Midwife Licensure Exam High-Risk Pregnancy & Complications (Recognize & Refer) — Complications of Labor & DeliveryRevision Notes

Exam Tips

• NLE PATTERN: 'Latent phase + frequent + painful + no progress + no relaxation between contractions' = HYPERTONIC → REST and SEDATION.
• NLE PATTERN: 'Active phase + contractions became weak and infrequent' = HYPOTONIC → OXYTOCIN augmentation.
• Back labor (severe back pain with contractions) strongly suggests persistent OP position.
• Always rule out CPD before augmenting with oxytocin — augmenting against an obstruction can cause uterine rupture.

Key Points

• Dystocia means prolonged, difficult, or abnormal labor. The root cause always falls under one (or more) of the 4 Ps: Powers, Passageway, Passenger, and Psyche.
• POWERS — Uterine dysfunction is either HYPOTONIC or HYPERTONIC. Knowing which type determines the entire management; mixing them up is a common NLE mistake.
• HYPOTONIC dysfunction: contractions become weak, short, and infrequent AFTER labor is established (usually the active phase). Common causes include overdistension of the uterus (multiple gestation, macrosomia, polyhydramnios) and a full bladder. Management: oxytocin augmentation + amniotomy (after ruling out obstruction/CPD).
• HYPERTONIC dysfunction: frequent, very painful, uncoordinated contractions in the LATENT phase that do NOT dilate the cervix. The uterus never fully relaxes. Management: REST, sedation, and hydration — NOT oxytocin (oxytocin would worsen incoordination).
• PASSAGEWAY: Cephalopelvic disproportion (CPD) — fetal head too large for the maternal pelvis. Often ends in cesarean delivery.
• PASSENGER: Malposition = persistent occiput-posterior (OP) causes 'back labor' — severe lumbosacral pain. Malpresentation = breech, brow, face, or shoulder presentation.
• PSYCHE: Maternal anxiety raises catecholamines (epinephrine, norepinephrine) which cause vasoconstriction of uterine blood vessels and inhibit effective contractions. Therapeutic communication and support are genuine nursing interventions here.
• Nursing care priorities: monitor contraction pattern (frequency, duration, intensity, resting tone) and fetal heart rate; encourage position changes (upright, lateral, knee-chest); ensure bladder is empty; provide hydration, comfort measures, and emotional support; prepare for operative or cesarean delivery if labor fails to progress.

Definitions

Section Title

Dystocia (Dysfunctional Labor) — The 4 Ps

Common Mistakes

• Giving oxytocin for HYPERTONIC dysfunction — this is dangerous; oxytocin is only for HYPOTONIC dysfunction.
• Forgetting to check the bladder before diagnosing labor dysfunction — a full bladder alone can inhibit contractions.
• Confusing malposition (OP, OT) with malpresentation (breech, brow, face, shoulder). Malposition refers to the direction the occiput faces; malpresentation refers to the presenting part itself.
• Overlooking the psyche as a genuine clinical factor — anxiety is a physiologic inhibitor of labor.

Formulas

Exam Tips

• MNEMONIC for preterm labor warning signs: 'CALL' — Contractions (regular), Ache (low back), Leaking fluid, Low pelvic pressure.
• If an NLE question asks which tocolytic ALSO protects the fetal brain → MAGNESIUM SULFATE.
• The antidote for MgSO4 toxicity is CALCIUM GLUCONATE (not calcium chloride routinely — though calcium chloride is used in cardiac arrest).
• Terbutaline question trigger words: 'maternal tachycardia,' 'palpitations,' 'hyperglycemia,' 'hold if heart rate > 120.'

