Department 15 · 25 scenarios

Labor & Delivery

See the risk. Understand the response.
Practise the reasoning you will carry to the bedside.

Plain English Primary sources Students & tutors

From routine safety to critical change

Learn the reasoning. Follow your local clinical pathway. These are fictional teaching cases, not patient-specific treatment instructions. Adult, pregnancy, pediatric and neonatal responses differ. Use the population-specific pathway and verified weight where required. Use current facility protocols, authorized orders and your scope of practice. Students work under supervision. In a real emergency, activate clinical help rather than consult this page.

How to use these cases Read the cues before opening the actions. Name your first priority, then compare your reasoning. The difficulty describes learning complexity; even an introductory case can involve a serious risk.

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Learning complexity

25 of 25 scenarios

Open a scenario to explore its actions25 original cases

Maternal assessment & communication

The birth plan needs language support

Introductory

The situation

A labouring patient cannot clearly explain their preferences in the language used by staff. A relative answers every question instead.

What should catch your attention

Communication barrier
Patient preferences
Consent discussions

Your immediate priority

Use competent interpretation and speak directly with the patient about the current plan.

01Communication barrier
02Use competent interpretation and speak directly with the patient about the current plan.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Use competent interpretation and speak directly with the patient about the current plan. [1]
Why it matters A patient’s report may reveal a significant change before a routine observation is abnormal.
2
Assess the actual change
Check symptoms, pregnancy or birth timing, relevant observations and the documented care plan, using respectful language assistance when needed. [1]
Why it matters A patient’s report may reveal a significant change before a routine observation is abnormal.
3
Use the maternity pathway
Inform the responsible maternity clinician and escalate warning signs through the appropriate maternal response. [1]
Why it matters Pregnancy and the postpartum period have specific risks and monitoring requirements.
4
Confirm understanding and follow-up
Deliver the prescribed care and use teach-back for the next steps and urgent-contact instructions. [1]
Why it matters A clear plan helps the patient recognize deterioration and avoid unsafe delay.

What to look for next

Check understanding. Reassess the reported concern and physiological trends; ensure unresolved symptoms and safety advice are handed over.

Avoid this shortcut

Do not substitute the relative's wishes for the patient's voice. Do not dismiss a concern as an unavoidable part of pregnancy or apply a generic adult plan without maternity review.

A clear way to hand it over

“I am calling about this new concern: the birth plan needs language support. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English Postpartum means after birth; some serious pregnancy-related complications first appear then.

Sources behind the actions 2 primary references

NICE · NG235: Intrapartum care
Individual labour care, maternal/fetal assessment and communication.
CDC · Urgent maternal warning signs
Serious pregnancy/postpartum symptoms requiring prompt medical attention.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

© 2026 RN Clarity · Lumiere Labs. All rights reserved. Original scenarios and diagrams are for personal learning. Do not copy, screenshot, print, repost, sell or reproduce them without written permission, except where applicable law permits. Cited guidance belongs to its respective owners.

Drug-allergy verification

The record and patient disagree about an allergy

Introductory

The situation

Before an ordered intrapartum antibiotic, the patient describes a previous serious reaction that is absent from the chart.

What should catch your attention

Missing reaction history
Medicine pending
Patient report

Your immediate priority

Pause administration and obtain maternity/prescriber allergy verification.

01Missing reaction history
02Pause administration and obtain maternity/prescriber allergy verification.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Pause administration and obtain maternity/prescriber allergy verification. [1]
Why it matters Different reaction patterns change future medicine safety.
2
Clarify the history
Ask what medicine or substance caused the reaction, what happened and when, and compare with the documented record. [1]
Why it matters Different reaction patterns change future medicine safety.
3
Verify the authorized plan
Report conflicting or serious history to the prescriber/pharmacist before administration and obtain a safe revised plan. [1]
Why it matters A missing chart entry does not prove there was no allergy.
4
Document and communicate
Record the verified reaction information and monitor any current exposure; activate emergency treatment for acute compromise. [1]
Why it matters Clear handover prevents repeated exposure and supports timely rescue.

