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Parity: Number of past viable pregnancies (after 24 weeks gestation).

●Nullipara-Patient has never completed a pregnancy (may or may not have aborted).

●Primipara-Patient has completed one pregnancy (>500 g, dead or alive).

●Multipara-Patient has two or more pregnancies.

Gravidity: Number of pregnancies.

●Nulligravida-Patient has never been pregnant.

●Primigravida-Patient has been pregnant whatever the outcome of pregnancy.

●Multigravida-Woman in at least her second pregnancy.

Effacement: Shortening of cervix and thinning of cervical wall.

Station: Refers to the descent of the fetal presenting part through the maternal pelvis.

GTPAL system: Describing pregnancy outcome.


Term births (after 37 weeks)

Premature birth

Abortion (before 20 weeks) or miscarriage.

Living children

Naegele’s rule: 

-3 + 7 +1

Determines the estimated date of confinement and works on the premise that the woman has a 28 day menstrual cycle.




Uterus:  20th week at the level of umbilicus, 36th week xiphoid descends during the last 3 weeks d/t fetal descend into the pelvis.

Cervix: Goodell’s sign, cervical plug formed by clot of thick mucus.

Ovaries: Ovulation ceases throughout pregnancy.

Vagina: Chadwick’s sign.

Breast: Tender, increased size, larger nipple and pigmented.

Weight gain: It will be depend on your BMI (normal 11kg-16kg).

Hematologic: ↑RBC.


Strea gravidarum: Reddish, slightly depressed streaks in the abdominal wall, breast and thighs.

Linea nigra: Line of dark pigment extending from the umbilicus down the midline to the symphisis.

Cloasma: “Mask of pregnancy” brownish patches of pigment on the face.


Heart: Displaced upwards by elevated diaphragm.

Circulation: Increase cardiac volume (CO increases on left side lying), (+) physiologic anemia, PR ↑.

Prenatal visit teaching:

7 months: monthly

7-8 months: q 2 weeks

8-9 months: weekly


  • Presumptive s/s: “changes felt by the woman” Morning sickness, amenorrhea, breast changes, fatigue, lassitude, urinary frequency, and quickening.

  • Probable s/s: “changes observed by the examiner” Chadwick’s, Goodell’s, Hegar’s, uterine enlargement, Positive pregnancy test, Braxton’s hicks contraction.

  • Positive signs: “definitive signs of pregnancy” Fetal heartbeat (10 weeks by Doppler), fetal movement (felt by examiner – 20 weeks), fetal skeleton (by sonography).

Chadwick’s sign: Bluish coloration of the vagina.

Goodell’s sign: Softening of cervix.

Hegar’s sign: Softening and thinning of the lower uterine segment.

Ballottement: Rebounding of the fetus against the examiner’s fingers on palpation.

Braxton hicks contractions: Prodromal labour or practice contractions.


Presentation: Cephalic (vertex, face, brow), breech, shoulder.

Attitude: Posture of the fetus (Flexion, deflexion, extension).

Lie: Relation of the long axis of the fetus to the mother (Longitudinal, Transverse, Oblique).

Position: Relationship of the presenting part to the mother’s pelvis (ROP, ROT, ROA, LOP, LOT, LOA).

Leopold’s maneuver: Method of observation and palpation to determine fetal position. ●Empty the bladder. ●Position supine with her knee flexed slightly. ●Warm hands. ●Gentle but firm touch.


German measles: Risk of maternal and fetal or congenital infection.

Sexually transmitted disease: Organism may cross the placenta.

●Syphilis: Usually leads to spontaneous abortions. Cause mental subnormality and physical deformities.

●Genital herpes: Fetus is contaminated after membrane rupture or with vaginal delivery.

●Gonorrhea: Fetus is contaminated at time of delivery. Neonate is risk for opthalmia neonatorum, pneumonia, and sepsis.

Human immunodeficiency: zidovudine decrease transmission.

Substance abuse: Alcohol, cocaine, crack, marijuana, amphetamines, barbiturates, heroin. (Cross the placenta). Risk for abnormal fetal growth, abruption placenta, and fetal bradycardia.

