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Maternal-Newborn

Maternal-Newborn Nursing Review

Educational Use Only. This app is not intended to replace instructor guidance, institutional policies, clinical judgment, or professional medical training.

Overview

Maternal-newborn nursing covers pregnancy, labor, delivery, and postpartum care. NCLEX focuses on normal vs high-risk pregnancy, stages of labor, fetal monitoring, and newborn assessment. Safety for both mother and baby is paramount.

Key Concepts

  • 1

    Pregnancy stages: 3 trimesters; fundal height correlates with gestational weeks (20 weeks at umbilicus)

  • 2

    Stages of labor: 1 (dilation, latent/active/transition), 2 (pushing/birth), 3 (placenta), 4 (recovery 1-4 hr)

  • 3

    Fetal heart rate: 110-160 bpm normal; accelerations (good), decelerations: early (normal), variable (cord compression), late (uteroplacental insufficiency)

  • 4

    Preeclampsia: hypertension + proteinuria after 20 weeks; HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets)

  • 5

    Eclampsia: preeclampsia + seizures — obstetric emergency requiring magnesium sulfate

  • 6

    Postpartum hemorrhage: >500 mL vaginal, >1000 mL cesarean; uterine atony most common cause

  • 7

    APGAR score: 0-10 at 1 and 5 min; Appearance, Pulse, Grimace, Activity, Respiration; <7 needs intervention

Nursing Interventions

  • Monitor maternal vital signs, fetal heart rate, and contraction pattern continuously during labor

  • Assess fundus, lochia, and perineum postpartum; massage boggy fundus to prevent hemorrhage

  • For preeclampsia: monitor BP, reflexes (deep tendon reflexes for magnesium toxicity), urine output, fetal status

  • Administer magnesium sulfate for preeclampsia; monitor for toxicity: absent reflexes, respiratory depression, calcium gluconate antidote

  • Position on left side during labor to optimize uteroplacental blood flow

  • Assess newborn: APGAR at 1 and 5 min, vital signs, reflexes, bonding, feeding

  • Encourage breastfeeding within first hour; assess latch, positioning, and infant swallowing

Critical Red Flags

  • BP ≥140/90 with proteinuria or end-organ dysfunction after 20 weeks — preeclampsia

  • Seizure in preeclamptic patient — eclampsia (give magnesium sulfate)

  • Heavy bright red bleeding with firm or boggy fundus — postpartum hemorrhage

  • Fetal heart rate <110 or >160, or late decelerations — fetal distress

  • Prolapsed cord — knee-chest position, call for emergency cesarean

  • Newborn APGAR <7 at 5 min — needs resuscitation and ongoing assessment

Key Lab Values

Fetal heart rate: 110-160 bpm

Maternal hemoglobin: >11 g/dL in pregnancy (physiologic anemia)

Platelets: 150,000-400,000 (low in HELLP)

Magnesium sulfate therapeutic: 4-7 mEq/L (toxic >10)

Urine protein: <300 mg/24hr normal (≥300 indicates preeclampsia)

APGAR: 7-10 normal, 4-6 moderate distress, 0-3 severe distress

Patient Teaching

  • Attend all prenatal visits; report danger signs: severe headache, vision changes, severe edema, bleeding

  • Take prenatal vitamins with folic acid; avoid alcohol, smoking, and certain medications

  • Recognize labor signs: regular contractions, water breaking, bloody show; when to go to hospital

  • Practice Kegel exercises postpartum; report heavy bleeding, fever, or severe pain

  • Breastfeed 8-12 times per 24 hours; ensure proper latch and positioning

  • Postpartum: report signs of depression (blues lasting >2 weeks, thoughts of harm)

Educational Use Only — Not a substitute for professional training.