What to look for next

Record the verified plan. Confirm the verified administration decision and monitor for new airway, breathing or circulation symptoms.

Avoid this shortcut

Do not treat the chart's blank field as proof of no allergy. Do not dismiss a patient-reported serious reaction or independently select a substitute medicine.

A clear way to hand it over

“I am calling about this new concern: the record and patient disagree about an allergy. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English An allergy is an immune-mediated reaction; other adverse effects also need accurate documentation.

Sources behind the actions 2 primary references

NICE · CG183: Drug allergy—recommendations
Confirm and document allergy history before drug administration; distinguish allergy from other adverse reactions.
NICE · NG5: Medicines optimisation
Reconciliation, medicine safety, communication and individual review.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Intrapartum fetal concern

The monitor may be recording maternal pulse

Introductory

The situation

The displayed fetal rate closely matches the mother's pulse after movement. Signal quality is poor and no independent comparison has been made.

What should catch your attention

Matching rates
Poor signal
Recent movement

Your immediate priority

Verify maternal and fetal signals with trained maternity staff before interpreting the trace.

01Matching rates
02Verify maternal and fetal signals with trained maternity staff before interpreting the trace.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Verify maternal and fetal signals with trained maternity staff before interpreting the trace. [1]
Why it matters A trace must be interpreted with the patient and context; maternal pulse can be mistaken for fetal rate.
2
Check signal and context
Compare maternal and fetal heart rates and assess the trace, contractions, medicines, position and new maternal symptoms within monitoring competency. [1]
Why it matters A trace must be interpreted with the patient and context; maternal pulse can be mistaken for fetal rate.
3
Activate review and conservative measures
Call the senior maternity team, stop oxytocin when directed by the abnormal-pattern protocol and use appropriate position or other ordered measures. [1]
Why it matters Excessive contractions or maternal physiological problems may reduce fetal oxygen supply.
4
Prepare escalation
Record times and response and prepare urgent birth and neonatal support if directed by the obstetric team. [1]
Why it matters Persistent abnormality or an acute obstetric event may require rapid definitive management.

What to look for next

Confirm reliable monitoring. Continuously reassess the pattern and maternal condition and communicate failure to recover promptly.

Avoid this shortcut

Do not assume a displayed rate is definitely fetal. Do not give routine oxygen solely for an abnormal fetal trace in a mother who is not hypoxic, or independently restart oxytocin.

A clear way to hand it over

“I am calling about this new concern: the monitor may be recording maternal pulse. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English A deceleration is a fall in fetal heart rate; a concerning trace needs trained interpretation with the whole situation.

Sources behind the actions 2 primary references

NICE · NG229: Fetal monitoring in labour
Signal verification, excessive contractions, conservative measures and urgent review; no routine maternal oxygen for fetal concerns alone.
NICE · NG235: Intrapartum care
Individual labour care, maternal/fetal assessment and communication.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Maternal assessment & communication

Pain relief expectations are unclear

Introductory

The situation

A patient thinks their requested analgesia will be immediate, but assessment and consent steps are still needed. They feel ignored.

What should catch your attention

Expectation gap
Pain
Plan unclear

Your immediate priority

Explain the next steps and offer the authorized interim comfort plan while arranging assessment.

01Expectation gap
02Explain the next steps and offer the authorized interim comfort plan while arranging assessment.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Explain the next steps and offer the authorized interim comfort plan while arranging assessment. [1]
Why it matters A patient’s report may reveal a significant change before a routine observation is abnormal.
2
Assess the actual change
Check symptoms, pregnancy or birth timing, relevant observations and the documented care plan, using respectful language assistance when needed. [1]
Why it matters A patient’s report may reveal a significant change before a routine observation is abnormal.
3
Use the maternity pathway
Inform the responsible maternity clinician and escalate warning signs through the appropriate maternal response. [1]
Why it matters Pregnancy and the postpartum period have specific risks and monitoring requirements.
4
Confirm understanding and follow-up
Deliver the prescribed care and use teach-back for the next steps and urgent-contact instructions. [1]
Why it matters A clear plan helps the patient recognize deterioration and avoid unsafe delay.

