NNC NLEM Midwifery cheat sheet

Naegele's rule: EDD = LMP + 280 days (adjust for cycle length: add (cycle length − 28) days).

Fundal height in cm approximates gestational age in weeks from 20–36 weeks; a discrepancy >3 cm warrants ultrasound assessment.

Recommended antenatal visit schedule for uncomplicated pregnancy: every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, then weekly until birth.

Rho(D) immune globulin 300 mcg IM at 28 weeks and within 72 hours postpartum if mother is Rh-negative and newborn is Rh-positive.

Daily elemental iron 30–60 mg and folic acid 400 mcg (5 mg if prior neural tube defect) started preconception through first trimester.

Blood pressure ≥140/90 mmHg on two occasions ≥4 hours apart after 20 weeks defines gestational hypertension; proteinuria or organ dysfunction upgrades to preeclampsia.

Symphysis-fundal height measured from 24 weeks; bladder must be empty; use tape in cm along abdominal midline.

Dating ultrasound: crown-rump length 7–13 weeks is most accurate (±5–7 days); first-trimester scan establishes EDD when LMP uncertain.

First stage latent phase: cervical dilation 0–5 cm with irregular contractions; active phase begins at 5–6 cm with regular contractions and faster dilation (≥1 cm/hour in nulliparas).

Second stage: full dilation to birth; nulliparous typically up to 3 hours with epidural, multiparous up to 2 hours; prolonged if exceeded.

Cardiotocography categories: baseline 110–160 bpm; variability 5–25 bpm; accelerations ≥15 bpm for ≥15 s; decelerations: early (head compression), variable (cord compression), late (uteroplacental insufficiency).

Partograph: plot cervical dilation, fetal heart rate, contractions, and maternal vitals; action line at 4 hours after alert line crossing indicates need for intervention.

Active management of third stage: prophylactic uterotonic (oxytocin 10 IU IM), controlled cord traction, and uterine massage reduce postpartum hemorrhage.

Delayed cord clamping ≥1 minute improves neonatal iron stores; for non-vigorous newborns, follow neonatal resuscitation algorithm.

Perineal support and warm compresses during crowning reduce third- and fourth-degree tear risk; mediolateral episiotomy only if indicated.

Water birth: maintain water temperature 37–37.5°C; monitor maternal temperature hourly; remove from water if maternal fever ≥38°C.

Postpartum hemorrhage definition: blood loss ≥500 mL after vaginal birth or ≥1000 mL after cesarean, or any loss causing hemodynamic instability.

Uterine atony management: uterine massage, oxytocin 10 IU IM/IV, then carboprost 250 mcg IM (contraindicated in asthma), misoprostol 800 mcg sublingual, tranexamic acid 1 g IV within 3 hours.

Newborn Apgar score at 1 and 5 minutes: Appearance, Pulse, Grimace, Activity, Respiration; score 0–3 indicates need for immediate resuscitation.

Newborn thermoregulation: dry immediately, skin-to-skin contact, hat, warm environment; target axillary temperature 36.5–37.5°C.

Breastfeeding initiation within 1 hour; exclusive breastfeeding for 6 months; support on-demand feeding 8–12 times/24 hours.

Newborn vitamin K prophylaxis: 1 mg IM at birth for term infants (0.5 mg for <1500 g) to prevent hemorrhagic disease of the newborn.

Postpartum endometritis: fever ≥38°C on two occasions after first 24 hours, uterine tenderness, foul lochia; treat with clindamycin plus gentamicin.

Newborn screening: heel prick for metabolic disorders after 24–72 hours of feeding; hearing screening before discharge.

Preeclampsia with severe features: BP ≥160/110 mmHg, platelets <100,000, AST/ALT >2× normal, creatinine >1.1 mg/dL, pulmonary edema, or new cerebral/visual symptoms.

Magnesium sulfate for eclampsia prophylaxis: 4–6 g IV loading dose over 20 min, then 1–2 g/hour; monitor reflexes, respiratory rate, urine output; antidote calcium gluconate 1 g IV.

Shoulder dystocia manoeuvres sequence: McRoberts position, suprapubic pressure, internal rotation (Rubin II), delivery of posterior arm, all-fours; avoid fundal pressure.

Cord prolapse: call for help, elevate presenting part, knee-chest or Trendelenburg position, fill bladder 500–700 mL if needed, immediate cesarean.

Preterm labour: corticosteroids (betamethasone 12 mg IM ×2, 24 h apart) between 24–34 weeks; magnesium sulfate for neuroprotection <32 weeks; tocolysis for 48 h to allow steroids.

Gestational diabetes screening: 75 g OGTT at 24–28 weeks; fasting ≥92, 1-h ≥180, 2-h ≥153 mg/dL (one value abnormal).

Postpartum preeclampsia can occur up to 6 weeks postpartum; monitor BP and symptoms after discharge.

Placenta accreta spectrum: risk with prior cesarean and placenta previa; plan delivery at 34–36 weeks in tertiary center with multidisciplinary team.

NRP algorithm: birth → warm, dry, stimulate, clear airway if needed → assess breathing and heart rate → if apneic or HR <100, start positive pressure ventilation (PPV) within 60 seconds.

PPV: initial peak inspiratory pressure 20–25 cm H2O; rate 40–60 breaths/min; use blended oxygen (21–30% for term, 21–30% for preterm 32–34 weeks, 21–30% for <32 weeks).

Chest compressions: if HR <60 after 30 seconds of effective PPV, start compressions at 90/min with 3:1 ratio (90 compressions:30 breaths) and increase oxygen to 100%.

Epinephrine: 0.01–0.03 mg/kg IV (1:10,000) or 0.05–0.1 mg/kg endotracheal if IV not available; repeat every 3–5 minutes.

