibers, catabolism, and endometrial regeneration back to a nonpregnant state.

Where is the uterine fundus located 1 hour after birth?

At the level of the umbilicus.

How much does the uterine fundus descend every 24 hours postpartum?

Approximately 1 to 2 cm (one fingerbreadth) per day.

When is the uterus no longer palpable abdominally after birth?

At approximately 2 weeks postpartum, when it lies within the true pelvis.

What is uterine subinvolution?

The failure of the uterus to descend or shrink on the expected postpartum schedule.

What are the two primary causes of uterine subinvolution?

Retained placental fragments and pelvic infection (endometritis).

What are postpartum afterpains?

Uterine cramping caused by intermittent contractions, more pronounced in multiparas and with breastfeeding.

What is lochia rubra?

Dark red, bloody vaginal discharge occurring on postpartum days 1 to 3 or 4.

What is lochia serosa?

Pinkish-brown, serosanguineous vaginal discharge occurring on postpartum days 3 or 4 to 10.

What is lochia alba?

Yellowish-white, mucous vaginal discharge occurring from day 10 up to 6 to 8 weeks postpartum.

How is scant lochia defined?

A blood stain on a perineal pad measuring less than 2.5 cm (about 10 mL).

How is heavy lochia defined?

One perineal pad saturated within 1 to 2 hours.

How is excessive postpartum blood loss defined by pad saturation?

A perineal pad saturated in 15 minutes or less, or pooling under the buttocks.

How does the cervix change permanently after childbirth?

The external os changes from a round-dimpled shape to a lateral, slit-like appearance.

Which hormonal drop triggers lactation and postpartum physiological changes?

The dramatic drop in estrogen and progesterone following the expulsion of the placenta.

Why is a WBC count up to 30,000 normal in the first 4-6 days postpartum?

It represents physiological leukocytosis, a normal response to birth stress, not necessarily infection.

What is puerperal bradycardia?

A normal postpartum heart rate of 40 to 60 bpm lasting 1 to 2 weeks due to increased stroke volume.

Why is a postpartum client at high risk for thromboembolism (DVT/PE)?

Because coagulation factors remain elevated for 2 to 3 weeks, creating a hypercoagulable state.

How long must a client avoid pregnancy after receiving the Rubella vaccine?

For at least 4 weeks (28 days) following vaccination.

What is the administration window for Rho(D) immune globulin (RhoGAM)?

Within 72 hours of birth for Rh-negative mothers with Rh-positive newborns.

How does a distended bladder cause uterine atony?

It displaces the uterus upward and laterally, preventing effective contractions and increasing hemorrhage risk.

What are the components of the REEDA scale?

Redness, Edema, Ecchymosis, Drainage, and Approximation.

How is a third-degree perineal laceration defined?

A tear that extends through the skin, superficial structures, and the anal sphincter.

How is a fourth-degree perineal laceration defined?

A tear that extends completely through the anal sphincter and the anterior rectal wall.

What is the recommended postpartum calorie increase for lactating clients?

An additional 450 to 500 kcal/day above prepregnancy intake.

What is the difference between bonding and attachment?

Bonding is a unidirectional parent-to-infant tie; attachment is a bidirectional, ongoing interactive process.

What characterizes Reva Rubin's Taking-In phase?

The first 24 to 48 hours postpartum; the mother is passive, dependent, and focused on her own needs.

What characterizes Reva Rubin's Taking-Hold phase?

Begins day 2 or 3; the mother focuses on baby care, competency, and active learning.

What is paternal engrossment?

A partner's intense visual and tactile awareness, attraction, and elation regarding the newborn.

How does magnesium sulfate administration affect the uterus?

It exerts a tocolytic effect, causing uterine relaxation.

What are two non-uterine causes of postpartum hemorrhage (PPH)?

Retained placental fragments and operative or traumatic birth.

What is the critical first assessment step when postpartum hemorrhage is suspected?

Evaluate uterine contractility and tone.

What are the expected uterine and bleeding findings in postpartum hemorrhage?

A boggy uterus, clots larger than a quarter, and pad saturation in 15 minutes or less.