Key Points

• Definition: Regular uterine contractions with cervical change between 20 and 37 weeks of gestation.
• Major risk factors: infection (chorioamnionitis — the LEADING modifiable cause), multiple gestation, previous preterm birth, polyhydramnios, incompetent cervix, and dehydration.
• The GOAL of management is to delay birth by approximately 48 hours to allow: (1) antenatal corticosteroids to mature fetal lungs, and (2) maternal transport to a tertiary facility with a neonatal intensive care unit (NICU).
• TOCOLYTICS suppress contractions — they buy time but do NOT treat the underlying cause.
• Magnesium sulfate (MgSO4): first-line tocolytic; ALSO provides neuroprotection of the preterm fetal brain (reduces risk of cerebral palsy). Toxicity signs: loss of deep tendon reflexes (DTRs) is the EARLIEST sign, followed by respiratory depression and cardiac arrest. Antidote: calcium gluconate 1g IV.
• Nifedipine (calcium channel blocker): oral tocolytic; watch for maternal hypotension. Do NOT combine with magnesium sulfate (risk of severe neuromuscular blockade).
• Terbutaline (beta-2 agonist): 0.25 mg subcutaneously. Side effects: maternal tachycardia, palpitations, tremors, and hyperglycemia. HOLD if maternal heart rate exceeds ~120 bpm. NOT for prolonged use (cardiac and metabolic risks).
• Indomethacin (prostaglandin synthetase inhibitor/NSAID): used before 32 weeks only. Risk: premature closure of the ductus arteriosus in the fetus.
• ANTENATAL CORTICOSTEROIDS for fetal lung maturity (surfactant production): given when birth is anticipated before 34 weeks. Two regimens: Betamethasone 12 mg IM every 24 hours × 2 doses (total 2 doses over 2 days), OR Dexamethasone 6 mg IM every 12 hours × 4 doses (total 4 doses over 2 days). Maximum benefit is achieved 24 hours to 7 days after the first dose.
• Teach the woman preterm labor warning signs: regular contractions (every 10 minutes or more frequent), low backache, pelvic pressure, a change in vaginal discharge, or fluid leakage from the vagina.
• Identify and treat underlying infection — prescribe antibiotics if GBS or chorioamnionitis is suspected.
• Bed rest and IV hydration are supportive measures.

Definitions

Section Title

Preterm Labor — Tocolytics and Corticosteroids

Common Mistakes

• Giving terbutaline without checking the maternal heart rate first — always hold if HR > ~120 bpm.
• Confusing betamethasone dose intervals: betamethasone is q24h × 2 doses; dexamethasone is q12h × 4 doses.
• Thinking corticosteroids work immediately — maximum benefit is 24 hours AFTER the first dose; hence the 48-hour tocolysis window.
• Forgetting to monitor blood glucose in women receiving terbutaline, especially those with gestational diabetes.
• Combining nifedipine with magnesium sulfate — this combination causes severe hypotension and neuromuscular blockade.

Exam Tips

• Key association: Post-term → oligohydramnios → cord compression → variable decelerations on FHR monitoring.
• Post-term + macrosomia = HIGH risk for shoulder dystocia. Be ready with McRoberts maneuver.
• When a question describes meconium-stained fluid and asks 'what do you prepare for?' — answer: neonatal resuscitation.

Key Points

• Post-term pregnancy is defined as a pregnancy that extends BEYOND 42 completed weeks (294 days) of gestation.
• The fundamental problem: the aging (senescent) placenta perfuses the fetus poorly. Blood flow, oxygen delivery, and nutrient transfer all decline.
• Major risks: OLIGOHYDRAMNIOS (decreased amniotic fluid → cord compression risk), meconium passage in utero (meconium aspiration syndrome), macrosomia (overgrown fetus → shoulder dystocia), and uteroplacental insufficiency (fetal hypoxia).
• Antepartum surveillance is intensified: Non-Stress Test (NST), Biophysical Profile (BPP), Amniotic Fluid Index (AFI), and Modified BPP. These detect fetal compromise early.
• Management: INDUCTION OF LABOR once 42 weeks is reached (or earlier if fetal surveillance is non-reassuring).
• At birth: anticipate MECONIUM-STAINED AMNIOTIC FLUID. A pediatrician or neonatologist should be present. If the newborn is not vigorous (weak cry, poor tone, HR < 100), suction the airway and begin neonatal resuscitation immediately.
• Macrosomia raises the risk of SHOULDER DYSTOCIA during delivery (see that section).

Definitions

Section Title

Post-Term Pregnancy and Labor

Common Mistakes

• Confusing post-term (> 42 weeks) with post-dates (> 40 weeks) — the clinical definition for intervention is > 42 weeks.
• Forgetting that oligohydramnios in post-term pregnancy causes cord compression (variable decelerations) — not late decelerations (which come from uteroplacental insufficiency).
• Not anticipating the need for a neonatologist at the delivery of a post-term infant with meconium-stained fluid.

