PERINATAL CARE REVIEWER (Care of the Mother)

1. Preconception and Antenatal Care

Key Points:

●​ Screening: Pap smear, HIV, Hepatitis B, rubella immunity, blood typing, genetic screening.
●​ Nutrition: Balanced diet, ↑ folic acid (400–800 mcg/day), ↑ iron, calcium, protein.
●​ Supplements: Folic acid (neural tube defect prevention), iron (prevent anemia), calcium & Vit D (bone health).
●​ Counseling: Healthy lifestyle (no smoking, alcohol, drugs), birth spacing, planned pregnancy.

Nursing Interventions:

●​ Educate on importance of early prenatal visits.

●​ Reinforce daily intake of folic acid.
●​ Counsel about avoiding teratogens (alcohol, certain meds, infections like rubella).
●​ Provide genetic counseling if risk factors present.

2. Maternal Risk Factors

Key Points:

●​ Age: <18 years (risk of preterm, LBW), >35 years (risk of chromosomal abnormalities, GDM, preeclampsia).
●​ Medical history: HTN, diabetes, renal disease, epilepsy.
●​ Obstetric history: Previous miscarriage, cesarean, preterm birth, stillbirth.

Nursing Interventions:

●​ Identify high-risk mothers early.

●​ Closely monitor BP, blood sugar, and fetal growth.
●​ Refer to specialists (perinatologist, endocrinologist) when needed.
●​ Provide emotional support and explain risks clearly.

3. Physical Assessment
Key Points:

●​ Vital signs: Detect early preeclampsia (↑ BP).

●​ Weight: Monitor for healthy gain (approx. 11–16 kg for normal BMI).
●​ Fundal height: Correlates with gestational age (after 20 weeks = cm = weeks).
●​ Leopold’s maneuvers: Determine fetal position, presentation, and engagement.

Nursing Interventions:

●​ Monitor maternal vital signs at each visit.

●​ Record weight and discuss appropriate gain.
●​ Perform fundal height measurement consistently.
●​ Teach mother about fetal movements and kick count.
4. Psychological and Emotional Support
Key Points:

●​ Pregnancy causes anxiety, mood swings, ambivalence.

●​ Adaptation progresses: acceptance → attachment → preparation for parenthood.

Nursing Interventions:

●​ Provide reassurance and open communication.

●​ Encourage partner/family involvement.
●​ Refer to counseling if depression or severe anxiety is noted.
●​ Teach relaxation techniques (breathing, visualization).

5. Common Discomforts of Pregnancy & Management

●​ Nausea/vomiting: Eat small frequent meals, avoid spicy foods, ginger tea.
●​ Backache: Correct posture, supportive shoes, pelvic tilt exercises.
●​ Constipation: High-fiber diet, ↑ fluids, mild exercise.
●​ Leg cramps: Stretching, dorsiflexion, adequate calcium.
●​ Heartburn: Small meals, avoid lying flat after eating.
●​ Urinary frequency: Void regularly, avoid caffeine, Kegel exercises.

Nursing Interventions:

●​ Provide non-pharmacologic relief measures.

●​ Educate on diet and lifestyle adjustments.
●​ Encourage compliance with prenatal visits.

6. High-Risk Conditions
●​ Preeclampsia: Hypertension, proteinuria, edema.
●​ Gestational Diabetes (GDM): Hyperglycemia, risk of macrosomia, neonatal hypoglycemia.
●​ Anemia: Fatigue, pallor, poor fetal growth.
●​ Infections: TORCH (Toxoplasmosis, Other [syphilis, hepatitis B], Rubella, CMV, Herpes).

Nursing Interventions:

●​ Monitor BP, urine protein, and reflexes for preeclampsia.

●​ Teach self-monitoring of blood sugar in GDM; advise on diet & insulin if needed.
●​ Administer iron supplements for anemia; encourage iron-rich foods.
●​ Teach infection prevention: safe sex, hand hygiene, avoiding raw meat & cat litter (toxoplasmosis).