What are three initial nursing actions to improve uterine tone in postpartum hemorrhage?

Perform fundal massage, empty the bladder, and administer IV fluids.

What medications are represented by the postpartum hemorrhage mnemonic "MOM Can't Do"?

Methergine, Oxytocin, Misoprostol, Carboprost (Hemabate), and Prostin.

What key nursing consideration is associated with oxytocin administration?

Monitor for water intoxication, including headache, malaise, nausea, and vomiting.

What is the primary contraindication for administering methylergonovine (Methergine)?

Hypertension.

In which patient population is carboprost tromethamine (Hemabate) contraindicated?

Patients with asthma.

What is the administration window for Tranexamic acid during postpartum hemorrhage?

Within 3 hours of birth.

Why should nurses not wait for classic shock signs before intervening in visible postpartum bleeding?

Signs of hypovolemic shock may not appear until 30% to 40% of blood volume is lost.

What autoimmune disorder causes antiplatelet antibodies to destroy platelets, affecting stability?

Idiopathic thrombocytopenic purpura (ITP).

What are the dual pathophysiology components of Von Willebrand disease?

Factor VIII deficiency and platelet dysfunction.

What is the most common cause of disseminated intravascular coagulation (DIC) in obstetric patients?

Abruptio placentae.

What lab value changes are expected in a patient with DIC?

Decreased platelets and fibrinogen, with increased PT, fibrin split products, and D-dimer.

What risk factors double a postpartum client's risk for thromboembolic disease?

Cesarean birth.

What are the classic clinical findings of a deep vein thrombosis (DVT)?

Unilateral leg pain, swelling, warmth, redness, and a hardened vein.

What are the clinical findings of a life-threatening pulmonary embolism (PE)?

Apprehension, pleuritic chest pain, dyspnea, tachypnea, hemoptysis, and tachycardia.

How should a patient's leg be positioned when treating deep vein thrombosis?

Elevated above heart level, avoiding knee gatch or pillows under the knees.

Why is massaging an extremity affected by DVT strictly contraindicated?

It risks dislodging the clot into a life-threatening pulmonary embolus.

What is the antidote for heparin, and what lab value monitors its therapy?

Protamine sulfate is the antidote; monitor activated partial thromboplastin time (aPTT).

What is the antidote for warfarin, and why must women use contraception while taking it?

Phytonadione (vitamin K) is the antidote; warfarin is teratogenic.

What temperature and timeline define a suspected puerperal (postpartum) infection?

Fever of 38°C (100.4°F) or higher after the first 24 hours postpartum.

What are the clinical findings of endometritis?

Uterine tenderness, dark/foul lochia, fever, chills, tachycardia, and pelvic pain.

What are the risk factors and timing associated with postpartum mastitis?

Cracked nipples, milk stasis, and poor latch; typically occurs after day 7 postpartum.

What is the key breastfeeding instruction for a mother diagnosed with mastitis?

Continue breastfeeding or pumping to empty the breast; stopping worsens outcomes.

What is the priority nursing action when postpartum psychosis is suspected?

Ask the parent directly about thoughts of harming themselves or the newborn.

What are the three postpartum mental health disorders categorized by severity?

Postpartum blues (mild/self-limiting), postpartum depression, and postpartum psychosis (psychiatric emergency).

What structural complications can occur as a result of childbirth trauma?

Uterine prolapse, cystocele (bladder protrusion), rectocele (rectum herniation), and genital fistulas.

How should a caregiver hold a newborn during bottle feedings to prevent aspiration?

Always hold the newborn and never prop the bottle.

What feeding position helps prevent newborn choking and ear infections?

A semi-upright position rather than a supine position.

Why must any formula remaining in a bottle after a feeding be discarded?

To prevent the risk of bacterial contamination.

What is the weight threshold used to diagnose newborn failure to thrive?

Weight falling below the 5th percentile on the growth chart.

What are three physical interventions to help wake a sleepy newborn for feeding?

Unwrap them, change their diaper, and massage their hands or feet.

What is the chronological definition of the neonatal period?

The first 28 days of life.

What is the most critical physiological adjustment a newborn must make after birth?

Establishing respiratory function with the first breath.