●Alcohol: Signs and symptoms of Fetal Alcohol Syndrome (FAS) jitterness, physical abnormalities, congenital anomalies, and growth deficits.

●Smoking: Low birth weight, increase risk of birth defects, and stillbirths.

Human immunodeficiency: zidovudine decrease transmission.

Substance abuse: Alcohol, cocaine, crack, marijuana, amphetamines, barbiturates, heroin. (Cross the placenta). Risk for abnormal fetal growth, abruption placenta, and fetal bradycardia.

●Alcohol: Signs and symptoms of Fetal Alcohol Syndrome (FAS) jitterness, physical abnormalities, congenital anomalies, and growth deficits.

●Smoking: Low birth weight, increase risk of birth defects, and stillbirths.

Physical signs of drug abuse: Dilated or contracted pupil, fatigue, needle marks, skin abscess, inflamed nasal mucosa, inappropriate behavior.


  1. Breast tenderness: ●↑estrogen and progesterone ●Wear support bra (wide strap).

  2. Palmar erythema ●↑estrogen. ●Apply calamine lotion.

  3. Constipation: ●Weight of uterus pressing the bowel and slows peristalsis ●↑fiber and fluids, exercise. ●Regular toileting (if urge).

  4. Nausea and vomiting: ●High HCG causing ↓motility ●Eat dry crackers or toast before getting up from bed. ●Small frequent meal, avoid odorous, fats and spicy foods.

  5. Fatigue:  ●↑ metabolic demand ●Adequate rest and sleep. ●No strenuous activity.

  6. Leg cramps: ●↓ Ca, ↑P ●Dorsiflex your foot. ●Apply heat and massage.

  7. Hypotension: ●Uterus pressing on vena cava. ●Side lying, rise slowly. ●Avoid prolong standing.

  8. Varicose veins: ●Uterus pressure on the veins of the lower extremities. ●Elevated leg 15 min twice a day. ●Use elastic stocking. Exercise (walk), vit. C.

  9. Hemorrhoids: ●Pressure on the rectal veins by the growing uterus. ●Prevent constipation. ●Tighten buttocks when sitting. ●Sitz baths.

  10. Frequent urination: ●Pressure of the uterus. ●Avoid caffeine or limit fluid in the evening. ●Perform kegel’s exercise. ●Voiding at regular intervals.

  11. Palpitations: ●Circulatory adjustments to increased blood volume. ●Gradual and slow movement.

  12. Leukorrhea: ●↑ estrogen and blood supply to vagina, epithelium and cervix. ●Daily bath and shower. ●Wear cotton underwear. ●Avoid tight underwear.

  13. Heart burn: ●D/t pressure of the uterus ●Avoid spicy food/fats. ●Stay 30 min upright after meal.



  1. Backache: ●D/t growing uterus. ●Avoid wearing high heels shoes. ●Walk with the pelvis tilted forward. ●Apply heat, proper body alignment.

  2. Ankle edema: ●Reduced blood circulation in the lower extremities. ●Elevate legs. ●Avoid prolong standing. ●Avoid wearing constrictive clothing. ●Do not cross legs.

  3. Headache: ●Expanding blood volume puts pressure on the cerebral artery. ●Rest with cold towel on the forehead.

  4. Dyspnea: ●D/t expanding uterus. ●Sleep upright (use pillow). ●Deep breathing exercises. ●Limit activities during the day.


  • Persistent vomiting: Hyperemesis gravidarum.

  • Facial and leg edema, hypertension: Preeclampsia.

  • Abdominal pain: Premature labor, Abruptio placenta.

  • Vaginal bleeding: Placenta previa.bAbruptio placenta, “bloody show”.

  • Leak of clear liquid from vagina: Premature rupture of membrane (PROM).

  • Absence of fetal movement: Fetal death.

          LABOR                                                                           TRUE                                                                                                   FALSE

CONTRACTION:                        ●Regular. ●Increase in frequency, duration and intensity.           ●Irregular. ●No change in frequency, duration, and intensity.

                                                     ●Short intervals.     

PAIN AND DISCOMFORT:      ●Radiates from back around the abdomen.                                     ●Pain at the abdomen.