What to look for next

Reassess comfort and understanding. Reassess the reported concern and physiological trends; ensure unresolved symptoms and safety advice are handed over.

Avoid this shortcut

Do not promise a timing or intervention outside the actual plan. Do not dismiss a concern as an unavoidable part of pregnancy or apply a generic adult plan without maternity review.

A clear way to hand it over

“I am calling about this new concern: pain relief expectations are unclear. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English Postpartum means after birth; some serious pregnancy-related complications first appear then.

Sources behind the actions 2 primary references

NICE · NG235: Intrapartum care
Individual labour care, maternal/fetal assessment and communication.
CDC · Urgent maternal warning signs
Serious pregnancy/postpartum symptoms requiring prompt medical attention.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Vascular access & infusion safety

An IV line pulls during position change

Introductory

The situation

During supported movement, the patient's IV tubing becomes taut and the site is painful. An ordered intrapartum infusion is running.

What should catch your attention

Line traction
Pain
Active infusion

Your immediate priority

Pause unsafe movement, inspect the site and trace the delivery route with trained staff.

01Line traction
02Pause unsafe movement, inspect the site and trace the delivery route with trained staff.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Pause unsafe movement, inspect the site and trace the delivery route with trained staff. [1]
Why it matters A correct pump display does not prove the right drug is connected to the right access.
2
Trace and assess
Trace the line from patient to pump; check site, labels, concentration, rate and the current order. [1]
Why it matters A correct pump display does not prove the right drug is connected to the right access.
3
Escalate the unsafe finding
Stop an unsafe infusion when indicated by the emergency pathway and obtain urgent clinical and pharmacy help; protect time-critical support using the prescribed alternative. [1]
Why it matters Extravasation, disconnection and delivery error can harm tissue or destabilize circulation.
4
Close the safety loop
Arrange safe replacement or investigation, document exposure and verify every connection before restarting under the agreed plan. [1]
Why it matters Correcting one connection must not accidentally interrupt another essential treatment.

What to look for next

Confirm safe infusion and positioning. Check the site, perfusion and clinical effect after correction; monitor for delayed tissue injury and report it.

Avoid this shortcut

Do not ignore site pain because the pump is running. Do not flush an unknown line, bypass a pump alert or abruptly interrupt lifesaving support without emergency assessment.

A clear way to hand it over

“I am calling about this new concern: an IV line pulls during position change. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English Line tracing checks the entire route between medicine and patient.

Sources behind the actions 2 primary references

CDC · Intravascular catheter infection prevention: summary
Regular catheter-site assessment and removal of malfunctioning peripheral catheters.
NICE · NG5: Medicines optimisation
Reconciliation, medicine safety, communication and individual review.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Maternal assessment & communication

Reduced fetal movements were not included in handover

Intermediate

The situation

At admission, a patient reports movements were reduced before labour began. This concern was omitted from the transfer note.

What should catch your attention

Newly reported risk
Handover omission
Fetal assessment needed

Your immediate priority

Tell the maternity team promptly and follow the indicated fetal assessment plan.

01Newly reported risk
02Tell the maternity team promptly and follow the indicated fetal assessment plan.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Tell the maternity team promptly and follow the indicated fetal assessment plan. [1]
Why it matters A patient’s report may reveal a significant change before a routine observation is abnormal.
2
Assess the actual change
Check symptoms, pregnancy or birth timing, relevant observations and the documented care plan, using respectful language assistance when needed. [1]
Why it matters A patient’s report may reveal a significant change before a routine observation is abnormal.
3
Use the maternity pathway
Inform the responsible maternity clinician and escalate warning signs through the appropriate maternal response. [1]
Why it matters Pregnancy and the postpartum period have specific risks and monitoring requirements.
4
Confirm understanding and follow-up
Deliver the prescribed care and use teach-back for the next steps and urgent-contact instructions. [1]
Why it matters A clear plan helps the patient recognize deterioration and avoid unsafe delay.

