Maternity Nursing Key Concepts

Overview

This lecture covers essential maternity nursing concepts for fast NCLEX preparation, including pregnancy monitoring, common complications, prenatal care, labor management, and key interventions.

Blood Pressure and Hypertension in Pregnancy

• Blood pressure decreases in the second trimester, returns to baseline in the third.
• Increases >15 mmHg diastolic or >30 mmHg systolic before 32 weeks may indicate gestational hypertension or preeclampsia.
• Gestational hypertension: BP ≥140/90 after 20 weeks, no proteinuria.
• Preeclampsia: hypertension plus proteinuria or organ dysfunction; eclampsia involves seizures.

Infectious Disease Management

• Syphilis in pregnancy: treat with IM benzathine penicillin G; desensitize if allergic, as alternatives are unsafe.
• Untreated syphilis risks miscarriage, stillbirth, prematurity, and congenital infection.
• Group B Streptococcus: screen at 35–37 weeks; treat with penicillin during labor if positive.

Prenatal Assessment and Nutrition

• Nagel’s Rule (due date): LMP + 9 months + 7 days or LMP - 3 months + 7 days; confirm by ultrasound if cycles irregular.
• Weight gain: 1 lb/month in trimester 1; 1 lb/week in 2nd & 3rd; total depends on BMI.
• Anemia: Hgb <11 g/dL (1st/3rd trimester), <10.5 (2nd); treat with iron & vitamin C, avoid calcium with iron.
• Folic acid 400–800 mcg daily prevents neural tube defects.

Common Pregnancy Disorders and Discomforts

• Constipation due to progesterone and iron; manage with fiber, fluids, exercise, avoid dairy with iron.
• No amount of alcohol is safe; risk of fetal alcohol syndrome.
• Oligohydramnios (AFI <5cm): risks of cord compression, pulmonary hypoplasia; manage with amnioinfusion, hydration.

Fetal Assessment

• Normal FHR: 110–160 bpm, detected by Doppler at 10–12 weeks.
• Kick counts: ≥10 movements in 2 hours is normal.
• Fundal height: matches gestational weeks after 20 weeks (+/- 2 cm).

Pregnancy Complications

• Ectopic pregnancy: severe unilateral pain, emergency if ruptured.
• Placenta abruptio: painful bleeding, tender uterus—risk of DIC and shock, emergency C-section if needed.
• Placenta previa: painless bleeding, avoid vaginal exams, C-section at 36+ weeks.

Labor and Delivery Management

• Three labor stages: latent (0–3 cm), active (4–7 cm), transition (8–10 cm).
• Oxytocin: monitor for hyperstimulation, bradycardia, water intoxication.
• Bishop score >6–8 indicates readiness for induction.
• Shoulder dystocia: McRoberts maneuver, suprapubic pressure, avoid fundal pressure.

Medications and Vaccines in Pregnancy

• Avoid NSAIDs in 3rd trimester; use acetaminophen.
• Tdap and flu vaccines are safe; MMR and varicella are contraindicated in pregnancy.
• Magnesium sulfate used to prevent seizures in preeclampsia; monitor for toxicity.

Key Terms & Definitions

• Preeclampsia — Hypertension in pregnancy with proteinuria or organ dysfunction.
• Eclampsia — Preeclampsia with seizures.
• Oligohydramnios — Low amniotic fluid (AFI <5cm).
• Kick counts — Maternal count of fetal movements; <10 in 2 hours needs evaluation.
• Nagel’s Rule — Method for estimating due date.
• Bishop Score — Assesses cervical readiness for labor induction.

Action Items / Next Steps

• Review recommended weight gain ranges by BMI.
• Memorize signs of complications requiring immediate evaluation (e.g., preeclampsia, placenta previa).
• Know gestational age norms for fundal height and quickening.
• Practice interpreting fetal heart rate tracings using VEAL CHOP.
• Study key medications, screening, and vaccine guidelines during pregnancy.