REST AND ACTIVITY:               ●Does not decrease with rest or activity/walking.                           ●Contraction may lessen with rest or activity.

CERVIX:                                      ●Progressive effacement and dilatation.                                           ●No cervical changes.

Stages of labor:

1st stage: Latent (0-3cm dilatation), Active (4-7cm dilatation), Transition (8-10cm dilatation).

2nd stage: Phase I (0 to +2 station), Phase II (+2 to +4 station), Phase III (+4 to birth).

3rd stage: Placental delivery (separation and expulsion).

4th stage: First four hours after delivery of placenta (Monitor: V/S, FUNDUS and LOCHIA q15 until stable).

Lochia: “RuSeAl” Discharge from the uterus that consists of blood and debris from decidua.

Rubra: red color, 1-3 days.

Serosa: pink to brown, 4-10 days.

Alba: colorless/yellow-white 10-14 days, may last for 6 weeks.


Patient teaching:

  • Teach newborn care skills as needed.

  • Allow mother to bathe the newborn infant if possible.

  • Teach feeding techniques.

  • Avoid heavy lifting for three weeks.

  • Postponed sexual activity until lochia ceases.

  • Follow up schedule at 4 to 6 weeks.

  • Report any signs of chills, fever, increase lochia, depressed mood to physician.


  • Monitor vital signs, pain and fundus.

  • Monitor lochia (COCA).

  • Assess breast for engorgement.

  • Assess perenium and episiotomy, if caesarean check dressing.

  • Monitor I and O.

  • Monitor bowel and bladder status.

  • Assess for Thrombophlebitis.

  • Assess bonding and emotional status.



●Involution: (begins immediately after delivery of the placenta), rapid decrease in the size of uterus as the body return to its pre-pregnant state.

●It will contract along with the uterine muscle, contracts the blood vessels at the site of placental attachment to control bleeding.

●Exfoliation: sloughing off of dead tissue at the site where the placenta attached to the uterine wall. Leaves the site smooth and without scar tissue for the next pregnancy.

●Fundus: MIDLINE and palpable halfway between the symphysis pubis and the umbilicus. One hour post-delivery is should be FIRM and at the level of UMBILICUS. It will continue to descend at the rate of approximately one cm (finger-breadth) per day. It should be nonpalpable by 10 days postpartum.

●Afterpains / intermittent uterine contractions: Due to release of oxytocin and subsequent relaxation and contraction of the uterine muscle. More common on multiparous and during breastfeeding. Can be alleviated by relaxation techniques and analgesics.

2. CERVIX: Slightly edematous and may appear bruised.

3. VAGINA: Rugae (vaginal folds-return approximately after 4 weeks), dyspareunia (painful intercourse).

4. PERENIUM: Lacerations of the perineum may occur during delivery, or an episiotomy. First-degree lacerations: extend through the skin and superficial layers of the perineum. Second-degree lacerations: extend through the perineal muscles. Third-degree lacerations: extend through the anal sphincter muscles. Fourth-degree lacerations extend through the anterior rectal wall and can be damaging to the perineum.

5. BREAST: Prolactin initiates milk production, and the breasts become full (engorged), as well as warm and tender.  Refers as come in.” Increase temperature. Non-breastfeeding women will also experience their milk coming in; however, lactation can be suppressed through the use of a well-fitted bra. Non-breastfeeding mothers should also avoid any type of nipple stimulation or heat to the breasts, such as warm or hot showers. Interventions: use ice packs or cool cabbage leaves to ease breast discomfort until milk production ceases. Analgesics as prescribed.

6. URINARY SYSTEM: The bladder, urethra, and urinary meatus are edematous after delivery as a result of the fetal head passing through the birth canal. Bladder tone is diminished, and many women are unable to feel the need to void, despite the rapid diuresis that occurs following delivery. Risk for bladder distention – it will displaced the uterus upward and DEVIATED TO THE SIDE, which prevents the uterine muscles from contracting properly and lead to postpartum hemorrhage – monitor the FIRMNESS of the fundus, NOT DEVIATED, in MIDLINE and no excessive bleeding during the postpartum period. ●Assess for UTI s/s: d/t Urinary retention as a result of decreased bladder tone and emptying

7. IMMUNE SYSTEM: Rh-negative patients to receive Rh immune globulin within 72 hours of delivery to prevent maternal antibody production. (Given at 28 weeks of pregnancy – first pregnancy the baby would probably not be affected).