What to look for next

Document the history and response. Reassess the reported concern and physiological trends; ensure unresolved symptoms and safety advice are handed over.

Avoid this shortcut

Do not dismiss the report because labour has started. Do not dismiss a concern as an unavoidable part of pregnancy or apply a generic adult plan without maternity review.

A clear way to hand it over

“I am calling about this new concern: reduced fetal movements were not included in handover. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English Postpartum means after birth; some serious pregnancy-related complications first appear then.

Sources behind the actions 2 primary references

NICE · NG235: Intrapartum care
Individual labour care, maternal/fetal assessment and communication.
CDC · Urgent maternal warning signs
Serious pregnancy/postpartum symptoms requiring prompt medical attention.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Intrapartum fetal concern

Contractions become too frequent during oxytocin

Intermediate

The situation

During oxytocin, contractions become excessively frequent and the fetal pattern changes. The next planned rate increase is due.

What should catch your attention

Oxytocin
Excessive contraction activity
Fetal change

Your immediate priority

Call maternity review and stop/reduce delivery as directed by the excessive-contraction/abnormal-pattern protocol.

01Oxytocin
02Call maternity review and stop/reduce delivery as directed by the excessive-contraction/abnormal-pattern protocol.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Call maternity review and stop/reduce delivery as directed by the excessive-contraction/abnormal-pattern protocol. [1]
Why it matters A trace must be interpreted with the patient and context; maternal pulse can be mistaken for fetal rate.
2
Check signal and context
Compare maternal and fetal heart rates and assess the trace, contractions, medicines, position and new maternal symptoms within monitoring competency. [1]
Why it matters A trace must be interpreted with the patient and context; maternal pulse can be mistaken for fetal rate.
3
Activate review and conservative measures
Call the senior maternity team, stop oxytocin when directed by the abnormal-pattern protocol and use appropriate position or other ordered measures. [1]
Why it matters Excessive contractions or maternal physiological problems may reduce fetal oxygen supply.
4
Prepare escalation
Record times and response and prepare urgent birth and neonatal support if directed by the obstetric team. [1]
Why it matters Persistent abnormality or an acute obstetric event may require rapid definitive management.

What to look for next

Track contraction and fetal recovery. Continuously reassess the pattern and maternal condition and communicate failure to recover promptly.

Avoid this shortcut

Do not make the scheduled increase automatically. Do not give routine oxygen solely for an abnormal fetal trace in a mother who is not hypoxic, or independently restart oxytocin.

A clear way to hand it over

“I am calling about this new concern: contractions become too frequent during oxytocin. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English A deceleration is a fall in fetal heart rate; a concerning trace needs trained interpretation with the whole situation.

Sources behind the actions 2 primary references

NICE · NG229: Fetal monitoring in labour
Signal verification, excessive contractions, conservative measures and urgent review; no routine maternal oxygen for fetal concerns alone.
NICE · NG235: Intrapartum care
Individual labour care, maternal/fetal assessment and communication.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Maternal infection & sepsis

New fever with maternal and fetal tachycardia

Intermediate

The situation

A labouring patient develops fever, feels unwell and has rising maternal and fetal heart rates.

What should catch your attention

Infection concern
Two physiological trends
Labour context

Your immediate priority

Seek prompt obstetric infection assessment and prepare ordered treatment and monitoring.

