Editing Maternal and Newborn Nursing – RN Flashcards (section)

== Bleeding and Preterm Labor ==

;Placenta previa versus placental abruption
:'''Previa''': painless, bright red bleeding, soft nontender uterus, '''no vaginal or digital exam'''. '''Abruption''': painful, dark red or concealed bleeding, rigid board-like tender uterus, frequent low-amplitude contractions, high risk of DIC and Category III tracing. A rising fundal height in abruption means concealed blood loss.

;Why an ectopic pregnancy can present with shoulder pain
:Rupture causes hemoperitoneum, and blood irritating the diaphragm produces referred shoulder pain (Kehr sign). Combined with unilateral pelvic pain, a missed period, positive hCG, and syncope, it is a surgical emergency.

;Why antenatal corticosteroids are given and when they help most
:Betamethasone 12 mg IM in two doses 24 hours apart (or dexamethasone) between about 24 and 34 weeks accelerates fetal lung maturity, reducing respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis. Benefit is greatest 24 hours to 7 days after the first dose, which is why tocolysis for roughly 48 hours is worthwhile.

;Two different indications for magnesium sulfate in obstetrics
:'''Seizure prophylaxis''' in preeclampsia with severe features, and '''fetal neuroprotection''' (reduced cerebral palsy) when birth is anticipated before about 32 weeks. Magnesium is no longer used as a primary tocolytic.

;Confirming rupture of membranes and the false-positive trap
:Pooling on sterile speculum exam, nitrazine paper turning blue (alkaline fluid), and ferning on microscopy. '''Blood, semen, and vaginal infection cause false-positive nitrazine results.''' With PPROM, limit vaginal exams and watch for chorioamnionitis and cord prolapse.