Rubella vaccine should also be administered to postpartum patients who tested nonimmune or had a rubella titer less than 1:10 prior to delivery. Patients should be informed that the vaccination is given to prevent fetal anomalies in subsequent pregnancies. Additionally, the rubella vaccine is a live virus and is contraindicated during pregnancy. Therefore, all women should be instructed to avoid becoming pregnant for the 4 weeks following the administration of the vaccine.

8. ATTACHMENT: BONDING! Affected by a multitude of factors, including socioeconomic status, family history, role models, support systems, cultural factors, and birth experiences. Attachment starts not only during postpartum but also during pregnancy. “USE POSTPARTUM BONDING QUESTIONNAIRE”.

Consider the factors that affect attachment such as:  anesthesia after a cesarean section, pain, or a traumatic birthing experience.


  • Touching.

  • Holding.

  • Kissing.

  • Cuddling.

  • Talking and singing.

  • Choosing the “en face” position.

  • Expressing pride in the infant.


  • Refusing to look at the infant.

  • Refusing to touch or hold the infant.

  • Refusing to name the infant.

  • Negative comments about the infant.

  • Refusing to respond or responding negatively to infant cues (e.g., crying, smiling).


 1. Breast:

Assess for signs of engorgement, including fullness usually at postpartum days 3 and 4.

Assess hot, red, painful, and edematous areas, which could indicate mastitis.

Assess nipple condition and latch-on technique of women who are breastfeeding.

Breastfeeding women should wear a comfortable, well-fitted support bra. Instruct them to gently rub colostrum or breast milk into their nipples and allow the nipples to air dry after each feeding to “condition” the nipples. Mothers can prevent drying by avoiding soap when washing the nipples.

Controlling nipple pain- applying warm-water compresses, breast milk, or teabags.

Instruct bottle-feeding patients to wear a well-fitting support bra and to avoid any type of nipple stimulation until lactation is discontinued.

 2. Uterus:

Assess the fundus:

By approximately one hour post delivery, the fundus is firm and at the level of the umbilicus.

The fundus continues to descend into the pelvis at the rate of approximately 1 cm or 1 finger-breadth per day and should be nonpalpable by 10 days postpartum.

In addition, assess patients for uterine cramping and treat for pain as needed.

Patients or a family member can be taught to assess the firmness of the fundus and to provide massage in the event of a boggy uterus or excessive bleeding. Encourage patients to void before palpation of the uterine fundus because a full bladder displaces the uterus and can lead to excessive bleeding.

 3. Bowel:

Assessment of the bowel is important in all postpartum patients. It is especially vital for patients following C-sections.

Assess for the following: Bowel sounds, Return of bowel function, Flatus, Color and consistency of stool

Administer prescribed stool softeners or laxatives as needed to treat constipation and ease perineal discomfort during defecation.

Encourage patients to ambulate soon after delivery. Teach the need to eat fruits, vegetables, and other high-fiber foods daily.

Postpartum patients should consume at least 2,000 mL/day of fluid.

 4. Bladder:

Assess urination and bladder function for the following: Return of urination, which should occur within 6 to 8 hours of delivery

Patients should void a minimum of 150 mL per void “to be well-emptied 200mL”; less than 150 mL per void could indicate urinary retention due to decreased bladder tone post delivery.

Assess for signs and symptoms of a urinary tract infection (UTI)

The bladder should be nonpalpable above the symphysis pubis.

Encourage patients to drink adequate fluid each day and to report signs and symptoms of a urinary tract infection.

 5. Lochia:

Assess lochia during the postpartum period:

Saturating one pad in less than an hour, a constant trickle of lochia, or the presence of large (i.e., golf-ball sized) blood clots is indicative of more serious complications (e.g., retained placenta fragments, hemorrhage) and should be investigated immediately. A significant amount of lochia despite a firm fundus may indicate a laceration in the birth canal, which should be addressed immediately.