01Infection concern
02Seek prompt obstetric infection assessment and prepare ordered treatment and monitoring.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Seek prompt obstetric infection assessment and prepare ordered treatment and monitoring. [1]
Why it matters Maternal sepsis may occur without a high fever and may deteriorate quickly.
2
Recognize illness beyond fever
Assess pregnancy/birth timing, possible source, breathing, perfusion, mental state and urine. [1]
Why it matters Maternal sepsis may occur without a high fever and may deteriorate quickly.
3
Arrange prompt treatment
Call the obstetric/emergency team and prepare ordered cultures and antimicrobials without unnecessary delay. [1]
Why it matters Infection with organ dysfunction needs rapid coordinated care.
4
Reassess and address the source
Support the individualized resuscitation plan and prepare specialist source-control assessment. [1]
Why it matters Fluid tolerance and obstetric source management require pregnancy-specific judgment.

What to look for next

Watch for organ dysfunction. Track perfusion, breathing, urine and the response after each prescribed intervention.

Avoid this shortcut

Do not explain all tachycardia as labour effort. Do not rely on fever alone or use an unreviewed standard fluid load.

A clear way to hand it over

“I am calling about this new concern: new fever with maternal and fetal tachycardia. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English Sepsis is organ dysfunction caused by a harmful response to infection.

Sources behind the actions 2 primary references

SMFM · Consult Series 67: Maternal sepsis (reaffirmed 2025)
Pregnancy/postpartum infection with organ dysfunction, prompt antimicrobials, individualized resuscitation and source control.
CDC · Urgent maternal warning signs
Serious pregnancy/postpartum symptoms requiring prompt medical attention.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Intrapartum fetal concern

The patient feels faint after neuraxial analgesia

Intermediate

The situation

Following neuraxial analgesia, maternal pressure falls and the fetal rate changes. The patient reports nausea and dizziness.

What should catch your attention

Maternal hypotension
Temporal procedure
Fetal effect

Your immediate priority

Summon anesthesia/maternity review and follow the prescribed position and hypotension response.

01Maternal hypotension
02Summon anesthesia/maternity review and follow the prescribed position and hypotension response.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Summon anesthesia/maternity review and follow the prescribed position and hypotension response. [1]
Why it matters A trace must be interpreted with the patient and context; maternal pulse can be mistaken for fetal rate.
2
Check signal and context
Compare maternal and fetal heart rates and assess the trace, contractions, medicines, position and new maternal symptoms within monitoring competency. [1]
Why it matters A trace must be interpreted with the patient and context; maternal pulse can be mistaken for fetal rate.
3
Activate review and conservative measures
Call the senior maternity team, stop oxytocin when directed by the abnormal-pattern protocol and use appropriate position or other ordered measures. [1]
Why it matters Excessive contractions or maternal physiological problems may reduce fetal oxygen supply.
4
Prepare escalation
Record times and response and prepare urgent birth and neonatal support if directed by the obstetric team. [1]
Why it matters Persistent abnormality or an acute obstetric event may require rapid definitive management.

What to look for next

Reassess both maternal and fetal findings. Continuously reassess the pattern and maternal condition and communicate failure to recover promptly.

Avoid this shortcut

Do not focus only on the fetal trace. Do not give routine oxygen solely for an abnormal fetal trace in a mother who is not hypoxic, or independently restart oxytocin.

A clear way to hand it over

“I am calling about this new concern: the patient feels faint after neuraxial analgesia. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English A deceleration is a fall in fetal heart rate; a concerning trace needs trained interpretation with the whole situation.

Sources behind the actions 2 primary references

NICE · NG229: Fetal monitoring in labour
Signal verification, excessive contractions, conservative measures and urgent review; no routine maternal oxygen for fetal concerns alone.
NICE · NG235: Intrapartum care
Individual labour care, maternal/fetal assessment and communication.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Maternal assessment & communication

Vomiting changes oral medicine safety

Intermediate

The situation

A patient in labour repeatedly vomits after an oral medicine. Staff are unsure how much was absorbed and whether another dose is safe.

What should catch your attention

Uncertain absorption
Repeat-dose risk
Persistent symptoms

Your immediate priority

Ask the prescriber/pharmacist for an authorized dosing and route decision.