What are the characteristics of the first period of reactivity in a newborn?

Alertness, exploring, sucking sounds, and rapid heart and respiratory rates.

What behavior is common during the second period of reactivity?

The newborn reawakens and often gags or chokes on accumulated mucus.

What are the five clinical signs assessed in an APGAR score?

Appearance, Pulse, Grimace, Activity, and Respiratory effort.

What APGAR score range indicates moderate difficulty in a newborn?

A score of 4 to 6.

What is the normal body temperature range for a newborn?

36.5°C to 37.5°C (97.9°F to 99.7°F).

How do newborns primarily produce heat during nonshivering thermogenesis?

By metabolizing brown fat.

What nursing intervention prevents newborn heat loss through evaporation immediately after birth?

Dry the newborn immediately and remove wet linens.

What is an example of newborn heat loss via conduction?

Direct contact with a cold scale or stethoscope.

How does convection cause heat loss in a newborn?

Flow of heat from the body to cooler surrounding air currents.

What clinical pathway is triggered by cold stress in a newborn?

Increased oxygen consumption leading to hypoglycemia, metabolic acidosis, and respiratory distress.

What is the normal respiratory rate for a newborn?

30 to 60 breaths per minute.

What causes transient tachypnea of the newborn (TTN)?

Slow clearance of fetal lung fluid, often after a scheduled cesarean.

What are the characteristics of breastfed newborn stools?

Yellow-gold, loose, and sour-smelling.

What does newborn jaundice occurring within the first 24 hours of life indicate?

Pathologic jaundice, which must be reported immediately.

Which immunoglobulin crosses the placenta to provide passive immunity to the fetus?

IgG.

What is the focal distance of a newborn's vision at birth?

8 to 12 inches.

What does a newborn head circumference 4 cm or more larger than chest circumference suggest?

Possible hydrocephalus.

What is the correct sequence for assessing newborn vital signs?

Respirations first, then heart rate, blood pressure, and temperature.

Which normal skin variation presents as small, pearly white bumps on a newborn's nose?

Milia.

How do caput succedaneum and cephalohematoma differ regarding cranial suture lines?

Caput succedaneum crosses suture lines; cephalohematoma does not.

What does an asymmetric Moro reflex in a newborn suggest?

A clavicle fracture or brachial palsy.

What is the normal range for newborn blood glucose?

Greater than 40 to 45 mg/dL.

What are the two identifiers applied to a newborn immediately after birth?

Matching wristbands with permanent locks on the newborn's ankle and wrist, plus parent/partner bands.

Which prints are obtained immediately after birth for identification?

The newborn's footprints and the mother's thumbprints.

When should the newborn's ID band be verified?

Every single time the newborn is returned to the parents.

What is the correct sequence for suctioning a newborn with a bulb syringe?

Suction the mouth first, then the nose, to prevent aspiration.

What temperature parameter must be met before a newborn can receive their first bath?

The axillary temperature must be stable at 36.5°C or higher.

What is the clinical purpose of administering erythromycin ointment to a newborn?

To prevent ophthalmia neonatorum caused by gonorrhea or chlamydia.

Why must Vitamin K (phytonadione) be administered soon after birth?

To prevent hemorrhagic disease, as the newborn's gut does not produce vitamin K until around day 7.

What is the administration rule regarding Vitamin K and Hepatitis B vaccine injections?

Do not give Vitamin K and the Hepatitis B vaccine in the same thigh.

Why is a circumcision never performed immediately after birth?

Due to low vitamin K levels causing hemorrhage risks, and cold stress risks.

What are the contraindications for performing a circumcision?

Hypospadias or epispadias, family history of bleeding disorders, and not having received vitamin K.

What is the difference in post-care between a Gomco clamp and a Plastibell circumcision?

Gomco requires petroleum gauze after the procedure; Plastibell uses a suture ring and no petroleum.

What is the correct action if a yellow mucus film forms on the circumcision site by day 2?

Do not wash it off, as it is a normal part of the healing process.

What is the safe sleep positioning recommendation to reduce the risk of SUID?

Always place the newborn in a supine ("back to sleep") position on a firm mattress.