Volume expansion: 10 mL/kg normal saline or blood over 5–10 min if hypovolemia suspected.

Therapeutic hypothermia for hypoxic-ischemic encephalopathy: cooling to 33.5–34.5°C for 72 hours, initiated within 6 hours of birth, for infants ≥36 weeks with moderate-to-severe HIE.

Kangaroo mother care: continuous skin-to-skin contact and exclusive breastfeeding reduces mortality in low-birth-weight infants; start as soon as stable.

Newborn hypoglycemia: blood glucose <45 mg/dL in first 24 h; treat with early feeding or IV dextrose 10% 2 mL/kg bolus if symptomatic.

Contraceptive effectiveness (typical use): implant >99%, IUD >99%, injectable 94%, pill 91%, male condom 82%, withdrawal 78%.

Combined oral contraceptives contraindicated (WHO MEC category 4) in: smoking ≥15 cigarettes/day and age ≥35, hypertension ≥160/100, history of DVT/PE, breast cancer, migraine with aura.

Emergency contraception: levonorgestrel 1.5 mg orally within 72 hours (best within 24 h); ulipristal acetate 30 mg within 120 hours; copper IUD within 5 days.

Lactational amenorrhea method (LAM) criteria: exclusively breastfeeding, amenorrhea, and <6 months postpartum → >98% effective.

Postpartum IUD insertion: immediate (within 10 minutes of placenta delivery) or delayed (4–6 weeks); immediate has higher expulsion risk.

Depot medroxyprogesterone acetate (DMPA) 150 mg IM every 12–13 weeks; return to fertility may be delayed up to 6–12 months after last injection.

Cervical cancer screening: Pap smear every 3 years from age 21, or co-testing every 5 years from age 30; HPV vaccination recommended for ages 11–12 (catch-up to 26).

STI screening in pregnancy: HIV, syphilis, hepatitis B at first visit; repeat HIV in third trimester if high risk; treat syphilis with penicillin G benzathine.

WHO 5 Moments for Hand Hygiene: before touching patient, before clean/aseptic procedure, after body fluid exposure risk, after touching patient, after touching patient surroundings.

Standard precautions: hand hygiene, gloves, gown, mask, eye protection, safe injection practices, and safe handling of sharps.

Oxytocin storage: refrigerate at 2–8°C; do not freeze; check expiry; high-alert medication-use independent double-check.

Magnesium sulfate is a high-alert medication; verify loading dose and maintenance rate; keep calcium gluconate at bedside.

Pharmacokinetics in pregnancy: increased plasma volume and renal clearance may lower drug levels; avoid live vaccines (MMR, varicella) during pregnancy.

Antibiotic prophylaxis for cesarean: cefazolin 2 g IV (3 g if ≥80 kg) within 60 minutes before incision; add azithromycin 500 mg IV for labor or ruptured membranes.

Safe medication practice: use two patient identifiers, read back verbal orders, label all medications, and report adverse drug events.

Hepatitis B: birth dose vaccine within 24 hours plus HBIG for infants of HBsAg-positive mothers; completion of vaccine series.

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

Confidentiality: disclose only with patient consent or as required by law (e.g., notifiable diseases, child protection, court order).

Professional scope of practice: midwives provide care for normal pregnancy, birth, postpartum, and newborn; refer complications to obstetrician or pediatrician.

Mandatory reporting: suspected child abuse, female genital mutilation, and certain communicable diseases must be reported to authorities.

Documentation: contemporaneous, accurate, legible; include date, time, signature, and designation; never alter records retrospectively.

Ethical principles: autonomy, beneficence, nonmaleficence, justice; apply in shared decision-making and resource allocation.

Conscientious objection: midwives may decline participation in certain procedures (e.g., abortion) but must provide timely referral and non-discriminatory care.

Regulation: maintain registration, meet continuing education requirements, and adhere to codes of conduct; fitness to practice is assessed by regulatory body.

Behaviour change counselling: use motivational interviewing (open questions, affirmations, reflections, summaries) to explore ambivalence.

Breastfeeding counselling: assess latch and position, provide skin-to-skin, avoid pacifiers in early weeks, refer to lactation consultant if poor weight gain.

Antenatal education topics: nutrition, exercise, warning signs, birth preparedness, breastfeeding, and newborn care.

Community midwifery: provide home visits, outreach, and linkage to services; use community health workers for education and referral.

Health literacy: use plain language, teach-back method, and visual aids; confirm understanding.

Cultural safety: respect beliefs and practices, involve family as desired, and avoid stereotyping.

Perinatal mental health: screen for depression with Edinburgh Postnatal Depression Scale (EPDS) ≥10 indicates possible depression; refer for counselling.

Immunization promotion: recommend influenza and Tdap vaccines during pregnancy; educate on benefits and safety.

Evidence hierarchy: systematic reviews/meta-analyses > randomized controlled trials > cohort studies > case-control > case series > expert opinion.

PICO framework: Population, Intervention, Comparison, Outcome; used to formulate answerable clinical questions.

Critical appraisal: assess validity, reliability, and applicability; check for bias, confounding, and generalizability.

Quality improvement models: PDSA (Plan-Do-Study-Act) cycles; measure outcomes, process, and balancing measures.

Statistical significance: p <0.05; confidence interval indicates precision; relative risk and odds ratio measure association.

Informed consent for research: voluntary participation, right to withdraw, confidentiality, and ethics committee approval.

Knowledge translation: integrate evidence into practice using guidelines, audit and feedback, and reminders.

Root cause analysis: identify system factors in adverse events; use fishbone diagram and 5 whys; focus on prevention.