01Uncertain absorption
02Ask the prescriber/pharmacist for an authorized dosing and route decision.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Ask the prescriber/pharmacist for an authorized dosing and route decision. [1]
Why it matters A patient’s report may reveal a significant change before a routine observation is abnormal.
2
Assess the actual change
Check symptoms, pregnancy or birth timing, relevant observations and the documented care plan, using respectful language assistance when needed. [1]
Why it matters A patient’s report may reveal a significant change before a routine observation is abnormal.
3
Use the maternity pathway
Inform the responsible maternity clinician and escalate warning signs through the appropriate maternal response. [1]
Why it matters Pregnancy and the postpartum period have specific risks and monitoring requirements.
4
Confirm understanding and follow-up
Deliver the prescribed care and use teach-back for the next steps and urgent-contact instructions. [1]
Why it matters A clear plan helps the patient recognize deterioration and avoid unsafe delay.

What to look for next

Record actual times and response. Reassess the reported concern and physiological trends; ensure unresolved symptoms and safety advice are handed over.

Avoid this shortcut

Do not automatically repeat a full dose. Do not dismiss a concern as an unavoidable part of pregnancy or apply a generic adult plan without maternity review.

A clear way to hand it over

“I am calling about this new concern: vomiting changes oral medicine safety. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English Postpartum means after birth; some serious pregnancy-related complications first appear then.

Sources behind the actions 2 primary references

NICE · NG235: Intrapartum care
Individual labour care, maternal/fetal assessment and communication.
CDC · Urgent maternal warning signs
Serious pregnancy/postpartum symptoms requiring prompt medical attention.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Hypertensive pregnancy emergency

Severe headache with visual symptoms

Difficult

The situation

A labouring patient develops severe headache, flashing visual symptoms and elevated pressure. They initially call it lack of sleep.

What should catch your attention

Neurological warnings
Hypertension
Labour

Your immediate priority

Activate prompt maternity hypertensive assessment.

01Neurological warnings
02Activate prompt maternity hypertensive assessment.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Activate prompt maternity hypertensive assessment. [1]
Why it matters Preeclampsia can affect multiple organs and can occur after birth.
2
Check warning findings
Assess pressure correctly and report severe headache, vision change, upper-abdominal pain, reduced urine, seizure or respiratory symptoms. [1]
Why it matters Preeclampsia can affect multiple organs and can occur after birth.
3
Activate urgent treatment
Call the maternity emergency team and assist prescribed antihypertensive and magnesium treatment with the required monitoring. [1]
Why it matters Control of severe pressure and seizure prevention/treatment require an authorized maternity plan.
4
Monitor complications
Track consciousness, breathing, pressure, urine and ordered laboratory findings and communicate fluid or treatment concerns. [1]
Why it matters Kidney, liver, platelet and respiratory complications can change treatment safety.

What to look for next

Track pressure and symptoms. Continue the prescribed pressure and magnesium-safety observations and escalate neurological or respiratory decline immediately.

Avoid this shortcut

Do not dismiss the symptoms as fatigue. Do not independently choose an antihypertensive, fluid bolus or magnesium dose, or dismiss symptoms because the baby has already been born.

A clear way to hand it over

“I am calling about this new concern: severe headache with visual symptoms. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English Preeclampsia is a pregnancy-related multisystem disorder often involving hypertension; eclampsia means associated seizures.

Sources behind the actions 2 primary references

NICE · NG133: Hypertension in pregnancy
Severe hypertension, magnesium safety, eclampsia and postpartum monitoring.
CDC · Urgent maternal warning signs
Serious pregnancy/postpartum symptoms requiring prompt medical attention.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Maternal assessment & communication

Pain and bleeding change abruptly

Difficult

The situation

During labour, a patient develops new constant severe abdominal pain and vaginal bleeding with a concerning fetal pattern.

What should catch your attention

Acute obstetric event
Bleeding
Fetal concern

Your immediate priority

Call immediate obstetric review and prepare the emergency assessment/birth pathway.

