OB Final Exam: Key Concepts and Postpartum

• The OB final exam consists of approximately 75-80 questions.
• Around 20-25 questions will cover material not previously tested, including postpartum and newborn complications.
• Remaining questions will be from previously covered areas.

Key Concepts in Growth and Development

• Key topics include the roles of the placenta and amniotic fluid, as well as the vessels of the umbilical cord.

Placenta

• Provides the fetus with oxygen and nutrients.
• Removes waste products.

Amniotic Fluid

• Cushions the baby.
• Regulates temperature.
• Allows movement for development.

Umbilical Cord

• Contains two arteries and one vein.
• Arteries carry deoxygenated blood from the baby.
• The vein carries oxygenated blood to the baby.

Cervical Changes

• Knowing dilatation (0-10 cm), effacement (0-100%), and station (-3 to +3) is essential.

Mastitis

• Preventative measures include proper latch, emptying breasts, and hygiene.
• Symptoms include redness, pain, and fever.

Jaundice

• Jaundice results in yellow discoloration of the skin and eyes due to elevated bilirubin levels.

Physiologic Jaundice

• Occurs after 24 hours
• Resolves within a week and is common in newborns.

Pathologic Jaundice

• Occurs within the first 24 hours.
• May indicate an underlying disease.

Jaundice Treatment

• Frequent feedings.
• Phototherapy.
• In severe cases, exchange transfusion.

Nursing Responsibilities During Phototherapy

• Protect the baby's eyes.
• Monitor hydration and skin care.
• Provide frequent feedings.

Malposition (OP)

• Includes signs and symptoms and nursing interventions.
• Causes back labor.
• Interventions include positioning (hands and knees), counterpressure, and possible rotation techniques.

Calculating Due Date

• Use Naegele's Rule: LMP - 3 months + 7 days = EDD

GTPAL

• G: Gravida (total number of pregnancies).
• T: Term (number of pregnancies carried to term).
• P: Preterm (number of pregnancies ending preterm).
• A: Abortions (number of abortions).
• L: Living children (number of living children).

Respiratory Distress Syndrome

• Caused by a lack of surfactant.
• Symptoms include grunting, retractions, and nasal flaring.
• Treatment includes surfactant administration and oxygen.

Hypoglycemia in Infants of Diabetic Mothers

• Monitor babies of diabetic mothers for hypoglycemia.
• Symptoms include jitteriness, poor feeding, and lethargy.
• Treatment includes early feedings and IV glucose if severe.

Hematoma

• Collection of blood under the skin due to trauma.
• Symptoms include swelling, pain, bruising, and difficulty urinating.
• Treatment includes ice packs, pain management, and possible drainage.

Signs of Pregnancy

• Know presumptive, probable, and positive signs.
• Presumptive signs include fatigue, nausea, and breast tenderness.
• Probable signs include a positive pregnancy test and Chadwick's sign.
• Positive signs include fetal heartbeat and ultrasound visualization.

Braxton Hicks Contractions

• Know what they are and how to differentiate them from real contractions.
• False labor contractions are irregular and do not increase in intensity.
• Real contractions are regular, painful, and increase in strength and frequency.

Fetal Well-Being

• Signs and symptoms of respiratory distress, hypoglycemia, cold stress, fetal attitude, lie, and position.

Signs and Symptoms of Respiratory Distress

• Tachypnea, nasal flaring, grunting, retractions, and cyanosis.
• Nursing interventions include providing oxygen, maintaining a neutral thermal environment, and monitoring blood gases.

Hypoglycemia in Newborns

• Symptoms: jitteriness, poor feeding, lethargy.
• Treatment: early feedings, IV glucose if severe.

Cold Stress

• Symptoms include: hypothermia, lethargy, and apnea.
• Treatment- Warm environment, skin-to-skin contact, proper swaddling.

Fetal Attitude, Lie, and Position

• Attitude refers to the flexed or extended fetal posture.
• Lie: Longitudinal (normal) vs. transverse.
• Position: Relation of fetal presenting part to maternal pelvis.

Endometriosis

• Includes signs, symptoms, and nursing responsibilities.
• Symptoms include pelvic pain, irregular cycles, and infertility.
• Nursing responsibilities include pain management, education on treatment options, and potential surgical intervention.

Magnesium Sulfate (MgSO4)

• Includes assessments for use and toxicity, and the corresponding antidote.

Magnesium Sulfate Toxicity

• Symptoms include decreased reflexes, respiratory depression, and decreased urine output.
• Antidote: Calcium gluconate.

Assessments for MgSO4 Use

• Monitor deep tendon reflexes, respiratory rate, urine output, and magnesium serum levels.