7. Preventive Measures
Key Points:
 ●​ Immunizations: Tdap (27–36 weeks), influenza, Hep B if needed. Avoid live vaccines (MMR, varicella) during
pregnancy.
●​ Health teaching: Breastfeeding, birth preparedness, warning signs (bleeding, severe headache, blurred vision, ↓ fetal
movement).
●​ Lifestyle modification: Balanced diet, safe exercise, avoid smoking/alcohol/drugs.

Nursing Interventions:

●​ Administer appropriate vaccines and explain contraindications.

●​ Teach warning signs that need immediate consultation.
●​ Provide health teaching on exercise (walking, prenatal yoga).
●​ Encourage adequate rest and sleep hygiene.

✅ TIP for Exams (Mnemonic for Antenatal Care Focus):

“SAFE MOM”

●​ Supplements (folic acid, iron, calcium)

●​ Assessment (vital signs, fundal height, labs)
●​ Food & lifestyle (nutrition, exercise, no alcohol/smoking)
●​ Education (warning signs, breastfeeding prep)
●​ Monitor risk factors (age, history, diseases)
●​ Observe for discomforts (and manage)
●​ Maternal emotional support

PERINATAL CARE REVIEWER (Care of the Fetus)

1. Assessment of Fetal Well-being
Key Points:

●​ Ultrasound: Determines fetal growth, amniotic fluid, placental location, anomalies.

●​ Doppler: Detects fetal heart tones (normal: 110–160 bpm).
●​ Kick counts: Mother counts fetal movements (normal: ≥10 movements in 2 hrs).
●​ Non-Stress Test (NST): Reactive = ≥2 accelerations in 20 mins (good oxygenation).
●​ Biophysical Profile (BPP): Score of 8–10 = normal; evaluates breathing, movements, tone, amniotic fluid, NST.

Nursing Interventions:

●​ Teach mother how to perform daily kick counts.

●​ Schedule and prepare mother for NST, BPP, or ultrasound.
●​ Monitor and document fetal heart rate (FHR) during antenatal visits.
●​ Educate about when to report ↓ fetal movement.

2. Fetal Growth and Development Monitoring

Key Points:

●​ Normal growth depends on maternal nutrition, placental function, and genetics.

 ●​ Fundal height correlates with gestational age after 20 weeks.
●​ Growth scans via ultrasound detect intrauterine growth restriction (IUGR) or macrosomia.

Nursing Interventions:

●​ Record fundal height and compare with gestational age.

●​ Encourage maternal nutrition with adequate protein, vitamins, and iron.
●​ Monitor mothers with chronic conditions (DM, HTN) more closely.
●​ Reinforce importance of regular prenatal check-ups.

3. Detection of Abnormalities
Key Points:

●​ IUGR (Intrauterine Growth Restriction): Poor fetal growth due to maternal illness, placental insufficiency, or
malnutrition.
●​ Congenital anomalies: Structural or functional defects seen on ultrasound.
●​ Oligohydramnios: Low amniotic fluid → risk of cord compression, poor lung development.
●​ Polyhydramnios: Excess fluid → risk of preterm labor, cord prolapse.

Nursing Interventions:

●​ Closely monitor high-risk pregnancies with serial ultrasounds.

●​ Educate mother about balanced diet and hydration.
●​ Collaborate with physician for amniocentesis or genetic counseling if anomalies suspected.
●​ Teach mother warning signs (↓ fetal movement, leaking fluid, vaginal bleeding).

4. Fetal Distress Recognition

Key Points:

●​ Abnormal FHR patterns:​

○​ Tachycardia >160 bpm

○​ Bradycardia <110 bpm
○​ Late decelerations = placental insufficiency
○​ Variable decelerations = cord compression
●​
●​ Meconium-stained amniotic fluid: Possible fetal hypoxia and distress.

