OB Exam 3 Blueprint
Chapter 18—Maternal Physiologic Changes (12 items)
Fundal height
● Measurement of fundal height in centimeters from the symphysis pubis to the top of the
uterine fundus (between 18 and 30 weeks of gestation).
● Approximates the gestational age, plus or minus 2 gestational weeks.
A woman gave birth to an infant boy 10 hours ago. Where would the nurse expect to locate this
woman's fundus?
A. One centimeter above the umbilicus
B. Two centimeters below the umbilicus
C. Midway between the umbilicus and the symphysis pubis
D. Nonpalpable abdominally
Assessment/Nursing interventions
● Interval between birth and the return of the reproductive organs to their normal
nonpregnant state is called puerperium, or the fourth trimester of pregnancy
● 2 weeks postpartum the uterus should not be palpable abdominally
Lochia
● Lochia is initially bright red (Lochia rubra) and may contain small clots
○ For first 2 hours postpartum, discharge should be about as much as a heavy
menstrual period
● After 3-4 days, flow pales and becomes pink or brown (Lochia serosa)
● Lochia alba occurs in most women after day 10 and can continue up to 6 weeks after
childbirth
● Lochia should smell like normal menstrual flow unless an infection is present
● Less lochia is seen after c-sections
Nursing Interventions
● Acknowledge client’s concerns about pregnancy and encourage sharing of these feelings
in an environment free of judgement
● Discuss expected changes and a possible timeline for a return to the prepregnant state
● Refer patient to counseling if body image concerns appear to have a negative impact on
the pregnancy
● Educate on common discomforts and ways to resolve them
● Encourage pt. to keep all follow-up appointments and to contact provider immediately if
there is any bleeding, leakage of fluid or contractions at any time during the pregnancy
Expected Findings
● Fetal heart tones have a normal baseline rate of 110-160 bpm
● Uterine size changes from a uterine wt. of 50 to 1000g
● By 36 weeks’ gestation, top of uterus and fundus reach the xiphoid process
, ● Cervical changes are observed as a purplish-blue color (Chadwick’s sign) and becomes
markedly soft
● Skin changes
○ Chloasma: an increase of pigmentation on the face
○ Linea nigra: dark line of pigmentation from the umbilicus to the pubic area
○ Striae gravidarum: stretch marks most commonly found on the abdomen and
thighs
Maternal physiological changes (ATI)
Reproductive system
● Uterus increases in size and changes shape and position
● Ovulation and menses cease during pregnancy
Cardiovascular system
● CO increases (30-50%) and blood volume increases (30-45%) to meet the greater
metabolic needs
● HR increases around week 5 and reaches a peak (10-15/min above prepregnancy rate)
around 32 weeks
● Varicosities of the legs and around the anus (hemorrhoids) are common during pregnancy
○ Hemorrhoids usually decrease in size within 6 weeks after childbirth
Respiratory system
● Maternal oxygen needs increase
● Respiratory rate increases and total lung capacity decreases
● Rib cage elasticity can take months to return to a pre-pregnancy state
● Respiratory function returns to nonpregnant levels by 6-8 weeks after birth
Musculoskeletal system
● Body alterations and weight increase necessitate an adjustment in posture--lordosis
● Pelvic joints relax
GI system
● N&V might occur due to hormone changes and/or an increase of pressure within the
abdominal cavity as the stomach and intestines are displaced within the abdomen
● Constipation might occur due to increased transit time of food through the GI tract,
increasing water absorption
● Spontaneous bowel evacuation may not occur for 2-3 days after childbirth
Renal system
● Filtration rate increases due to pregnancy hormones and an increase in blood volume and
metabolic demands
○ Within 12 hours of birth, women begin losing excess tissue fluid accumulated
during pregnancy
○ Profuse sweating often occurs, especially at night for first 2-3 days postpartum
● Amount of urine produced remains the same
● Urinary frequency is common
Endocrine system
, ● The placenta becomes an endocrine organ that produces large amounts of hCG,
progesterone, estrogen, human placental lactogen, and prostaglandins
● Hormones are very active during pregnancy and function to maintain the pregnancy
Chapter 21—Postpartum Complications (13 items)
PPH/Nursing interventions/signs and symptoms
Postpartum Hemorrhage
● Defined as the loss of 500mL or more after a vaginal birth and 1000mL or more after
cesarean birth
● Early, acute, or primary PPH occurs more than 24 hours but less than 6 weeks after birth
● Late PPH usually is the result of infection, subinvolution of the placental site, retained
placental tissue, or coagulopathy
● Inversion of the uterus and hypovolemic shock are considered medical emergency
conditions of PPH
Signs and Symptoms
● Uterine atony
○ Marked hypotonia (relaxation) of the uterus
○ Leading cause of early PPH
○ Associated with high parity, polyhydramnios, fetal macrosomia, and multifetal
gestation
■ In these conditions the uterus is overstretched and contracts poorly after
birth
○ Magnesium sulfate acts as a smooth muscle relaxant and can contribute to
uterine atony
● Retained placenta
○ When the placenta hasn’t been delivered within 30 minutes after birth despite
gentle traction on the umbilical cord and uterine massage
○ Fragments of the placenta can remain in the uterus after spontaneous separation of
the placenta
○ D&C allows examination of uterine contents and removal of any retained
placental fragments or blood clots
● Blood clots larger than a quarter
● Perineal pad saturation in 15 minutes or less
● Tachycardia and hypotension
● Pallor of skin and mucous membranes; cool and clammy with loss of turgor
Nursing Interventions
● Early recognition and treatment are critical
● Evaluate contractility of the uterus
Chapter 18—Maternal Physiologic Changes (12 items)
Fundal height
● Measurement of fundal height in centimeters from the symphysis pubis to the top of the
uterine fundus (between 18 and 30 weeks of gestation).
