OB and peds cheat sheet

Part 1 · Apgar score chart

The Apgar scoring chart

Five signs, each scored 0, 1 or 2, for a total from 0 to 10. The letters spell the name and also work as a memory aid: Activity, Pulse, Grimace, Appearance, Respirations. Textbook reference for nursing students, not a guide for scoring a real baby.

• AActivity (muscle tone)

  0 points

  Absent, loose, flaccid, floppy

  1 point

  Arms and legs flexed with little movement

  2 points

  Spontaneous, active motion; flexed tone that resists extension

• PPulse (heart rate)

  0 points

  Absent

  1 point

  Less than 100 beats per minute

  2 points

  Greater than 100 beats per minute

• GGrimace (reflex irritability)

  0 points

  No response to stimulation

  1 point

  Limited response to stimulation

  2 points

  Crying, movement, pulling away when stimulated

• AAppearance (skin color)

  0 points

  Pale or blue

  1 point

  Pink, but hands and feet are blue

  2 points

  Entirely pink

• RRespirations (breathing)

  0 points

  Not breathing

  1 point

  Slow and irregular, weak or gasping

  2 points

  Crying vigorously

What the textbook says about timing and the total

• The tool was created in 1953 by Dr. Virginia Apgar. It is done at 1 minute and again at 5 minutes after birth.
• Five signs are each given 0, 1 or 2 points, so a total runs from 0 to 10.
• The textbook says the score describes the newborn’s condition and records the move from life in the uterus to life outside it. It does not predict neurologic outcome, illness or death.
• If the 5-minute score is under 7, ACOG and the AAP are cited as recommending another assessment at 10 minutes.
• A 1-minute score of 6 or below is described as a point where care is escalated as needed.
• Acrocyanosis, blue color on the hands and feet only, is an expected finding that can last up to a week and is the 1-point appearance descriptor.

Part 2 · Score a fictional newborn

Practice scoring with the chart

Three written cases. Read the five observations, choose 0, 1 or 2 for each sign using the chart in Part 1, then check. The cases are invented for study; nothing here is for a real baby.

Part 3 · Naegele’s rule and G/TPAL

Naegele’s rule, with worked examples

A three-step date rule from the first day of the last menstrual period. The examples below are fixed, fictional dates for practice; this page does not calculate dates for anyone.

1. Step 1

   Subtract 3 months

   from the first day of the last menstrual period (LMP).

2. Step 2

   Add 7 days

   to the date that gives.

3. Step 3

   Adjust the year

   if needed (in the textbook example the year goes up by one).

• The rule is a three-step calculation based on a 28-day menstrual cycle.
• The estimated date of delivery (EDD) is the date a birth is expected, plus or minus 2 weeks.
• The textbook uses it when the person is sure of the first day of the last menstrual period; an ultrasound can also be used to determine or confirm the EDD.
• Gestation is 280 days. Each trimester is 14 weeks: the first is 0 weeks to 13 weeks 6 days, the second 14 weeks to 27 weeks 6 days, and the third starts at 28 weeks.

G/TPAL: gravidity and parity

G

Gravida. The number of pregnancies, including the current one, whatever the outcome or number of fetuses.

T

Term. The number of births at 37 weeks of gestation or later.

P

Preterm. The number of births after 20 weeks and before 37 weeks.

A

Pregnancy loss before 20 weeks. The number of pregnancies that ended before 20 weeks, whether spontaneous or induced. A multiple pregnancy counts once.

L

Living. The number of children born who lived past 28 days from the date of birth.

Textbook case: pregnant now, with two earlier births (one at 39 weeks, one at 36 weeks) and a twin pregnancy that ended in the fourth month (about 16 weeks). G = 4, T = 1, P = 1, A = 1, L = 2, written G4 P1112.

Part 4 · Developmental milestones

Developmental milestones chart, birth to preschool

The textbook defines a developmental milestone as something 75 percent or more of children can do by a certain age, and says each child develops on their own timeline. The table below is the infancy table in the open textbook, adapted from CDC. It is a study reference, not a way to judge a real child.

Two developmental patterns

Cephalocaudal

Development starts at the head and moves down toward the trunk (head and neck control before trunk control).

Proximodistal

Development starts near the midline and moves outward (trunk control before control of hands and feet).

Newborn reference values in the maternal-newborn text

Heart rate

120 to 160 beats per minute (counted for 1 full minute); it can reach 180 when the newborn is crying or moving.

Respirations

30 to 60 breaths per minute; newborns are obligate nose breathers and periodic breathing is expected.

Early weight change

A physiologic loss of about 5 to 10 percent in the first week; a loss of more than 10 to 12 percent calls for further evaluation.

Moro (startle) reflex

Present at birth and usually gone around 2 months.