Foul-smelling lochia typically indicates an infection and needs to be addressed as soon as possible.

Lochia should progress from rubra to serosa to alba. Any changes in this progression could be considered abnormal and should be reported. Lochia rubra is present on days 1–3, lochia serosa on days 4–10, and lochia alba on days 11–21.

It is important to note that patients who had a C-section will typically have less lochia than patients who delivered vaginally; however, some lochia should be present.

After discharge, patients should report any abnormal progressions of lochia, excessive bleeding, foul-smelling lochia, or large blood clots to their physician immediately. Instruct patients to avoid sexual activity until lochial flow has ceased.

 6. Episiotomy/Perineum:

Assess an episiotomy or laceration of the perineum. REEDA stands for:

Redness Edema Ecchymosis Discharge Approximation

The use of ice packs during the immediate postpartum period is generally indicated.

Assess the rectal area for hemorrhoids

Various actions can aid in perineal healing.  Perineal care after each voiding, analgesics as prescribed. To avoid infection, teach patients to pat from front to back and to use a peri-bottle for gentle cleansing of the perineum after a bowel movement or urination. Instruct patients to avoid tampons and sexual activity until the perineum has healed.

Performing Kegel exercises are an important component of strengthening the perineal muscles after delivery and may be begun as soon as it is comfortable to do so.

Other recommendations: Cold sitz bath during the first 24h, Lukewarm sitz bath after the first 24h, Keep the buttocks tightened when patient sit down.

 7. Lower Extremities:

Assess for deep vein thrombosis (DVT), the lower extremities should be examined for the presence of hot, red, painful, and/or edematous areas. “NEUROVASCULAR SIGNS”

To improve circulation and prevent the development of thrombi:

Encourage patients to ambulate shortly after delivery.

Also teach them to avoid crossing the legs for long periods of time.

Keep the legs elevated while sitting.

Encourage to wear TED hose.

 8. Emotions:

Postpartum patients typically exhibit symptoms of the “baby blues” or “postpartum blues,” demonstrated by tearfulness, irritability, and sometimes insomnia. Possible causes:  hormonal fluctuations, physical exhaustion, and maternal role adjustment.

If symptoms last longer than a few weeks or if the postpartum patient becomes nonfunctional or expresses a desire to harm herself or her infant: Patient should report this to her certified nurse-midwife or physician immediately. Appropriate interventions should be implemented to protect the mother and her infant; this behavior is indicative of postpartum depression.

Postpartum mothers and their families should be taught to understand that the baby blues are a normal part of the postpartum experience. Encourage patients to rest regularly and to allow family members to care for them as needed. Instruct patients to get plenty of fresh air and gentle exercise. Acquaint patients with groups for new mothers that provide the support of others experiencing postpartum blues. Finally, teach postpartum mothers and their families about the signs and symptoms of postpartum depression.


In addition to the typical assessments deemed necessary during the postpartum period, it is vital to assess for signs and symptoms of intimate partner violence (IPV), formally known as domestic violence. 


Intimate partner violence is abuse that occurs between two people who are in a close or intimate relationship. It can manifest as physical, verbal/emotional, or sexual abuse, or as threatened abuse. Symptoms of IPV include:

Chronic pain, Migraine, Depression, Anxiety, Bruises at various stages of healing, Bruises resembling cords or belts, Pelvic inflammatory disease (PID), Urinary tract infections (UTI).

An abusive partner may exhibit hostile or demanding behavior or may refuse to leave the patient’s side. Abusers may also answer for the patient and find ways to alienate the patient from her family and friends.



Note: Ask this questions “Do you feel safe at home?” or “Is anyone abusive to you?” but not in the presence of others, including family members and friends. Please don’t ask judgmental questions: “Why don’t you just leave?” or “Why do you continue to go back?” It is essential to assess patients in an unhurried and supportive manner. “Use the IPV screening tool if available” – also refer the patient to the appropriate resources within your healthcare facility and the community.

Encourage women to prepare in advance to leave by performing the following:

  • Packing and hiding a bag with needed items.

  • Having personal documents (Social Security card, driver’s license, medical cards, etc.) available.

  • Hiding extra sets of house and car keys.