● Approximates the gestational age, plus or minus 2 gestational weeks.
A woman gave birth to an infant boy 10 hours ago. Where would the nurse expect to locate this
woman's fundus?
A. One centimeter above the umbilicus
B. Two centimeters below the umbilicus
C. Midway between the umbilicus and the symphysis pubis
D. Nonpalpable abdominally
Assessment/Nursing interventions
● Interval between birth and the return of the reproductive organs to their normal
nonpregnant state is called puerperium, or the fourth trimester of pregnancy
● 2 weeks postpartum the uterus should not be palpable abdominally
Lochia
● Lochia is initially bright red (Lochia rubra) and may contain small clots
○ For first 2 hours postpartum, discharge should be about as much as a heavy
menstrual period
● After 3-4 days, flow pales and becomes pink or brown (Lochia serosa)
● Lochia alba occurs in most women after day 10 and can continue up to 6 weeks after
childbirth
● Lochia should smell like normal menstrual flow unless an infection is present
● Less lochia is seen after c-sections
Nursing Interventions
● Acknowledge client’s concerns about pregnancy and encourage sharing of these feelings
in an environment free of judgement
● Discuss expected changes and a possible timeline for a return to the prepregnant state
● Refer patient to counseling if body image concerns appear to have a negative impact on
the pregnancy
● Educate on common discomforts and ways to resolve them
● Encourage pt. to keep all follow-up appointments and to contact provider immediately if
there is any bleeding, leakage of fluid or contractions at any time during the pregnancy
Expected Findings
● Fetal heart tones have a normal baseline rate of 110-160 bpm
● Uterine size changes from a uterine wt. of 50 to 1000g
● By 36 weeks’ gestation, top of uterus and fundus reach the xiphoid process
, ● Cervical changes are observed as a purplish-blue color (Chadwick’s sign) and becomes
markedly soft
● Skin changes
○ Chloasma: an increase of pigmentation on the face
○ Linea nigra: dark line of pigmentation from the umbilicus to the pubic area
○ Striae gravidarum: stretch marks most commonly found on the abdomen and
thighs
Maternal physiological changes (ATI)
Reproductive system
● Uterus increases in size and changes shape and position
● Ovulation and menses cease during pregnancy
Cardiovascular system
● CO increases (30-50%) and blood volume increases (30-45%) to meet the greater
metabolic needs
● HR increases around week 5 and reaches a peak (10-15/min above prepregnancy rate)
around 32 weeks
● Varicosities of the legs and around the anus (hemorrhoids) are common during pregnancy
○ Hemorrhoids usually decrease in size within 6 weeks after childbirth
Respiratory system
● Maternal oxygen needs increase
● Respiratory rate increases and total lung capacity decreases
● Rib cage elasticity can take months to return to a pre-pregnancy state
● Respiratory function returns to nonpregnant levels by 6-8 weeks after birth
Musculoskeletal system
● Body alterations and weight increase necessitate an adjustment in posture--lordosis
● Pelvic joints relax
GI system
● N&V might occur due to hormone changes and/or an increase of pressure within the
abdominal cavity as the stomach and intestines are displaced within the abdomen
● Constipation might occur due to increased transit time of food through the GI tract,
increasing water absorption
● Spontaneous bowel evacuation may not occur for 2-3 days after childbirth
Renal system
● Filtration rate increases due to pregnancy hormones and an increase in blood volume and
metabolic demands
○ Within 12 hours of birth, women begin losing excess tissue fluid accumulated
during pregnancy
○ Profuse sweating often occurs, especially at night for first 2-3 days postpartum
● Amount of urine produced remains the same
● Urinary frequency is common
Endocrine system
, ● The placenta becomes an endocrine organ that produces large amounts of hCG,
progesterone, estrogen, human placental lactogen, and prostaglandins
● Hormones are very active during pregnancy and function to maintain the pregnancy
Chapter 21—Postpartum Complications (13 items)
PPH/Nursing interventions/signs and symptoms
Postpartum Hemorrhage
● Defined as the loss of 500mL or more after a vaginal birth and 1000mL or more after
cesarean birth
● Early, acute, or primary PPH occurs more than 24 hours but less than 6 weeks after birth
● Late PPH usually is the result of infection, subinvolution of the placental site, retained
placental tissue, or coagulopathy
● Inversion of the uterus and hypovolemic shock are considered medical emergency
conditions of PPH
Signs and Symptoms
● Uterine atony
○ Marked hypotonia (relaxation) of the uterus
○ Leading cause of early PPH
○ Associated with high parity, polyhydramnios, fetal macrosomia, and multifetal
gestation
■ In these conditions the uterus is overstretched and contracts poorly after
birth
○ Magnesium sulfate acts as a smooth muscle relaxant and can contribute to
uterine atony
● Retained placenta
○ When the placenta hasn’t been delivered within 30 minutes after birth despite
gentle traction on the umbilical cord and uterine massage
○ Fragments of the placenta can remain in the uterus after spontaneous separation of
the placenta
○ D&C allows examination of uterine contents and removal of any retained
placental fragments or blood clots
● Blood clots larger than a quarter
● Perineal pad saturation in 15 minutes or less
● Tachycardia and hypotension
● Pallor of skin and mucous membranes; cool and clammy with loss of turgor
Nursing Interventions
● Early recognition and treatment are critical
● Evaluate contractility of the uterus