Nursing Interventions:

●​ Monitor FHR with Doppler/EFM (electronic fetal monitoring).

●​ Place mother in left lateral position to improve uteroplacental blood flow.
●​ Administer O2 via mask at 8–10 L/min if distress is noted.
●​ Notify physician immediately of abnormal FHR or meconium-stained fluid.
●​ Prepare for possible emergency delivery (C-section).
5. Interventions to Promote Fetal Health
Key Points:

●​ Maternal rest: Enhances placental circulation.

●​ Oxygen therapy: Improves oxygen supply to fetus.
●​ Positioning: Left lateral recumbent position prevents vena cava compression.
●​ Hydration: Adequate fluid intake improves uterine blood flow.

Nursing Interventions:

●​ Encourage daily rest periods and adequate sleep.

●​ Place mother in left lateral position during NST or if fetal distress suspected.
●​ Administer oxygen when ordered.
●​ Teach importance of hydration and proper nutrition for fetal growth.
●​ Reinforce adherence to prenatal visits and fetal monitoring schedules.

✅ TIP for Exams (Mnemonic for Fetal Well-being):

“FETUS”

●​ FHR monitoring (Doppler, NST, BPP)

●​ Evaluate growth (fundal height, ultrasound)
●​ Track movements (kick counts)
●​ Understand abnormalities (IUGR, amniotic fluid issues)
●​ Support with interventions (rest, O2, positioning)

INTRAPARTAL PERIOD REVIEWER

1. Theories of Labor
Causes of Onset:

●​ Hormonal theory: ↑ Oxytocin and prostaglandins, ↓ progesterone → uterine contractions.

●​ Mechanical theory: Uterine stretching + pressure of presenting part → stimulates contractions.
●​ Biochemical theory: Changes in estrogen-progesterone ratio, fetal adrenal activity, and prostaglandins.

True vs. False Labor:

●​ True labor: Regular contractions, increase in intensity/duration, cervical effacement & dilation, pain radiates from back
to abdomen.
●​ False labor (Braxton Hicks): Irregular contractions, do not ↑ in strength, no cervical changes, relieved by rest.

Stages & Phases of Labor:

●​ First Stage (Onset → full dilation 10 cm):​

○​ Latent phase: 0–3 cm, mild contractions.

○​ Active phase: 4–7 cm, stronger contractions.
 ○​ Transition: 8–10 cm, very strong, frequent contractions.
●​
●​ Second Stage: Full dilation → delivery of baby.
●​ Third Stage: Delivery of placenta.
●​ Fourth Stage: 1–4 hrs postpartum, physiologic stabilization.

Nursing Interventions:

●​ Educate about true vs. false labor.

●​ Support relaxation and breathing techniques.
●​ Monitor contractions and cervical changes.

2. Assessment
Maternal:

●​ Vital signs, contractions (frequency, duration, intensity), cervical dilation & effacement, emotional state.

Fetal:

●​ FHR monitoring (110–160 bpm).

●​ Variability (6–25 bpm normal).
●​ Accelerations (good sign of fetal oxygenation).
●​ Decelerations:​

○​ Early = benign (head compression).

○​ Late = placental insufficiency (dangerous).
○​ Variable = cord compression.
●​

Partograph:

●​ Tool to record progress of labor, fetal condition, and maternal condition.

●​ Shows cervical dilation, contractions, FHR, descent of head, and vital signs.

Vaginal Examination:

●​ Determines dilation, effacement, station, presenting part, and membrane status.

Nursing Interventions:

●​ Monitor mother’s VS and contraction pattern.

●​ Perform intermittent/continuous FHR monitoring.
●​ Record on partograph regularly.
●​ Use aseptic technique during vaginal exams.