  • Establishing an emergency code with family and friends.

  • Having a plan for where to go after leaving.

  • Nurses can also refer patients who are experiencing IPV to women’s shelters and provide a list of other resources, such as legal aid clinics, free clinics, mental health services, and local hotlines.



  • Breastfeed as soon as possible.

  • Stay and reassure patient until confident with the baby.

  • Assess proper latch on.

  • Explain that uterine cramping is normal during breastfeeding.

  • Wash breast daily (do not use soap-increase risk of cracked nipples).

  • Use well fitted bra.

  • Baby stool is light yellow, watery and frequent.

  • Avoid OTC medications unless prescribed.

  • Avoid gas producing foods and caffeine.

  • Hormonal contraceptives may cause decrease in the milk supply.



  • Breast feed frequently.

  • Apply warm packs before feeding.

  • Apply ice packs between feeding.


  • Expose nipples to air for 10-20 minutes after feeding.

  • Rotate the position of the baby for each feeding.

  • Be sure baby is properly latched on to the areola.

Physiologic jaundice: Normal appears after the first 24 hours in full terms, the first 48 hours in premature.

  • Breastfeed at least 8x in a day.

  • Expose the baby to daylight.

  • Pathologic jaundice: Occurring before the first 24 hours – indicate early haemolysis of RBC – notify MD.

Provide cord care: (falls of within 2 weeks)

Keep it clean and dry.

Avoid covering it with diaper.

Assess for odor, swelling and discharge.

Baby should be cleaned with sponge bath until cord falls off.

Signs for proper latched on:

  • Takes a large part of the areola.

  • Opens his/her mouth very wide.

  • Chin touches the breast and his/her nose remains clear.

  • Tongue forms a funnel around the breast, under the nipple.

  • Lips are flanged outward.

  • Does not have dimples or cheeks are not hallow.

  • No smacking sound during nursing.

Signs if the baby is getting enough milk:

  • 5-6 diaper change in a day.

  • 2-5 loose stools.

  • Well-hydrated: Skin and mouth.

  • Quiet after nursing or good muscle tone.

  • Breastfeed at least 6x or on demand in a 24 hour period.

Community resources for breastfeeding: “La Liche”

Informed decision on vaccine:

  • Vaccine has mild S/E and short lived – easily treated.

  • Protects against the diseases that have severe complication.

  • No link between vaccination and autism.

  • Breastfeeding does not protect against the diseases targeted by the vaccine.

Vitamin K (Aqua-MEPHYTON):

Not synthesized until intestinal bacteria are present.

Prevent hemorrhagic disorders (HDN).

Usual dose: 0.5 to 1.0 mg.

Administer in lateral aspect of the middle third of vastus lateralis muscle.


Provide prophylaxis for neisseria gonorhoeae and Chlamydia trachomatis.


B-est for babies

R-educe allergies



S-tool is inoffensive

T-emperature is always right


E-motional bonding

E-asier recovery from pre-pregnancy state, E-asy once established.

D-igested easily

I-mmediately available

N-utritionally balance

G-astroenteritis reduced.

Disadvantage of breastfeeding:

Rarely breast engorgement and cracked nipples.

Cannot be done when mother is at work.


Anyone can feed your baby unless you decide to pump.

Can see the quantity/volume that the baby is taking directly.

Disadvantages of bottle-feeding:

Increased risk of infections, allergies & some diseases.

More expensive.

More preparation.

Risk of contamination.

Dental cavities when children go to bed with bottle.

Breast feeding procedure:

  • Wash hand and assume comfortable position.

  • Start with the breast with which last feeding ended.

  • Brush the baby’s lower lip with nipple.

  • Touch lips to have the baby open the mouth wide.

  • Encourage the baby to nurse for 15-20 minutes on each breast.

  • Release suction by depressing the baby’s chin or inserting a clean finger in the baby’s mouth.

  • Burp the baby after the first breast.

  • Repeat procedure for the second breast then burp again.

  • Instruct the mother to listen for audible sucking and swallowing.

Early post-partum hemorrhage (PPH)

Uterine atony: boggy uterus, fundus higher than expected upon palpation, and excessive lochia.

