NCLEX Review: Maternity Module
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This week, we will be covering the Maternity Module from our Online NCLEX Review. The topics covered in this review are Maternal Risk Factors, Risks in the Prenatal Period, Complications in Labor, and Care of the Newborn.
Maternal Risk Factors
For maternal risk factors and newborn effects, use the acronym TORCH for any kind of infections.
- T = Toxoplasmosis
- O = Other infections
- R = Rubella
- C = Cytomegalovirus
- H = Herpes simplex
- Related to exposure to cats, gardening or eating raw meat
- Treat during the pregnancy with sulfa drugs
- Can lead to stillbirth, microcephaly, hydrocephalus blindness and deafness
- Condylomata acuminate (venereal warts)
- Causes a rash
- Infection of the mother during pregnancy can be serious
- If the mother is infected within the first 20 weeks of pregnancy, the child may be born with congenital rubella syndrome (CRS), which entails a range of serious incurable illnesses
- Can lead to stillbirth, congenital CMV, microcephaly, intrauterine growth retardation, cerebral palsy, mental retardation and liver enlargement
- No treatment available for mother or infant
- Can cross the placenta and be transmitted at delivery
- If active lesions are present, C-section recommended
Additional information on this subject is covered in the full NCLEX review book, available with our online NCLEX review or on Amazon and iTunes.
Risks in the Prenatal Period
We do an in-depth discussion on each of these risk factors in the Maternity Module full book and program. For this article, we’ll just discuss the risks of pregnancy induced hypertension.
Pregnancy induced hypertension (Gestational hypertension)
Develops after the 20th week of gestation. Most common type of hypertension in pregnancy.
Classic triad of PIH: Increased BP, proteinuria, and edema.
- First pregnancy
- Age < 19 or > 40 years
- Chronic renal failure
- Chronic hypertension
- Rh incompatibility
- History of PIH
HELLP syndrome can occur with eclampsia
- Elevated Liver function tests
- Low Platelet count
Seizure is the major complication. As they move from preeclampsia to eclampsia, priority is airway because of the seizures.
The additional risks in the prenatal period that are covered thoroughly are:
- Cardiac disease
- Chronic hypertension
- Gestational diabetes
- Diabetes mellitus
Complications in Labor
Transient decrease in HR
- Possible head compression or fetal descent. Doesn’t indicate fetal distress. Usually see at 4-7 cm.
- The decelerations are not related to the timing of contractions. May drop 10-60 beats per minute below the baseline.
- Can be cord compression or the baby is rapidly declining. Put Mom in knee chest to take the pressure off the cord. May need a C-section if not resolved.
- If it occurs after a gush of fluid, do a sterile vaginal examination and check for cord compression.
- Due to uteroplacental insufficiency. Rarely below 100 BPM
- Diabetes mellitus or cardiac disease.
- Abruption of the placenta or the uterus.
- Severe is <70 BPM lasting longer than 30-60 seconds and a slow return to baseline.
- To remember: Decels are acceptable in labor but “never be late”…..late decels means baby is in trouble.
VEALCHOP is used frequently by OB instructors.
Care of the Newborn
Apgar scores are done several times, remember that a ten is the best score that you can get.
Please use this flashcard to remember more about Apgar Scores
- Done at 1 and 5 minutes.
- If ≤ 6 at 5 minutes, repeat.
- Score 7-10: Baby is good.
- Score 4-6: Baby needs moderate resuscitation.
Gentle stimulation and oxygen.
- Score 0-3B: Baby severely compromised.
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