3. Nursing Diagnosis (Examples)

 ●​ Risk for infection r/t frequent vaginal exams.
●​ Acute pain r/t uterine contractions.
●​ Anxiety r/t unfamiliar environment and labor pain.
●​ Risk for fetal distress r/t compromised uteroplacental circulation.
●​ Ineffective coping r/t prolonged labor and fatigue.

4. Planning and Intervention

Maternal Support:

●​ Provide continuous emotional support.

●​ Teach relaxation and breathing techniques.
●​ Offer comfort measures (back rubs, warm compress, positioning).

Positioning:

●​ Encourage upright, lateral, or squatting positions to enhance labor progress.

Pain Management:

●​ Non-pharmacologic: Breathing exercises, massage, music therapy, hydrotherapy.

●​ Pharmacologic: Epidural, analgesics (meperidine, fentanyl), anesthesia.

Hydration & Nutrition:

●​ Provide clear fluids or IV hydration if NPO.

●​ Avoid heavy meals during active labor.

Infection Prevention:

●​ Handwashing, sterile technique, limit vaginal exams.

Assisting with Delivery:

●​ Prepare sterile delivery set.

●​ Support during pushing in 2nd stage.
●​ Assist physician/midwife with complications (shoulder dystocia, PPH, fetal distress).

5. Early Essential Newborn Care (EINC)

●​ Immediate and thorough drying with warm cloth.
●​ Skin-to-skin contact with mother for thermoregulation & bonding.
●​ Delayed cord clamping (1–3 minutes) to improve newborn iron stores.
●​ No separation (rooming-in).
●​ Early initiation of breastfeeding within 1 hour of birth.

Nursing Interventions:
 ●​ Prepare warm, clean environment before delivery.
●​ Support immediate breastfeeding and latch-on.
●​ Document newborn’s condition (APGAR).

6. Evaluation
●​ Maternal comfort and anxiety managed.
●​ Labor progresses normally (cervical dilation, descent).
●​ FHR remains within normal range.
●​ Safe delivery achieved.
●​ Newborn stable (Apgar 7–10, effective breathing, good tone).

7. Documentation
●​ Maternal VS, contractions, cervical exams.
●​ FHR monitoring results and interpretations.
●​ Interventions provided (pain relief, fluids, meds).
●​ Delivery details: time, type, placenta status, blood loss.
●​ Newborn assessment: Apgar scores, weight, sex, condition.

✅ TIP for Exams (Mnemonic for Intrapartum Nursing):

“LABOR”

●​ Look after mother & fetus (assessments)

●​ Assist with pain relief & positioning
●​ Breathe (teach breathing & relaxation)
●​ Observe progress with partograph
●​ Record & reinforce EINC

POSTPARTUM CARE REVIEWER

1. Mother
Immediate Care After Delivery

●​ Fundal massage: To prevent uterine atony & postpartum hemorrhage (PPH).

●​ Lochia monitoring:​

○​ Rubra (1–3 days, red)

○​ Serosa (4–10 days, pink/brown)
○​ Alba (11–14 days, whitish/yellow)
●​
●​ Vital signs: Monitor for hypovolemia (↓ BP, ↑ HR, pallor, clammy skin).

Nursing Interventions:

●​ Massage uterus if boggy.

 ●​ Record lochia amount, color, odor.
●​ Monitor VS frequently during first 24 hrs.
●​ Encourage voiding to prevent bladder distension.

Postpartum Physiological Changes

●​ Uterine involution: Uterus returns to non-pregnant size (by 6 weeks).

●​ Lactation: Prolactin ↑ → milk production; oxytocin → milk let-down.
●​ Hormonal changes: ↓ Estrogen/progesterone → menstrual cycle resumes (if not breastfeeding, usually 6–8 wks).

Complications

●​ Postpartum hemorrhage (PPH): Blood loss >500 mL vaginal / >1000 mL C-section.

●​ Infection: Endometritis, wound infection, UTI.
●​ Thromboembolism: Pain, swelling, redness in leg.
●​ Postpartum depression: Sadness, irritability, hopelessness lasting >2 weeks.

