NNC NLEM Midwifery flashcards
NNC NLEM Midwifery · Build recall with a focused review session.
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- Naegele's rule
- Estimated date of delivery calculated as last menstrual period plus 280 days, adjusted for cycle length by adding or subtracting the difference from 28 days.
- Fundal height
- Symphysis-fundal height in centimeters correlates with gestational age in weeks from 20 to 36 weeks; a discrepancy greater than 3 cm warrants ultrasound evaluation.
- Rho(D) immune globulin
- Given to Rh-negative unsensitized women at 28 weeks and within 72 hours postpartum if the newborn is Rh-positive, to prevent hemolytic disease of the newborn.
- Preeclampsia definition
- New-onset hypertension after 20 weeks with proteinuria or maternal organ dysfunction; severe features include blood pressure at least 160/110, low platelets, or liver dysfunction.
- Magnesium sulfate
- Used for eclampsia prophylaxis; loading dose 4–6 g IV then 1–2 g/hour; monitor reflexes, respiration, and urine output; antidote is calcium gluconate.
- Shoulder dystocia
- Obstetric emergency where the anterior shoulder impacts behind the symphysis pubis; managed with McRoberts manoeuvre, suprapubic pressure, and internal rotation, avoiding fundal pressure.
- Partograph action line
- A line parallel to and 4 hours to the right of the alert line on the partograph; crossing it indicates need for intervention such as augmentation or referral.
- Active third stage
- Administration of a prophylactic uterotonic, controlled cord traction, and uterine massage to reduce postpartum hemorrhage after birth.
- Apgar score
- Assessment at 1 and 5 minutes of Appearance, Pulse, Grimace, Activity, and Respiration; scores 0–3 indicate need for immediate resuscitation.
- Postpartum hemorrhage
- Blood loss of at least 500 mL after vaginal birth or 1000 mL after cesarean, or any loss causing hemodynamic instability; most common cause is uterine atony.
- Delayed cord clamping
- Clamping the umbilical cord at least 1 minute after birth improves neonatal iron stores; for non-vigorous newborns, follow resuscitation algorithm.
- Neonatal resuscitation PPV
- Positive pressure ventilation initiated within 60 seconds for apnea or heart rate below 100; initial peak inspiratory pressure 20–25 cm H2O at 40–60 breaths per minute.
- Chest compressions ratio
- For newborns with heart rate below 60 after effective ventilation, provide 90 compressions per minute with a 3:1 compression-to-ventilation ratio and 100% oxygen.
- Therapeutic hypothermia
- Cooling to 33.5–34.5°C for 72 hours initiated within 6 hours of birth for infants at least 36 weeks with moderate-to-severe hypoxic-ischemic encephalopathy.
- Kangaroo mother care
- Continuous skin-to-skin contact and exclusive breastfeeding for low-birth-weight infants, started as soon as stable, reduces mortality and morbidity.
- LAM criteria
- Lactational amenorrhea method requires exclusive breastfeeding, amenorrhea, and infant under 6 months; effectiveness exceeds 98% when all three criteria are met.
- Emergency contraception
- Levonorgestrel 1.5 mg orally within 72 hours, ulipristal acetate 30 mg within 120 hours, or copper IUD within 5 days after unprotected intercourse.
- Combined pill contraindications
- WHO category 4 contraindications include smoking at least 15 cigarettes daily at age 35 or older, blood pressure at least 160/100, history of venous thromboembolism, and migraine with aura.
- Five moments hand hygiene
- Before patient contact, before aseptic procedure, after body fluid exposure risk, after patient contact, and after touching patient surroundings.
- Oxytocin storage
- Refrigerate at 2–8°C, do not freeze, and protect from light; it is a high-alert medication requiring independent double-check before administration.
- Cesarean antibiotic prophylaxis
- Cefazolin 2 g IV (3 g if 80 kg or more) within 60 minutes before incision; add azithromycin 500 mg IV for women in labor or with ruptured membranes.
- Informed consent
- Voluntary agreement after disclosure of material risks, benefits, and alternatives, by a patient with capacity; document the discussion.
- Mandatory reporting
- Legal obligation to report suspected child abuse, female genital mutilation, and certain communicable diseases to authorities, overriding usual confidentiality.
- Scope of practice
- Midwives provide care for normal pregnancy, birth, postpartum, and newborn; complications are referred to obstetricians or pediatricians.
- Motivational interviewing
- Counselling approach using open questions, affirmations, reflections, and summaries to explore ambivalence and strengthen motivation for behaviour change.
- Edinburgh scale
- Edinburgh Postnatal Depression Scale; a score of 10 or more indicates possible depression and warrants further assessment and referral.
- PICO framework
- Population, Intervention, Comparison, Outcome; a structure for formulating answerable clinical questions in evidence-based practice.
- PDSA cycle
- Plan-Do-Study-Act; a quality improvement method for testing changes on a small scale before wider implementation.
- Evidence hierarchy
- Systematic reviews and meta-analyses rank highest, followed by randomized controlled trials, cohort studies, case-control studies, case series, and expert opinion.
- Gestational diabetes screening
- 75 g oral glucose tolerance test at 24–28 weeks; diagnosis if fasting at least 92, 1-hour at least 180, or 2-hour at least 153 mg/dL.
- Preterm labour steroids
- Betamethasone 12 mg intramuscularly twice, 24 hours apart, between 24 and 34 weeks gestation, to accelerate fetal lung maturity.
- Newborn vitamin K
- 1 mg intramuscularly at birth for term infants (0.5 mg if under 1500 g) to prevent hemorrhagic disease of the newborn.