01Acute obstetric event
02Call immediate obstetric review and prepare the emergency assessment/birth pathway.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Call immediate obstetric review and prepare the emergency assessment/birth pathway. [1]
Why it matters A patient’s report may reveal a significant change before a routine observation is abnormal.
2
Assess the actual change
Check symptoms, pregnancy or birth timing, relevant observations and the documented care plan, using respectful language assistance when needed. [1]
Why it matters A patient’s report may reveal a significant change before a routine observation is abnormal.
3
Use the maternity pathway
Inform the responsible maternity clinician and escalate warning signs through the appropriate maternal response. [1]
Why it matters Pregnancy and the postpartum period have specific risks and monitoring requirements.
4
Confirm understanding and follow-up
Deliver the prescribed care and use teach-back for the next steps and urgent-contact instructions. [1]
Why it matters A clear plan helps the patient recognize deterioration and avoid unsafe delay.

What to look for next

Track loss and maternal perfusion. Reassess the reported concern and physiological trends; ensure unresolved symptoms and safety advice are handed over.

Avoid this shortcut

Do not assume this is ordinary contraction pain. Do not dismiss a concern as an unavoidable part of pregnancy or apply a generic adult plan without maternity review.

A clear way to hand it over

“I am calling about this new concern: pain and bleeding change abruptly. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English Postpartum means after birth; some serious pregnancy-related complications first appear then.

Sources behind the actions 2 primary references

NICE · NG235: Intrapartum care
Individual labour care, maternal/fetal assessment and communication.
CDC · Urgent maternal warning signs
Serious pregnancy/postpartum symptoms requiring prompt medical attention.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Intrapartum fetal concern

The fetal trace remains concerning after initial measures

Difficult

The situation

A concerning fetal pattern persists despite the initial authorized measures. Maternal observations and contraction history need review together.

What should catch your attention

Persistent abnormality
Initial measures failed
Whole picture needed

Your immediate priority

Request urgent senior obstetric review and prepare escalation and neonatal support.

01Persistent abnormality
02Request urgent senior obstetric review and prepare escalation and neonatal support.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Request urgent senior obstetric review and prepare escalation and neonatal support. [1]
Why it matters A trace must be interpreted with the patient and context; maternal pulse can be mistaken for fetal rate.
2
Check signal and context
Compare maternal and fetal heart rates and assess the trace, contractions, medicines, position and new maternal symptoms within monitoring competency. [1]
Why it matters A trace must be interpreted with the patient and context; maternal pulse can be mistaken for fetal rate.
3
Activate review and conservative measures
Call the senior maternity team, stop oxytocin when directed by the abnormal-pattern protocol and use appropriate position or other ordered measures. [1]
Why it matters Excessive contractions or maternal physiological problems may reduce fetal oxygen supply.
4
Prepare escalation
Record times and response and prepare urgent birth and neonatal support if directed by the obstetric team. [1]
Why it matters Persistent abnormality or an acute obstetric event may require rapid definitive management.

What to look for next

Document time and response. Continuously reassess the pattern and maternal condition and communicate failure to recover promptly.

Avoid this shortcut

Do not repeat the same measures indefinitely. Do not give routine oxygen solely for an abnormal fetal trace in a mother who is not hypoxic, or independently restart oxytocin.

A clear way to hand it over

“I am calling about this new concern: the fetal trace remains concerning after initial measures. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English A deceleration is a fall in fetal heart rate; a concerning trace needs trained interpretation with the whole situation.

Sources behind the actions 2 primary references

NICE · NG229: Fetal monitoring in labour
Signal verification, excessive contractions, conservative measures and urgent review; no routine maternal oxygen for fetal concerns alone.
NICE · NG235: Intrapartum care
Individual labour care, maternal/fetal assessment and communication.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Hypertensive pregnancy emergency

Low urine while magnesium is prescribed

Difficult

The situation

A patient receiving prescribed magnesium has markedly reduced urine. Renal findings affect treatment monitoring and toxicity risk.