Nursing interventions:

  • Massage the uterine fundus.

  • Monitor vital signs and fundus q 5 to 15 minutes.

  • Administer prescribed medications: Pitocin, Ergonovine, Methergine, or hemabate.

  • Prepare a large-bore IV catheter and administer IV and O2.

  • If full bladder: Encourage patient to void or catheterize as needed.

Note: Methergine can cause ↑ BP and should not be given with hypertensive women.

            Expressing blood clot is only done when uterus is firmly contracted. 

Post-partum Hemorrhage (PPH)

●500 mL for vaginal birth

●1000 mL after C-section


Early–within 24h after birth.

Late–after 24h.

Risk factors:

●Full bladder. ●Prolong labor.                ●Placenta previa. ●Multiparous. ●Macrosomia. ●Forceps delivery.


●After 20th week but before the 37th week of gestation.

●Frequent contractions, longer and persist.

●May be caused by infection (UTI).


●Painful or painless uterine contractions. ●Abdominal cramps. ●Low back pain. ●Rupture of amniotic membrane. ●Vaginal discharge (thick, thin, bloody, brown, colorless or odorous).


  • Maintain bedrest (lateral position).

  • Monitor fetal status.

  • Focus on stopping the labor: Hydration, restrict activity, and treating any infection.

  • Administer medication as prescribed: Tocolytics (Ritodrine, Mg SO4, Terbutaline, Nifedipine, and Indomethacin).

VENA CAVA SYNDROME (Supine hypotensive syndrome)

Occurs when venous return to the heart in insufficient due to the weight of uterus.

Vena cava and descending aorta is partially occluded leading to decrease in cardiac output, cardiac return and BLOOD PRESSURE.


Faintness, light-headedness, dizziness.

  • Hypotension.

  • Fetal distress.


  • Position the patient in left lateral recumbent position to shift the weight of the fetus off the inferior vena cava.

  • Monitor vital signs and fetal heart rate.


Breast infection caused by S. Aureus. Bacteria can enter through cracked nipples caused by improper latch-on during breastfeeding. Mastitis can develop due to blocked milk ducts and milk stasis in breastfeeding women. Blocked milk ducts and milk stasis occurs as a result of improper latching and inadequate breast emptying.

Classic symptoms: Pain and redness. Others: low-grade fever, chills, and general malaise.

Nursing interventions:

  • Teach proper latch techniques.

  • Feed the baby regularly and allow the breast to empty completely.

  • Avoid missing feeding and allowing the breast to become engorged.

  • Apply cold or warm compress as needed + analgesic.

Warm: can help allow milk to flow more freely and reduce some pain/swelling.

Cold: decrease inflammation and pain.

Note: If untreated, a breast abscess may develop – treated by antibiotic therapy.

PROM (Premature Rupture Of Membrane)

Rupture and loss of amniotic fluid that occurs before labor begins. RISK FOR PREMATURE BIRTH.

●Do a NITRAZINE paper test: color becomes BLUE because of the ALKALINITY of amniotic fluid which is >6.5. If urine the color will be RED due to acidity. Note: Blood is alkaline: blue

Nursing interventions:

●Watch and monitor signs of infection (fever, chills).

●No COITUS and douching.

●Strict BEDREST.

●Tocolytic therapy: Betamethasone: accelerates fetal lung maturity.


Associated with:

  • Miscarriage, stillbirth, and abortion.
  • Preterm infant.
  • Infant with congenital anomalies.
  • Infant with complications.

Nursing interventions:

  • Therapeutic communication, active listening and give time to grieve.
  • Provide options: Seeing, holding, bathing, and/or dressing the deceased infant. Visualization by family members, religious rituals, and funeral arrangement.
  • Prepare a memory box with keepsakes: Foot/handprints, and pictures.
  • Provide privacy.


●Premature separation of NORMALLY implanted placenta either partial or total.

●Common among women with hypertension, Multiparity, advanced maternal age, short umbilical cord, direct trauma and alcohol use.


Fetal distress, DIC

Signs and symptoms:

  • Board like abdomen.

  • Severe abdominal and low back pain (sharp stabbing).

  • Vaginal bleeding (dark red) or absent of bleeding.