Pregnancy-Induced Hypertension (PIH)

• Include signs of mild and severe PIH.
• Mild: BP >140/90, proteinuria.
• Severe: BP >160/110, headache, blurred vision.

HELLP Syndrome

• Hemolysis, Elevated Liver enzymes, Low Platelets.

Postpartum Hemorrhage

• Uterine atony causes postpartum hemorrhage and can be treated with fundal massage and medications (Pitocin, Methergine).

Epidural

• Knowledge of Epidural and side effects, and related nursing responsibilities is important.

Hypotension

• Treat with fluids.
• Assess for bladder distension.
• Monitor fetal heart rate.

Lightening and Quickening

• Lightening: Baby drops into pelvis.
• Quickening: First fetal movements felt.

Sepsis

• Symptoms include temperature instability, poor feeding, respiratory distress, and lethargy.
• Treatment includes antibiotics, supportive care, and frequent monitoring.

Fetal Assessment

• Knowledge of NST, CST, and BPP, including their purposes, timing, and desired results is needed.
• NST evaluates fetal heart rate response to movement and is performed to assess fetal oxygenation.
• CST observes fetal heart rate reaction to contractions to detect uteroplacental insufficiency.
• BPP combines ultrasound with NST to assess fetal breathing, movement, tone, amniotic fluid, and heart rate to determine fetal well-being.

Rupture of Membranes

• Rupture of membranes and Nitrazine and fern tests are important concepts.

Nitrazine Test

• Uses pH paper to detect amniotic fluid.
• A positive result (paper turns blue) indicates rupture.

Fern Test

• Examines dried vaginal fluid under a microscope.
• A ferning pattern confirms the presence of amniotic fluid.

Signs of Rupture

• Sudden gush or slow leakage of fluid from the vagina.
• Monitor for signs of infection or umbilical cord prolapse.

Terminology

• Term (37+ weeks).
• Preterm (<37 weeks).
• Postdates (>42 weeks).

Normal Hemoglobin and Hematocrit Levels

• Normal H&H Levels in Pregnancy: Hgb 11-14 g/dL, Hct 33-40%.
• Normal H&H Levels Postpartum: Hgb 10-12 g/dL, Hct 30-36% (due to normal postpartum blood loss and hemodilution).

Cord Prolapse

• Causes: the umbilical cord slips through the cervix before the baby, leading to cord compression.
• Call for immediate help and prepare for an emergency C-section.
• Place the mother in knee-chest or Trendelenburg position to relieve pressure.
• Use a sterile-gloved hand to push the presenting part off the cord and maintain pressure until delivery if the cord is visible.
• Administer oxygen and IV fluids to improve oxygenation.

Hypertonic Contractions

• Too frequent, strong, and painful with little rest between them.
• Treatment includes stopping oxytocin if in use, providing fluids and pain management, and possibly administering tocolytics (e.g., Terbutaline).

Hypotonic Contractions

• Weak, infrequent, and ineffective at dilating the cervix.
• Treatment includes administering Pitocin (Oxytocin), encouraging ambulation, or performing amniotomy (artificial rupture of membranes).

Episiotomy Types

• Midline Episiotomy (Straight down):
  • Pros: Less pain, heals better.
  • Cons: Higher risk of extending into the rectum (3rd/4th degree tear).
• Mediolateral Episiotomy (Angled):
  • Pros: Lower risk of rectal tear.
  • Cons: More painful, longer healing time.

Dystocia

• Dystocia: Difficult labor due to uterine, pelvic, or fetal issues.
• Shoulder Dystocia: The baby's head delivers, but the shoulders get stuck behind the pubic bone.

Interventions for Shoulder Dystocia

• McRoberts Maneuver: Mother flexes thighs to widen the pelvis.
• Suprapubic Pressure: Apply pressure to dislodge the shoulder.
• Emergency C-section if necessary.

Newborn Cord Care

• The cord falls off in about 10-14 days.
• Keep dry.
• Do not submerge baby in water until the cord falls off (10-14 days).
• Clean with warm water and mild soap if soiled.
• Watch for infection signs (redness, foul odor, pus).

Newborn Heat Loss

• Convection: Heat loss from air movement (e.g., fan).
• Conduction: Heat loss through direct contact with cold surfaces.
• Evaporation: Heat loss from wet skin (dry newborn immediately).
• Radiation: Heat loss from nearby cold objects (keep bassinet away from windows).
• Know circumcision care and nursing responsibilities.
• Apply petroleum jelly with each diaper change.
• Monitor for bleeding, swelling, and infection.
• Avoid tub baths until healed (~5-7 days).

