Obstetric & Maternity Nursing Flashcards

A newborn is born with a myelomeningocele. What is the immediate priority nursing intervention?

Answer: Cover the sac with a sterile, moist, saline dressing and position prone

A myelomeningocele (open spinal defect) must be covered immediately with sterile, moist, non-adherent saline-soaked dressings to prevent infection and drying of neural tissue. The infant is positioned prone to avoid pressure on the sac. Surgical repair within 24–72 hours is planned.

A G1P0 woman is in active labor. The nurse notes late decelerations on the monitor. What is the most likely cause?

Answer: Uteroplacental insufficiency

Late decelerations (onset after peak of contraction, slow return to baseline) are caused by uteroplacental insufficiency — the intervillous blood flow is insufficient to oxygenate the fetus during contractions. This is an ominous finding requiring position change, oxygen, and physician notification.

What is the recommended breastfeeding position to prevent mastitis?

Answer: Ensure complete breast drainage by varying feeding positions and ensuring a correct latch

Mastitis results from milk stasis and bacterial entry. Varying positions ensures all ducts drain completely. A correct deep latch prevents nipple cracking (which allows bacterial entry). Frequent complete emptying prevents the milk stasis that allows bacterial proliferation.

A woman with a prior cesarean section is being considered for vaginal birth (VBAC). Which is an absolute contraindication?

Answer: Prior classical (vertical) uterine incision

A prior classical (vertical midline) uterine incision extends into the thick uterine fundus, which is under higher tension during labor, carrying a uterine rupture risk of 4–9% — unacceptably high for VBAC. Low-transverse incisions carry only ~0.5–1% rupture risk, making VBAC a reasonable option.

Which finding during a prenatal visit at 20 weeks indicates the fundal height is appropriate?

Answer: Fundal height measures 20 cm at the umbilicus

Between 20–36 weeks, fundal height (in cm) roughly equals gestational age (in weeks) ±2 cm — a useful clinical rule. At 20 weeks, the fundus should be at or near the umbilicus (approximately 20 cm). Discrepancies suggest growth restriction or multiple gestation.

What is the most common cause of postpartum hemorrhage?

Answer: Uterine atony

Uterine atony (failure of the uterus to contract after delivery) accounts for ~80% of postpartum hemorrhage. Risk factors include prolonged labor, multiparity, overdistended uterus (twins, polyhydramnios), oxytocin augmentation, and magnesium sulfate use. The '4 T's': Tone, Tissue, Trauma, Thrombin.