Exam Tips

• NLE QUESTION TRIGGER: 'Sudden fetal bradycardia immediately after rupture of membranes' → think PROLAPSED CORD until proven otherwise.
• The VERY FIRST nursing action is to RELIEVE CORD PRESSURE — reposition (knee-chest/Trendelenburg) and elevate the presenting part manually.
• NEVER push the cord back in — this is a frequently tested 'wrong answer' in NLE scenarios.
• The moist gauze is to PREVENT DRYING and VASOSPASM of the cord — not to reduce infection (though sterile technique is still observed).
• Emergency cesarean is the DEFINITIVE treatment — all bedside nursing actions are BRIDGE measures until the OR is ready.

Key Points

• DEFINITION: The umbilical cord slips ahead of or beside the presenting fetal part. When the presenting part descends, it compresses the cord, cutting off fetal blood flow and oxygen supply — this is an OBSTETRIC EMERGENCY.
• TYPES: Overt (cord is visible outside the vagina) or Occult (cord is beside the fetus but not visible — only detected by sudden FHR changes).
• PREDISPOSING FACTORS: Unengaged or high presenting part, malpresentation (breech, transverse lie), polyhydramnios, rupture of membranes before engagement, multiparity, preterm infant, and multiple gestation.
• RECOGNITION: (1) Visible or palpable cord at the vaginal introitus, OR (2) Sudden, severe fetal bradycardia or variable decelerations — especially immediately after rupture of membranes (spontaneous or artificial).
• PRIORITY NURSING ACTIONS — the goal is to RELIEVE PRESSURE ON THE CORD immediately:
• STEP 1 — REPOSITION the mother: knee-chest position OR steep Trendelenburg (hips higher than the head). This uses gravity to shift the fetal presenting part AWAY from the cord.
• STEP 2 — With a STERILE GLOVED HAND, insert two fingers into the vagina and apply UPWARD PRESSURE on the presenting part, physically lifting it off the cord. Keep the hand in place and maintain this pressure until the operating room team takes over.
• STEP 3 — If the cord is protruding from the vagina, cover it with STERILE SALINE-MOISTENED GAUZE to prevent drying and vasospasm. Do NOT attempt to push the cord back in.
• STEP 4 — Apply OXYGEN by face mask to the mother (improves fetal oxygenation).
• STEP 5 — Maintain continuous FHR monitoring. Notify the physician immediately. Prepare for EMERGENCY CESAREAN DELIVERY.
• Do NOT leave the mother alone. Call for help while maintaining hand pressure on the presenting part.
• Time is critical — every minute of cord compression without intervention increases fetal neurological injury.

Definitions

Section Title

Prolapsed Umbilical Cord — Emergency Priority Actions

Common Mistakes

• Attempting to PUSH THE CORD BACK IN — this traumatizes the cord and causes vasospasm, worsening the emergency.
• Placing the mother in a FLAT supine position — this INCREASES pressure on the cord. Always use knee-chest or Trendelenburg.
• Applying pressure on the CORD itself instead of on the PRESENTING PART.
• Leaving the mother alone to call for help — call for help while STAYING with the mother and maintaining hand pressure.
• Forgetting oxygen for the mother — maternal supplemental oxygen improves fetal oxygenation.

Exam Tips

• PATTERN: 'Sudden sharp tearing pain' + 'contractions stop' + 'fetal distress' + 'signs of shock' = UTERINE RUPTURE.
• Previous CLASSICAL (vertical) cesarean incision = highest risk for rupture in subsequent labor. This woman should NOT labor — she needs a scheduled cesarean.
• A previous LOW TRANSVERSE incision = lower rupture risk; VBAC (vaginal birth after cesarean) may be attempted under close monitoring.

