RNC-OB cheat sheet

Naegele's rule: estimated due date = first day of the last menstrual period minus 3 months plus 7 days, then add 1 year.

GTPAL: gravida, term births (≥37 weeks), preterm births (20–36 6/7 weeks), abortions (losses before 20 weeks), living children.

Visit schedule: every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, then weekly until birth.

Serum hCG becomes detectable about 8–11 days after conception, with an early doubling time of 48–72 hours.

From about 20 to 36 weeks, symphysis-fundal height in centimeters approximates gestational age in weeks; a discrepancy of 3 cm or more prompts evaluation.

Preeclampsia: blood pressure ≥140/90 on two occasions at least 4 hours apart after 20 weeks, plus proteinuria or end-organ dysfunction (thrombocytopenia, renal or hepatic impairment, pulmonary edema, visual or cerebral symptoms).

Magnesium sulfate monitoring: deep tendon reflexes present, respirations ≥12/min, urine output ≥30 mL/h; antidote is calcium gluconate 1 g IV.

Antenatal corticosteroids at 24–34 weeks: betamethasone 12 mg IM every 24 hours for 2 doses, or dexamethasone 6 mg IM every 12 hours for 4 doses.

Group B streptococcus culture is collected at 36 0/7 to 37 6/7 weeks; RhD immune globulin is offered at 28 weeks to Rh-negative unsensitized women.

First stage latent phase extends to 6 cm dilation; active phase runs 6 cm to full dilation; second stage is full dilation to birth; third stage ends with placental expulsion; fourth stage is the first 1–2 hours after birth.

Fetal heart rate baseline is 110–160 beats per minute; moderate variability (6–25 bpm) is the pattern most consistent with adequate oxygenation.

Accelerations at or beyond 32 weeks: rise of at least 15 bpm lasting at least 15 seconds.

Early decelerations mirror contractions and reflect head compression; late decelerations are gradual, begin after the contraction peak, and reflect uteroplacental insufficiency.

Variable decelerations are abrupt drops from cord compression; respond with position change, and consider amnioinfusion for recurrent patterns.

Category III tracing: absent variability with recurrent late or variable decelerations, bradycardia, or a sinusoidal pattern - requires immediate bedside response and preparation for expedited birth.

Tachysystole is more than 5 contractions in 10 minutes averaged over 30 minutes; reduce or stop oxytocin, reposition, and give an IV fluid bolus.

Shoulder dystocia: McRoberts maneuver plus suprapubic pressure first, then internal rotation maneuvers or delivery of the posterior arm; fundal pressure is never used.

Uterine rupture signs: sudden loss of fetal station, prolonged fetal bradycardia, tearing abdominal pain, and loss of the contraction pattern.

The fundus is at the level of the umbilicus immediately after birth, descends about 1 cm per day, and is no longer palpable abdominally by about 2 weeks.

Lochia rubra lasts 1–3 days, serosa 4–10 days, and alba from about day 10 up to 6 weeks.

Postpartum hemorrhage: cumulative blood loss of 1000 mL or more, or any loss accompanied by signs of hypovolemia, within 24 hours of birth.

Atony sequence: uterine massage and emptying the bladder, oxytocin, then methylergonovine (avoid with hypertension), carboprost (avoid with asthma), misoprostol, and tranexamic acid.

Endometritis: temperature ≥38 °C after the first 24 hours with uterine tenderness and foul lochia; treated with IV broad-spectrum antibiotics.

Rh-negative unsensitized woman who delivers an Rh-positive infant receives Rh immune globulin within 72 hours of birth.

Postpartum preeclampsia can first appear up to 6 weeks after birth, presenting with hypertension, headache, or visual changes.

Lactation: colostrum for the first 2–3 days, transitional milk by days 3–5, mature milk by about 2 weeks.

Discharge teaching: rubella vaccination if nonimmune, Tdap if not current, contraception counseling, and warning signs of hemorrhage, infection, and thromboembolism.

Apgar score at 1 and 5 minutes rates heart rate, respiratory effort, muscle tone, reflex irritability, and color from 0 to 2 each; 7–10 is normal, 4–6 moderately depressed, 0–3 severely depressed.

Normal newborn vital signs: heart rate 110–160, respiratory rate 30–60, axillary temperature 36.5–37.5 °C.

Heat loss occurs by evaporation, conduction, convection, and radiation; nonshivering thermogenesis depends on brown adipose tissue.

Physiologic jaundice appears after 24 hours and peaks at 3–5 days in term infants; jaundice within the first 24 hours is always pathologic.

Glucose screening: values below 25 mg/dL, or below 40 mg/dL with symptoms, are treated with feeding or IV dextrose.

Vitamin K 0.5–1 mg IM within 1 hour of birth prevents hemorrhagic disease of the newborn; erythromycin 0.5% ophthalmic ointment is applied to both eyes.

Hepatitis B vaccine is given within 24 hours of birth; infants of HBsAg-positive mothers also receive HBIG within 12 hours.

Newborn metabolic screening is collected by heel stick after 24 hours of age and before discharge, following adequate feeding.

Critical congenital heart disease screening by pulse oximetry is performed at or after 24 hours; a saturation below 90% or a difference above 3% between right hand and foot is a failed screen.

SBAR (Situation, Background, Assessment, Recommendation) is the standard structure for handoffs and for escalating a deteriorating patient.

A sentinel event is an unexpected occurrence involving death or serious injury and triggers a root cause analysis; near misses are reported without individual blame under just culture.

AWHONN staffing guidance assigns one registered nurse to one woman in active labor and one nurse to two women not in active labor.

The Joint Commission National Patient Safety Goals include two-patient identifiers, improving staff communication, safe medication use, infection prevention, identification of safety risks, and prevention of surgical mistakes.

Informed consent requires the diagnosis, nature and purpose of the procedure, risks and benefits, alternatives, and the right to refuse.

Care for patients with limited English proficiency uses a qualified medical interpreter, not family members or unlicensed staff.

Nurses may use the chain of command when an assignment or order is unsafe; the concern is documented and escalated in writing if unresolved.

Mandatory reporting includes suspected abuse or neglect and specified communicable diseases; reportable events are documented objectively and reported to the designated agency.

Late documentation entries are labeled as late, timed, and dated; documentation reflects objective assessment data and interventions with the patient response.

SBAR (Situation, Background, Assessment, Recommendation) is the standard structure for handoffs and for escalating a deteriorating patient.

A sentinel event is an unexpected occurrence involving death or serious injury and triggers a root cause analysis; near misses are reported without individual blame under just culture.

AWHONN staffing guidance assigns one registered nurse to one woman in active labor and one nurse to two women not in active labor.

The Joint Commission National Patient Safety Goals include two-patient identifiers, improving staff communication, safe medication use, infection prevention, identification of safety risks, and prevention of surgical mistakes.

Informed consent requires the diagnosis, nature and purpose of the procedure, risks and benefits, alternatives, and the right to refuse.

Care for patients with limited English proficiency uses a qualified medical interpreter, not family members or unlicensed staff.

Nurses may use the chain of command when an assignment or order is unsafe; the concern is documented and escalated in writing if unresolved.

Mandatory reporting includes suspected abuse or neglect and specified communicable diseases; reportable events are documented objectively and reported to the designated agency.

Late documentation entries are labeled as late, timed, and dated; documentation reflects objective assessment data and interventions with the patient response.