  • Frequent low intensity uterine contraction.

  • Uterine tenderness or rigidity.


  • Place the patient in lateral position or trendelenburg as indicated (to decrease pressure of the fetus to placenta).

  • O2 therapy.

  • Monitor FHT and V/S q15.

  • No IE or rectal examination or enema.

  • Fluid replacement and possible blood transfusion.

  • Stay and reassure the patient

  • Assess for S/S of shock

  • Emergency caesarean section:  if active labor and bleeding cannot be stopped with bedrest.


●Development of the placenta in the lower uterine segment, partially or completely or low lying or marginal covering the internal cervical os.

●Common in Asian and African.

●Smoking/cocaine use, multiparity, advanced maternal age, endometritis.


PPH, Hypovolemic shock, and preterm labor.

Signs and symptoms:

  • Sudden onset of PAINLESS bright red vaginal bleeding.

  • Uterus is soft.

  • Fundal height may be more than expected for gestational age.

  • Bleeding may be profuse or scanty.


  • Monitor vital signs and fetal heart rate.

  • Notify M.D. immediately.

  • Prepare for ultrasound to confirm diagnosis.

  • Avoid vaginal exam or any stimulation of uterine activity.

  • Place patient on bed rest in side lying position.

  • Start IV fluids, blood products, or Tocolytic medication as prescribed.

  • Monitor amount of bleeding (assess s/s of shock).

  • For heavy bleeding: Caesarean must be done to prevent further blood loss.

PIH (Pregnancy Induced Hypertension): Pre-eclampsia and Eclampsia

●↑ systolic BP >30 and diastolic >15 (140/90 mmHg).

●+ proteinuria.

●Weight gain.

●Facial and extremity edema.

●Headache, blurred vision, oliguria, abdominal pain.

Note: Preeclampsia and Eclampsia: risk for CONVULSION OR COMA: so apply seizure precaution!

Preeclampsia management:

  • Assess BP, protein in the urine, change in LOC, weight, FHT, and vaginal bleeding.


  • Left lateral position.

  • High protein diet.

  • Increase fluid intake, avoid salt.

  • Seizure precaution.

NOTE: Most common complication is: ECLAMPSIA AND HELLP syndrome.

Eclampsia management:

  • Seizure precautions/interventions!

  • Maintain an IV line.

  • O2 and airway equipment at bedside


Administer medication as ordered: MAGNESIUM SULFATE, valium, and hypotensive drugs such as hydralazine (Apresoline) or labetalol (Normodyne).

MgSO4: Drug of choice for prevention and treatment of convulsions. Therapeutic level is 5.8 mg/100mL. Given slowly by piggy back IV or IM via Z-track.

Nursing considerations:

  • Accurate I & O: ↓ urine excretion may lead to toxicity!

  • Assess symptoms of overdose: Decrease urine output, depressed DTR, change in LOC, respiratory distress.

  • Monitor maternal and fetal vital signs.

  • CALCIUM GLUCONATE as antidote (always at the bedside).

Post-partum depression – 10-15% of women after delivery.

Symptoms are generally noted within the first 3 months but may occur up to a year after delivery.


After screening and assessment, women who are at risk for developing (or who are suffering from) postpartum depression can be referred to the appropriate healthcare professional for follow-up and treatment. 

Depression respond best to combination of:

  • Psychotherapy

  • Social support

  • Medication

  • Post-partum depression is usually treated with counseling and medication.

  • As a nurse support the patient in the healing process at follow-up appointments and during home visits.

  • Help the patient and their families understand what postpartum depression is.

Additionally: Encourage adequate nutrition, rest, relaxation and exercise.


Postpartum patients and their families should be instructed to call the healthcare provider if the patient has any of the following:

  • Fever.

  • Foul-smelling lochia.

  • Large blood clots or bleeding that saturates a pad in one hour.

  • Discharge or severe pain from incisions.

  • Hot, red, painful areas on the breasts or legs.

  • Bleeding and/or severe pain in the nipples.

  • Severe headaches and/or blurred vision.

  • Chest pain and/or dyspnea without exertion.

  • Frequent, painful urination.

  • Signs of depression.



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