4.5 Antepartum, Intrapartum, and Postpartum Care

Antepartum (Prenatal) Care

Term pregnancy is 37-42 weeks, dated from the first day of the last menstrual period (LMP) and divided into three trimesters. Naegele's rule estimates the due date: LMP minus 3 months plus 7 days.

Visit Schedule and Weight Gain

Common Discomforts

Warning Signs to Report Immediately

Fetal Assessment

• Fetal heart rate: 110-160 bpm—a number you must know cold.
• Fetal movement (kick) counts in the third trimester: 10 movements within 2 hours is reassuring; a significant decrease is reported promptly for evaluation.

Routine Prenatal Labs and the GBS Screen

The exam expects familiarity with the standard prenatal workup. Early pregnancy labs include blood type and Rh, antibody screen, complete blood count, rubella immunity, hepatitis B surface antigen, HIV, and syphilis. An Rh-negative mother carrying an Rh-positive fetus receives Rho(D) immune globulin (RhoGAM) around 28 weeks and again within 72 hours after birth to prevent isoimmunization—a heavily tested point. Between 24 and 28 weeks, a glucose challenge screens for gestational diabetes.

Between 36 and 37 weeks, a vaginal-rectal swab screens for group B streptococcus (GBS); a positive result means the mother receives intravenous antibiotics during labor, not before, to prevent neonatal infection. The LPN/LVN reinforces why each test matters and reports abnormal results to the RN.

Intrapartum and Postpartum Care

Stages of Labor

First-stage phases: latent (0-6 cm, mild irregular contractions), active (6-10 cm, strong regular contractions 2-3 min apart). True labor brings regular, intensifying contractions and cervical change; false labor (Braxton Hicks) is irregular, eases with walking, and produces no cervical change.

Postpartum Assessment — BUBBLE-HE

Fundal involution: at the umbilicus right after delivery, descending about one fingerbreadth (1 cm) per day, non-palpable by ~day 10. A boggy fundus → massage first; if it stays boggy or bleeding is heavy, notify the RN. Check the bladder—distension is a common cause of a displaced, boggy fundus.

Lochia progression: rubra (dark red, days 1-3) → serosa (pinkish-brown, days ~4-10) → alba (yellow-white, days 10-14+). Colors lighten over time; returning to rubra or foul odor signals a problem.

Preeclampsia and HELLP

Preeclampsia is a pregnancy-specific hypertensive disorder after 20 weeks: BP ≥140/90 on two readings 4 hours apart with proteinuria. Severe features: BP ≥160/110, severe headache, visual changes, epigastric/right-upper-quadrant pain, thrombocytopenia. It can progress to eclampsia (seizures). HELLP = Hemolysis, Elevated Liver enzymes, Low Platelets.

LPN/LVN scope: monitor BP and warning signs, maintain a quiet, dimly lit environment and seizure precautions if ordered, and report changes to the RN immediately—do not independently manage complications or titrate medications.

Postpartum red flags to report: soaking a pad in ≤15 min, foul lochia, fever >100.4°F (38°C), chest pain or dyspnea, unilateral leg pain/swelling, severe headache or visual changes, or thoughts of self-harm.

Newborn Assessment and Postpartum Mood

Maternal-newborn items often pair mother and infant. The Apgar score is assigned at 1 and 5 minutes, rating heart rate, respiratory effort, muscle tone, reflex irritability, and color from 0 to 2 each; a total of 7-10 is reassuring, while lower scores prompt support and reassessment. A normal newborn heart rate is 110-160 bpm and respirations 30-60 per minute.

Distinguish the three postpartum mood states: "baby blues" are mild, self-limiting tearfulness peaking around days 3-5 and resolving within two weeks; postpartum depression is persistent, interferes with infant care, and requires treatment; postpartum psychosis with hallucinations or thoughts of harming the baby is a psychiatric emergency requiring immediate intervention and supervision. Any statement suggesting the mother might harm herself or the infant is always reported and never left for follow-up. Throughout, the LPN/LVN monitors, reinforces teaching about warning signs and infant care, and escalates concerns to the RN.