Key Points

• Uterine rupture is a catastrophic tear in the uterine wall — life-threatening for BOTH mother and fetus.
• MOST COMMON CAUSE: Rupture of a PREVIOUS UTERINE SCAR (e.g., prior classical cesarean incision). Other causes: excessive oxytocin, obstructed labor, trauma, and grand multiparity.
• TYPES: Complete rupture (all layers torn — uterus and peritoneum) vs. Incomplete/dehiscence (inner layers open but peritoneum intact — may be less dramatic).
• CLASSIC CLINICAL PRESENTATION of complete rupture: (1) Sudden, SHARP, TEARING abdominal pain ('something popped' or 'something tore') that the woman often describes precisely; (2) Contractions ABRUPTLY STOP — the uterus can no longer contract because its structural integrity is gone; (3) Fetal heart rate becomes ABNORMAL or absent — fetal distress or fetal demise; (4) Signs of HYPOVOLEMIC SHOCK — rapid hypotension, tachycardia, pallor, cold clammy skin, decreased urine output; (5) LOSS OF FETAL STATION — the fetus may ascend or become non-palpable in the usual location; (6) In complete rupture, the fetus or fetal parts may be PALPABLE THROUGH THE ABDOMINAL WALL as the fetus extrudes into the peritoneal cavity.
• MANAGEMENT — emergency actions: (1) Call for help immediately; (2) Large-bore IV access (two lines) and aggressive IV fluid resuscitation; (3) Type and crossmatch for blood transfusion; (4) Oxygen by face mask; (5) Continuous vital signs and fetal monitoring; (6) Prepare for EMERGENCY LAPAROTOMY (surgical exploration). Surgical options: uterine repair (if feasible) or emergency hysterectomy.
• PREVENTION: Cautious use of oxytocin, monitoring for uterine tachysystole, and respecting contraindications to VBAC (previous classical incision).

Definitions

Section Title

Uterine Rupture

Common Mistakes

• Confusing uterine rupture with abruptio placentae: abruption causes INCREASING abdominal pain with a RIGID, board-like uterus and CONTINUED contractions; rupture causes a sudden CESSATION of contractions after the acute tearing pain.
• Forgetting that contractions STOP after complete rupture — this is pathognomonic.
• Delaying IV access and fluid resuscitation while waiting to 'confirm' the diagnosis.

Exam Tips

• If asked about future VBAC eligibility: LOW TRANSVERSE = possible VBAC. CLASSICAL = no VBAC, scheduled repeat cesarean.
• Post-cesarean hemorrhage priority assessment: FUNDUS first (tone, height, position), then LOCHIA, then vital signs.
• For thromboembolism prevention post-cesarean, the priority nursing intervention is EARLY AMBULATION.
• Paralytic ileus post-cesarean: no bowel sounds + distension → hold oral feeds, encourage ambulation, notify physician.

Key Points

• INDICATIONS: CPD, fetal distress (non-reassuring FHR), malpresentation (breech, transverse), placenta previa, active genital herpes, previous classical uterine incision, failed induction, and cord prolapse.
• TYPES OF UTERINE INCISIONS:
• LOW TRANSVERSE (Pfannenstiel) — incision across the lower uterine segment. Preferred choice because: less blood loss, lower infection rate, lower risk of uterine rupture in subsequent pregnancies, and PERMITS future trial of labor (VBAC/TOLAC).
• CLASSICAL (Vertical, midline) incision — extends through the upper uterine body. Higher blood loss and rupture risk. CONTRAINDICATION for future vaginal labor — elective repeat cesarean is required.
• PRE-OPERATIVE NURSING CARE: Obtain informed consent (nursing responsibility under RA 9173 includes ensuring the consent is properly obtained by the physician and the patient understands); NPO status (aspiration prevention); IV access; insertion of indwelling urinary catheter (Foley); skin preparation; administer prescribed antacid or H2 blocker (e.g., sodium citrate, ranitidine) to reduce gastric acid (aspiration risk during regional/general anesthesia); support and education for the client and partner.
• POST-OPERATIVE NURSING CARE (First priority: HEMORRHAGE DETECTION):
• Monitor FUNDAL TONE and HEIGHT — a soft, boggy uterus indicates uterine atony (risk of hemorrhage).
• Monitor LOCHIA — amount, color, and character. Saturation of a pad in less than 1 hour = excessive bleeding.
• Monitor VITAL SIGNS — q15 min for the first hour, then q30 min, then q1h.
• Monitor IV site, urine output (should be at least 30 mL/hr), incision site, and bowel sounds.
• Pain management: administer prescribed analgesics, encourage splinting of incision with a pillow when coughing.
• THROMBOEMBOLISM PREVENTION: Early ambulation (priority), leg exercises (ankle pumps), sequential compression devices (SCDs). Cesarean = major risk factor for DVT and pulmonary embolism.
• Monitor for PARALYTIC ILEUS: no bowel sounds, abdominal distension, nausea. Encourage early ambulation, avoid solid food until bowel sounds return.
• SUPPORT BREASTFEEDING: Assist with positioning (football hold or side-lying reduces incision pressure). Skin-to-skin contact promotes bonding.
• WOUND CARE: Assess incision for REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation).

