Midwifery Exam cheat sheet

Naegele's rule: first day of last menstrual period minus 3 months plus 7 days; add 1 year if needed.

Estimated date of birth by ultrasound is most accurate in the first trimester (crown-rump length), with accuracy declining after 20 weeks.

Gravida counts all pregnancies including the current one; para counts births at 20+ weeks or 500+ g, not miscarriages before viability.

Normal fetal heart rate baseline is 110-160 beats per minute; variability is the most reassuring single indicator of fetal status.

Physiologic anemia of pregnancy: plasma volume rises about 40-50% versus red cell mass about 20-30%, lowering hematocrit.

Human chorionic gonadotropin doubles roughly every 48 hours in early viable intrauterine pregnancy; a plateau or fall suggests ectopic or nonviable pregnancy.

Rho(D) immune globulin is given to unsensitized Rh-negative patients at 28 weeks and within 72 hours of delivery of an Rh-positive infant.

Fundal height in centimeters approximates gestational age in weeks between 20 and 36 weeks; a discrepancy over 3 cm warrants evaluation.

First-trimester combined screening: nuchal translucency plus free beta-hCG and PAPP-A at 11-14 weeks; cell-free DNA has the highest aneuploidy detection rate.

First stage of labor: latent phase to 6 cm dilation, active phase from 6 cm; active-phase dilation of under 1.2 cm/hour in nulliparas is abnormally slow (Zhang criteria).

Second stage: nullipara up to 3 hours and multipara up to 2 hours without epidural; add 1 hour with epidural anesthesia.

Category I tracing: baseline 110-160, moderate variability, no late or variable decelerations; Category III includes absent variability with recurrent decelerations or sinusoidal pattern.

Late decelerations mirror uterine contractions and reflect uteroplacental insufficiency; intrauterine resuscitation includes position change, oxygen, IV fluids, and stopping oxytocin.

Variable decelerations are abrupt and reflect umbilical cord compression; amnioinfusion is an option for recurrent variables.

Uterine tachysystole: more than 5 contractions in 10 minutes averaged over 30 minutes; reduce or stop uterotonics.

Bishop score components: dilation, effacement, station, consistency, and cervical position; a score of 8 or more predicts successful induction.

Magnesium sulfate for seizure prophylaxis in preeclampsia: 4-6 g loading dose then 1-2 g/hour; monitor reflexes, respirations, and urine output; antidote is calcium gluconate.

Postpartum hemorrhage after vaginal birth is blood loss over 500 mL (over 1000 mL after cesarean); uterine atony is the most common cause.

Lochia progresses from rubra (days 1-3), to serosa (days 4-10), to alba (after about day 10); return to rubra suggests retained tissue or infection.

Involution: fundus is at the umbilicus immediately after birth, descends about 1 cm per day, and is nonpalpable abdominally by 10-14 days.

Endometritis presents with fever, uterine tenderness, and foul lochia after cesarean; treat with clindamycin plus gentamicin.

Mastitis: unilateral breast pain, redness, fever over 38.5 C; continue breastfeeding and treat with antibiotics (dicloxacillin or cephalexin).

Apgar scored at 1 and 5 minutes: heart rate, respiratory effort, muscle tone, reflex irritability, color; it does not predict neurologic outcome.

Newborn transitional period: heart rate 110-160, respiratory rate 30-60, and physiologic weight loss up to 7-10% of birth weight in the first week.

Physiologic jaundice appears after 24 hours; jaundice within the first 24 hours is pathologic and requires urgent bilirubin measurement.

Vitamin K 1 mg intramuscular to the newborn prevents hemorrhagic disease of the newborn; erythromycin eye ointment prevents gonococcal ophthalmia.

Postpartum depression screening with the Edinburgh Postnatal Depression Scale; scores of 10 or higher warrant further evaluation.

Preeclampsia: blood pressure of 140/90 or higher after 20 weeks plus proteinuria or end-organ dysfunction; severe features include 160/110, platelets under 100,000, and transaminases over twice normal.

Eclampsia management: magnesium sulfate, control of blood pressure, and delivery; left lateral positioning reduces aortocaval compression.

HELLP syndrome: hemolysis, elevated liver enzymes, low platelets; may present with right upper quadrant pain and no hypertension.

Placenta previa causes painless bright red bleeding; avoid digital vaginal examination. Abruptio placentae causes painful bleeding with a tense uterus.

Shoulder dystocia maneuvers: McRoberts position, suprapubic pressure, internal rotation, and delivery of the posterior arm; avoid fundal pressure.

Umbilical cord prolapse: relieve pressure on the cord, fill the bladder or elevate the presenting part, and proceed to emergency cesarean.

Gestational diabetes screening at 24-28 weeks with a 1-hour 50 g glucose challenge; a 3-hour 100 g test confirms the diagnosis.

Preterm labor before 34 weeks: antenatal corticosteroids (betamethasone) accelerate fetal lung maturity; magnesium sulfate provides neuroprotection before 32 weeks.

Ectopic pregnancy triad: amenorrhea, abdominal pain, and vaginal bleeding; treat with methotrexate if unruptured and stable, surgery if ruptured.

Oxytocin induction: start at 1-2 mU/min and increase by 1-2 mU/min every 30 minutes; titrate to contraction pattern, not to a fixed maximum.

Contraindications to oxytocin include cephalopelvic disproportion, malpresentation, and prior classical cesarean or uterine surgery.

Terbutaline tocolysis: beta-2 agonist causing maternal tachycardia, hyperglycemia, and pulmonary edema risk; not for maintenance therapy.

Category X medications in pregnancy include warfarin, isotretinoin, and methotrexate; use heparin or low-molecular-weight heparin for anticoagulation.

Informed consent requires capacity, disclosure of risks and alternatives, comprehension, and voluntariness; document the discussion.

Mandatory reporting obligations include suspected child abuse, certain communicable diseases, and maternal deaths, per jurisdiction.

Scope of practice for certified nurse-midwives is defined by state law and regulated by the American Midwifery Certification Board.

Documentation must be contemporaneous, objective, and complete; late entries are labeled as such with date and time.

Patient autonomy permits refusal of treatment, including cesarean; the clinician's duty is to inform of risks and document the refusal.

Combined oral contraceptives are contraindicated with a history of venous thromboembolism, migraine with aura, smoking over age 35, and breast cancer.

Progestin-only pills require strict daily timing (within 3 hours) because they primarily thicken cervical mucus.

Copper intrauterine device is effective as emergency contraception up to 5 days after unprotected intercourse; levonorgestrel IUD up to 5 days.

Depot medroxyprogesterone acetate can cause reversible bone density loss; counsel on calcium and exercise with long-term use.

Lactational amenorrhea method is effective only with exclusive breastfeeding, amenorrhea, and under 6 months postpartum.

Follicular phase: estrogen rises, endometrial proliferation; luteal phase is fixed at about 14 days, while the follicular phase varies.

Ovulation occurs about 14 days before the next menses, not 14 days after the last menses.

Menopause is defined retrospectively after 12 months of amenorrhea; perimenopause may include vasomotor symptoms and irregular cycles.

Emergency contraception with ulipristal acetate is effective up to 120 hours and is more effective than levonorgestrel for later administration.