Nursing Interventions:

●​ Monitor bleeding and uterine tone.

●​ Observe for fever, foul-smelling lochia.
●​ Encourage early ambulation to prevent DVT.
●​ Screen for depression, provide referrals.

Breast Care and Breastfeeding Support

●​ Wear supportive bra.

●​ For engorgement: Warm compress before feeding, cold compress after.
●​ Proper latch to prevent sore nipples.

Nursing Interventions:

●​ Teach proper breastfeeding techniques (baby’s mouth covers areola, not just nipple).
●​ Encourage frequent feeding every 2–3 hrs.
●​ Observe for signs of mastitis (red, painful breast, fever).

Family Planning & Contraceptive Counseling

●​ Lactational Amenorrhea Method (LAM): Effective up to 6 months if exclusively breastfeeding, amenorrheic, feeding
day & night.
●​ Other methods: Condoms, pills, injectables, IUD, sterilization.

2. Immediate Care of the Newborn

●​ Apgar Scoring (1 & 5 minutes): HR, Respiration, Muscle tone, Reflex, Color (0–10 score).
●​ Airway clearance & warmth: Suction mouth → nose, dry thoroughly, skin-to-skin.
●​ Eye care: Credé’s prophylaxis (erythromycin/tetracycline ointment).
 ●​ Vitamin K (0.5–1 mg IM): Prevents hemorrhagic disease.
●​ Cord care: Keep stump clean, dry, clamp removed once dry.

Nursing Interventions:

●​ Ensure warmth (skin-to-skin, room temp 25–28°C).

●​ Administer Vit K within 1 hr of birth.
●​ Educate on clean cord care (no alcohol, just keep dry).

3. Health Education & Postpartum Newborn Care

Breastfeeding

●​ Benefits: Nutrition, immunity, bonding, ↓ infection risk, natural contraception.

●​ Teach proper positioning and latch.

Cord Care & Hygiene

●​ Keep stump clean and dry until it falls off (1–2 weeks).
●​ No bandages or powder.

Immunization Schedule (Philippines – EPI):

●​ At birth: BCG, Hep B (within 24 hrs).

●​ 6, 10, 14 wks: DPT-HepB-Hib, OPV, PCV, Rotavirus.
●​ 9 mos: Measles/MMR.

Danger Signs in Newborn:

●​ Fever, poor feeding, lethargy, difficulty breathing, jaundice, convulsions.

Mother’s Self-Care:

●​ Nutrition (high-protein, iron-rich foods).

●​ Adequate rest.
●​ Report warning signs: heavy bleeding, foul discharge, fever, severe headache, calf pain, persistent sadness.

4. Discharge Planning
Follow-up Schedules:

●​ Mother: 1–2 weeks, then 6 weeks postpartum.

●​ Newborn: Within 1 week, then regular immunization visits.

Home Instructions:
 ●​ Breastfeeding on demand.
●​ Monitor mother’s lochia & recovery.
●​ Safe sleep for baby (back to sleep, no pillows).

Family Support & Community Resources:

●​ Encourage husband/family involvement.

●​ Link to barangay health workers/midwives for follow-up.

Continuity of Care:

●​ Connect family to local health centers for vaccinations, well-baby checks, family planning services.

✅ TIP for Exams (Mnemonic for Postpartum Care):

“MOTHER-BABY”

●​ Monitor fundus, lochia, VS

●​ Observe for complications (PPH, infection, depression)
●​ Teach breastfeeding & cord care
●​ Hormonal & physical changes explained
●​ Encourage family planning
●​ Rest, nutrition, self-care for mother
●​ Baby’s immediate care (Apgar, Vit K, eye care)
●​ Assess newborn danger signs
●​ Bonding (skin-to-skin, rooming-in, breastfeeding)
●​ Yield (document & refer to follow-up services)