Definitions

Section Title

Cesarean Birth — Pre-op and Post-op Nursing Care

Common Mistakes

• Stating that 'once a cesarean, always a cesarean' — this is outdated. VBAC IS possible after a LOW TRANSVERSE incision.
• Forgetting the antacid preoperatively — aspiration pneumonitis (Mendelson syndrome) is a leading cause of anesthesia-related maternal death.
• Monitoring only the incision site postoperatively and missing signs of hemorrhage from the uterus (fundal assessment is the priority).
• Withholding breastfeeding because of the cesarean — cesarean delivery is NOT a contraindication to breastfeeding.

Exam Tips

• SHOULDER DYSTOCIA NLE KEY: McRoberts + SUPRAPUBIC pressure = PRIORITY. FUNDAL pressure = NEVER.
• TURTLE SIGN is the clinical cue that immediately identifies shoulder dystocia in NLE questions.
• AFE question trigger: 'sudden respiratory distress during or after labor' + 'cardiovascular collapse' + 'DIC' with no other explanation → AFE.
• For precipitous labor: the nurse's role is to STAY with the client, SUPPORT the delivery, and call for help — not to interfere with the natural process.

Key Points

• SHOULDER DYSTOCIA: The fetal head delivers but the ANTERIOR SHOULDER is impacted behind the maternal symphysis pubis.
• TURTLE SIGN: After the head delivers, it retracts tightly against the perineum like a turtle pulling into its shell — the head cannot be delivered further. This is the clinical hallmark of shoulder dystocia.
• RISK FACTORS: Macrosomia (most common), maternal diabetes, obesity, post-term pregnancy, and prolonged second stage.
• PRIORITY MANAGEMENT MANEUVERS (in order): (1) MCROBERTS MANEUVER — sharply hyperflex both of the mother's thighs onto her abdomen (knees to chest). This flattens the lumbar lordosis, rotates the symphysis pubis superiorly, and increases the functional AP diameter of the pelvis; (2) SUPRAPUBIC PRESSURE — an assistant applies firm downward and lateral pressure just above the symphysis pubis to dislodge the anterior shoulder. NEVER apply FUNDAL PRESSURE — this WORSENS impaction and can cause uterine rupture.
• FETAL COMPLICATIONS of shoulder dystocia: BRACHIAL PLEXUS INJURY (Erb palsy — weakness or paralysis of the arm), clavicle fracture, and hypoxic brain injury.
• AMNIOTIC FLUID EMBOLISM (AFE): Amniotic fluid (containing fetal cells, vernix, meconium, and prostaglandins) enters the maternal circulation, triggering anaphylaxis-like massive inflammation, pulmonary hypertension, cardiovascular collapse, and DIC.
• AFE PRESENTATION: Sudden onset of ACUTE RESPIRATORY DISTRESS → CYANOSIS → CARDIOVASCULAR COLLAPSE (cardiac arrest) → DISSEMINATED INTRAVASCULAR COAGULATION (DIC) with uncontrolled bleeding. Mortality is extremely high.
• AFE MANAGEMENT: Supportive and emergent — CPR (if cardiac arrest), high-flow oxygen / intubation / mechanical ventilation, IV fluids, vasopressors, blood products for DIC, and multidisciplinary team response. There is no specific antidote.
• PRECIPITOUS LABOR: Entire labor (onset of regular contractions to delivery) lasting LESS THAN 3 HOURS. The uterus contracts too rapidly without adequate rest periods.
• RISKS of precipitous labor: Maternal lacerations (cervical, vaginal, perineal), postpartum hemorrhage, and fetal hypoxia (insufficient oxygenation between contractions) or birth trauma.
• NURSING ACTIONS in precipitous labor: STAY WITH THE WOMAN AT ALL TIMES — never leave her alone. Support (not restrain) the emerging fetus. Prepare for emergency delivery. Call for help.

