Editing Maternal and Newborn Nursing – RN Flashcards (section)

== Antepartum ==

;GTPAL, and why para does not equal number of babies
:'''G'''ravida (total pregnancies), '''T'''erm births at 37 0/7 weeks or later, '''P'''reterm births from 20 0/7 through 36 6/7 weeks, '''A'''bortions or losses before 20 weeks, '''L'''iving children. Para counts pregnancies carried to 20 weeks or beyond, not infants, so a twin birth at 36 weeks is T0, P1, L2.

;Naegele's rule and its main limitation
:First day of the last menstrual period minus 3 months, plus 7 days, plus 1 year. It assumes a regular 28-day cycle with day 14 ovulation, so it is unreliable with irregular cycles. First-trimester ultrasound is the more accurate dating method.

;The only three '''positive''' signs of pregnancy
:Fetal heart tones auscultated by an examiner, fetal movement palpated by an examiner, and visualization of the fetus on ultrasound. Everything else, including a positive hCG test, is presumptive or probable.

;Why hemoglobin falls in a healthy pregnancy
:Plasma volume rises proportionally more than red cell mass (total blood volume up 40 to 50 percent), producing dilutional or physiologic anemia. True anemia is suggested below about 11 g/dL in the first and third trimesters and below about 10.5 g/dL in the second.

;Supine hypotensive syndrome: mechanism and intervention
:After about 20 weeks the gravid uterus compresses the inferior vena cava when supine, reducing venous return, cardiac output, and uteroplacental perfusion. Signs are dizziness, pallor, nausea, hypotension, and fetal heart rate changes. '''Intervention: reposition to a lateral (classically left lateral) position.'''

;Why a "normal" creatinine can be abnormal in pregnancy
:GFR increases about 50 percent, so baseline creatinine and BUN are lower than in nonpregnant adults. A creatinine above about 1.1 mg/dL, or a doubling from baseline, signals renal impairment and is a severe feature of preeclampsia.

;Timing of Rho(D) immune globulin
:About 28 weeks' gestation, and again within 72 hours after birth of an Rh-positive newborn. Also after miscarriage, ectopic pregnancy, termination, amniocentesis, chorionic villus sampling, external cephalic version, and abdominal trauma. It prevents sensitization and has no effect once anti-D antibodies already exist.

;Group B ''Streptococcus'': when to screen and when to treat
:Rectovaginal culture at '''36 0/7 to 37 6/7 weeks'''. Treatment is '''intrapartum''' IV antibiotic prophylaxis, usually penicillin G, ideally at least 4 hours before birth. Antepartum treatment does not prevent neonatal GBS disease.

;Nonstress test: what makes it '''reactive'''
:At least 2 accelerations in 20 minutes, each 15 beats per minute above baseline lasting 15 seconds, in a fetus 32 weeks or older (10 by 10 before 32 weeks). Reactive is reassuring. A nonreactive test calls for further testing, not automatic delivery.

;Contraction stress test: which result is the good one
:'''Negative''' is the reassuring result, meaning no late decelerations with adequate contractions. This is the one test where "negative" equals normal, which is a common trap.