PRC Midwives LE cheat sheet

Naegele's rule: first day of last menstrual period minus 3 months plus 7 days plus 1 year; estimated date of birth assumes a 28-day cycle with ovulation on day 14.

Gravida counts all pregnancies including the current one; para counts births at 20 weeks or more gestation, with twins counting as one para event.

Normal fetal heart rate baseline is 110-160 beats per minute; decelerations, tachycardia, or bradycardia require evaluation and referral.

Fundal height in centimeters approximates gestational age in weeks between 20 and 36 weeks; a discrepancy over 2-3 cm suggests growth restriction, macrosomia, or polyhydramnios.

Daily elemental iron 30-60 mg and folic acid 400 mcg are standard antenatal supplements; folic acid 4 mg daily is used when there is a prior neural tube defect.

Blood pressure 140/90 mmHg or higher after 20 weeks with proteinuria defines preeclampsia; severe features include 160/110, platelets under 100,000, and transaminase elevation.

Routine screening: 24-28 weeks for gestational diabetes with a 50 g glucose challenge, and 35-37 weeks for group B streptococcus vaginal-rectal culture.

Quickening is usually felt at 18-20 weeks in nulliparas and 16-18 weeks in multiparas; absent fetal movement by 22 weeks warrants ultrasound assessment.

Rho(D) immune globulin is given at 28 weeks and within 72 hours postpartum to Rh-negative unsensitized women with an Rh-positive or unknown-status newborn.

First stage: latent phase to 6 cm with slow dilation, active phase 6-10 cm with faster dilation; second stage is full dilation to birth; third stage is birth to placental delivery.

Normal active-phase dilation is at least 1 cm per hour in nulliparas and 1.2 cm per hour in multiparas; slower progress suggests protraction or arrest.

Fetal descent is documented by station from -5 to +5, with 0 at the ischial spines; engagement occurs when the presenting part reaches station 0.

Leopold maneuvers in four steps determine fetal lie, presentation, position, and engagement before and during labor.

Deceleration patterns: early decelerations mirror contractions and are benign; variable decelerations indicate cord compression; late decelerations indicate uteroplacental insufficiency and require position change, oxygen, and provider notification.

Uterine tachysystole is more than 5 contractions in 10 minutes averaged over 30 minutes; reduce or stop oxytocin and reposition the woman.

Active management of the third stage includes a uterotonic within 1 minute of birth, controlled cord traction, and uterine massage to reduce postpartum hemorrhage.

Full cervical dilation is 10 cm; pushing is delayed until the woman has an urge or the fetal head is visible in some protocols to reduce exhaustion and perineal trauma.

Shoulder dystocia maneuvers in sequence: McRoberts position, suprapubic pressure, then internal rotation or posterior arm delivery; never apply fundal pressure.

Postpartum hemorrhage is blood loss of 500 mL or more after vaginal birth or 1000 mL or more after cesarean birth, or any loss causing hemodynamic instability.

Uterine atony causes about 70 percent of postpartum hemorrhage; first-line treatment is bimanual uterine massage plus oxytocin, then carboprost, methylergonovine, or misoprostol per protocol.

The uterus should be firm and midline at or below the umbilicus after birth; a boggy uterus with heavy bleeding requires immediate massage and uterotonic therapy.

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

Afterpains are stronger in multiparas and during breastfeeding because oxytocin release increases uterine contractions.

Endometritis presents with fever, uterine tenderness, and foul lochia after the first 24 hours; treatment is broad-spectrum intravenous antibiotics.

Postpartum depression screening uses the Edinburgh Postnatal Depression Scale; a score of 10 or more or any self-harm response requires prompt referral.

Deep vein thrombosis risk peaks in the first 2 weeks postpartum; unilateral calf pain, swelling, and warmth warrant urgent evaluation before massage.

Breast engorgement peaks around days 3-5; frequent feeding, cold compresses between feeds, and hand expression relieve symptoms without suppressing supply.

Apgar scoring at 1 and 5 minutes assesses heart rate, respiratory effort, muscle tone, reflex irritability, and color, each scored 0-2 for a maximum of 10.

Routine newborn resuscitation begins with warmth, drying, stimulation, and airway positioning; positive pressure ventilation starts if heart rate is under 100 or apnea persists after stimulation.

Normal newborn vital signs: heart rate 110-160 beats per minute, respiratory rate 30-60 per minute, axillary temperature 36.5-37.5 degrees Celsius.

Thermoregulation: newborns lose heat by evaporation, conduction, convection, and radiation; skin-to-skin contact and a hat reduce heat loss.

Physiologic jaundice appears after 24 hours, peaks at days 3-5, and is treated with phototherapy; jaundice within 24 hours is always pathologic and needs urgent investigation.

Newborn weight loss up to 7-10 percent of birth weight in the first week is normal; birth weight is usually regained by 10-14 days.

Vitamin K 1 mg intramuscularly is given once after birth to prevent hemorrhagic disease of the newborn.

Erythromycin eye ointment or another approved agent is applied within 1 hour of birth to prevent gonococcal ophthalmia neonatorum.

Newborn screening blood is collected between 24 and 72 hours after birth and after adequate feeding, with repeat testing for infants tested before 24 hours.

The midwife's scope covers normal pregnancy, birth, postpartum, and newborn care; complications require consultation, referral, or transfer of care per regulation.

Prenatal visit schedule: monthly to 28 weeks, every 2 weeks to 36 weeks, then weekly until birth; more frequent visits for high-risk pregnancies.

Danger signs requiring immediate referral: vaginal bleeding, severe headache with visual changes, fever, decreased fetal movement, leaking fluid, and convulsions.

Community health education topics include birth preparedness, danger-sign recognition, exclusive breastfeeding for 6 months, and postpartum family planning.

Home visit schedule after birth commonly includes visits within 24 hours, at day 3, day 7, day 14, and day 28, with extra visits for low-birth-weight or ill infants.

Cold chain integrity for vaccines requires storage at 2-8 degrees Celsius with continuous temperature monitoring and no freezing of adsorbed vaccines.

Hand hygiene with soap and water or alcohol rub before and after every client contact is the single most effective infection-control measure in community practice.

Referral documentation should include maternal history, vital signs, labor progress, treatments given, and time of transfer to ensure continuity of care.

Informed consent requires disclosure of risks, benefits, and alternatives, plus voluntary decision-making by a competent client; documentation follows every consent.

Confidentiality protects all health information; disclosure is permitted only with client consent, legal requirement, or serious public health risk.

Mandatory reporting duties include suspected child abuse, domestic violence where legally required, and communicable diseases specified by public health law.

Midwives must practice within their licensed scope; performing procedures outside that scope is grounds for disciplinary action regardless of client request.

Accurate, timely, and legible records are legal documents; alterations must be dated, signed, and never obliterated, because records may be used in litigation.

Negligence requires a duty of care, a breach of that standard, causation, and actual harm; all four elements must be proven.

Ethical principles applied in midwifery: autonomy respects client choice, beneficence promotes good, nonmaleficence avoids harm, and justice ensures fair treatment.

A conscientious objection to a procedure must not abandon the client; the midwife must disclose the objection and arrange safe referral or alternative care.