Definitions

Section Title

Major Obstetric Emergencies — Shoulder Dystocia, Amniotic Fluid Embolism, and Precipitous Labor

Common Mistakes

• Applying FUNDAL PRESSURE for shoulder dystocia — this is CONTRAINDICATED; it pushes the shoulder further into the pelvis and can cause uterine rupture.
• Forgetting that suprapubic pressure is applied ABOVE the symphysis (to push the shoulder DOWN and laterally), not on the fundus.
• Delaying CPR in AFE while waiting for diagnostic confirmation — TREAT FIRST (CPR, oxygen), then diagnose.
• Trying to SLOW DOWN or HOLD BACK a precipitous delivery — do NOT apply counterpressure to restrain the baby; support the delivery gently.

Exam Tips

• MNEMONIC for deceleration causes: HC-CC-PI — Head Compression (Early), Cord Compression (Variable), Placental Insufficiency (Late).
• Any question about late decelerations → STOP OXYTOCIN is the first intervention, followed by reposition, fluids, O2.
• NLE question: 'Which deceleration is benign and requires no intervention?' → EARLY deceleration.
• For water intoxication from oxytocin: the key electrolyte abnormality is HYPONATREMIA.

Key Points

• Oxytocin is classified as a HIGH-ALERT MEDICATION. It is administered only via controlled IV infusion pump, titrated slowly to achieve an effective contraction pattern (every 2–3 minutes, lasting 60–90 seconds, with adequate uterine rest between).
• INDICATIONS: Induction or augmentation of labor.
• UTERINE TACHYSYSTOLE (hyperstimulation): defined as MORE THAN 5 CONTRACTIONS IN 10 MINUTES, OR contractions lasting > 90 seconds, OR resting uterine tone that does not return to baseline between contractions. This is an emergency.
• NURSING RESPONSE TO TACHYSYSTOLE (intrauterine resuscitation bundle):
• (1) DISCONTINUE the oxytocin infusion IMMEDIATELY.
• (2) REPOSITION the mother to the LEFT LATERAL DECUBITUS position (relieves aortocaval compression).
• (3) Increase the MAINTENANCE IV FLUID (bolus of plain IV fluid to improve uteroplacental perfusion).
• (4) Apply OXYGEN by face mask (8–10 L/min via non-rebreather).
• (5) NOTIFY the physician.
• (6) If the uterus does not relax, the physician may order TERBUTALINE (a tocolytic) to relax the uterus.
• OXYTOCIN ANTIDIURETIC EFFECT: Oxytocin structurally resembles ADH (antidiuretic hormone). High, prolonged doses can cause WATER INTOXICATION (hyponatremia) — manifested by headache, confusion, nausea, and seizures. Monitor urine output.
• FETAL HEART RATE (FHR) INTERPRETATION:
• Normal Baseline: 110–160 bpm with moderate variability and accelerations = REASSURING.
• EARLY DECELERATIONS: Mirror-image of the contraction (onset and nadir coincide with contraction peak; return to baseline by end of contraction). Cause: HEAD COMPRESSION (benign vagal response). Action: NONE required — observe.
• VARIABLE DECELERATIONS: Abrupt, V-shaped or U-shaped drops in FHR that vary in timing relative to contractions. Cause: CORD COMPRESSION (e.g., cord prolapse, oligohydramnios). Action: Reposition to relieve cord pressure; if persistent or severe, prepare to relieve cord compression (including vaginal examination to check for prolapse).
• LATE DECELERATIONS: Gradual onset AFTER the contraction peak; FHR does not return to baseline until AFTER the contraction ends. Cause: UTEROPLACENTAL INSUFFICIENCY (decreased oxygen delivery — abruption, preeclampsia, oxytocin overstimulation). Action: Intrauterine resuscitation bundle (stop oxytocin, left lateral position, IV fluid, O2, notify physician). OMINOUS if persistent or with absent variability.
• MNEMONIC: HC = Head Compression = Early decelerations. CC = Cord Compression = Variable decelerations. PI = Placental Insufficiency = Late decelerations.

Definitions

Section Title

Oxytocin Administration and Fetal Heart Rate Interpretation

Common Mistakes

• Increasing oxytocin when late decelerations appear — the correct action is to STOP the oxytocin, not adjust it upward.
• Confusing variable decelerations (cord compression) with late decelerations (placental insufficiency).
• Forgetting to LEFT-LATERALLY POSITION the mother — supine hypotension syndrome worsens fetal oxygenation.
• Forgetting the antidiuretic effect of prolonged oxytocin use — monitor urine output and watch for signs of water intoxication.