Gestational Diabetes

• Increased risk of C-section, preeclampsia, and Type 2 diabetes later for the mother.
• Macrosomia (large size), hypoglycemia, respiratory distress, and jaundice for the baby.

OP Position

• Occiput Posterior (OP) causes intense back pain during labor.
• Interventions: Counterpressure on lower back, hands-and-knees position to rotate baby, pelvic tilts and squats.

Lochia Changes

• Rubra: Dark red (1-3 days postpartum).
• Serosa: Pink/brown (4-10 days).
• Alba: White/yellow (10-14 days).

Metabolic Screening Test (MST) or PKU

• Best time: 48-72 hours after birth, but must be at least 24 hours after first feeding.

Pregnancy Screening

• Chorionic Villus Sampling (CVS): Genetic testing at 10-13 weeks.
• Biophysical Profile (BPP): Assesses fetal well-being via ultrasound + NST.
• Amniocentesis: Genetic disorders & lung maturity testing at 15-20 weeks.
• Alpha-Fetoprotein (AFP): Screens for neural tube defects at 16-18 weeks.
• CST (Contraction Stress Test): Looks for late decelerations.
• NST (Non-Stress Test): Reactive = good (2 accelerations in 20 min).
• OCT (Oxytocin Challenge Test): Stimulates contractions to check fetal response.

Newborn Assessment and Normal Alterations

• Mongolian Spots: Bluish-gray birthmarks (common in darker skin tones).
• Lanugo: Fine hair on body.
• Milia: White spots on the nose, normal, no treatment needed.
• Cephalohematoma: Bleeding between skull & periosteum (does NOT cross suture lines).
• Caput Succedaneum: Edema that crosses suture lines, resolves in days.

Signs of Pregnancy

• Presumptive: Subjective (nausea, fatigue, breast tenderness).
• Probable: Objective (positive pregnancy test, Hegar's sign).
• Positive: Definitive proof (fetal heartbeat, ultrasound, fetal movement felt by provider).

Hormones in Pregancy

• Progesterone: Maintains pregnancy, prevents contractions.
• hCG: Detected in pregnancy tests.
• hPL: Promotes fetal growth & maternal insulin resistance.

Vaginal Examinations

• Never do vaginal examinations if a patient is bleeding since you donot know if the bleed is due to placenta previa.
  • Could indicate placenta previa → Increases hemorrhage risk.

Stages of Labor

• Stage 1: Latent, Active, Transition.
• Stage 2: Pushing & birth.
• Stage 3: Placenta delivery.
• Stage 4: Recovery.

True vs False Labor

• True Labor: Regular contractions, cervical changes.
• False Labor: Irregular contractions, no cervical change.

Medications

• Pitocin: Induces labor, controls postpartum bleeding.
• Magnesium Sulfate- Prevents seizures in pre-eclampsia; monitor for toxicity (decreased reflexes, respiratory depression).
• Narcan-Reverses opioid effects in newborns.
• Celestone/Betamethasone, Dexamethasone-Given to enhance fetal lung maturity.
• Methergine/Hemabate: Used for postpartum hemorrhage (contraindicated in HTN & asthma, respectively).
• Calcium gluconate- Antidote for magnesium sulfate toxicity.
• Erythromycin- Eye prophylaxis against gonorrhea
• Vitamin K- Prevents newborn bleeding
• Surfactant- Treats neonatal respiratory distress

Uterine Atony

• KNOW Postpartum Complications, Nursing Responsibilities, Assessment, and Treatment, Uterine Atony.

DIC Review

• Review DIC.

Cord Compression

• REVIEW Fetal Monitoring, Fetal Heart Beat Changes and the Causes. EG Variable Decels Caused by Cord Compression.

Pregnancy Anatomy

• KNOW the ANATOMY of the PREGNANCY - placenta, uterus, amniotic fluid, umbilical cord with 3 vessels

Amniotic Fluid, Umbilical Cord, & Placenta

• KNOW the JOB of EACH of the FOLLOWING -- Placenta, Umbilical Cord, & Amniotic Fluid

###Jaundice and phototherapy

• KNOW SIGNS and SYMPTOMS and NURSING RESPONSIBILITIES FOR Jaundice and phototherapy

###Cold Stress

• KNOW Signs and Symptoms and Nursing Responsibilities for: Cold Stress

###Hypoglycemia

• KNOW Signs and Symptoms and Nursing Responsibilities for: Hypoglycemia

###Sepsis

• KNOW Signs and Symptoms and Nursing Responsibilities for: Sepsis

Prepare for the OB final exam covering key concepts such as the roles of the placenta, amniotic fluid, and umbilical cord. Also includes cervical changes, mastitis prevention, and postpartum complications. Focus on dilatation, effacement, station, and proper breastfeeding techniques.