What should catch your attention

Magnesium exposure
Low urine
Renal safety

Your immediate priority

Inform the maternity team urgently and follow the specific magnesium-safety and renal assessment protocol.

01Magnesium exposure
02Inform the maternity team urgently and follow the specific magnesium-safety and renal assessment protocol.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Inform the maternity team urgently and follow the specific magnesium-safety and renal assessment protocol. [1]
Why it matters Preeclampsia can affect multiple organs and can occur after birth.
2
Check warning findings
Assess pressure correctly and report severe headache, vision change, upper-abdominal pain, reduced urine, seizure or respiratory symptoms. [1]
Why it matters Preeclampsia can affect multiple organs and can occur after birth.
3
Activate urgent treatment
Call the maternity emergency team and assist prescribed antihypertensive and magnesium treatment with the required monitoring. [1]
Why it matters Control of severe pressure and seizure prevention/treatment require an authorized maternity plan.
4
Monitor complications
Track consciousness, breathing, pressure, urine and ordered laboratory findings and communicate fluid or treatment concerns. [1]
Why it matters Kidney, liver, platelet and respiratory complications can change treatment safety.

What to look for next

Check breathing, reflexes and ordered levels as indicated. Continue the prescribed pressure and magnesium-safety observations and escalate neurological or respiratory decline immediately.

Avoid this shortcut

Do not continue routine delivery without the required review. Do not independently choose an antihypertensive, fluid bolus or magnesium dose, or dismiss symptoms because the baby has already been born.

A clear way to hand it over

“I am calling about this new concern: low urine while magnesium is prescribed. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English Preeclampsia is a pregnancy-related multisystem disorder often involving hypertension; eclampsia means associated seizures.

Sources behind the actions 2 primary references

NICE · NG133: Hypertension in pregnancy
Severe hypertension, magnesium safety, eclampsia and postpartum monitoring.
CDC · Urgent maternal warning signs
Serious pregnancy/postpartum symptoms requiring prompt medical attention.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Blood-product reaction

A transfusion reaction during obstetric bleeding

Difficult

The situation

During blood replacement for maternal bleeding, new rigors, dyspnea and worsening pressure appear.

What should catch your attention

Product exposure
New reaction pattern
Concurrent hemorrhage

Your immediate priority

Stop the suspect product and activate reaction assessment while coordinating continued correct hemorrhage support.

01Product exposure
02Stop the suspect product and activate reaction assessment while coordinating continued correct hemorrhage support.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Stop the suspect product and activate reaction assessment while coordinating continued correct hemorrhage support. [1]
Why it matters Continuing a harmful transfusion can intensify the reaction.
2
Stop exposure and call
Stop the transfusion, assess airway, breathing and circulation and obtain urgent clinical help. Keep access using the approved pathway without flushing residual blood into the person. [1]
Why it matters Continuing a harmful transfusion can intensify the reaction.
3
Check identity and notify
Recheck patient and product identifiers, notify the transfusion service and retain the bag and tubing for investigation. [1]
Why it matters Identity errors and several serious reaction types need immediate investigation.
4
Support the diagnostic plan
Collect ordered blood or urine samples and monitor observations while the team provides reaction-specific treatment. [1]
Why it matters Breathlessness, shock, fever and pain can have different causes that need different treatments.

What to look for next

Track ABCs and product identity. Trend symptoms and circulation continuously in an unstable reaction. Document product details, volume, onset and actions precisely.

Avoid this shortcut

Do not assume all deterioration is solely blood loss. Do not restart a severe reaction or assume every breathless reaction needs the same fluid or diuretic treatment.

A clear way to hand it over

“I am calling about this new concern: a transfusion reaction during obstetric bleeding. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English A transfusion reaction is an adverse response associated with a blood component.

Sources behind the actions 1 primary references

Australian Red Cross Lifeblood · Management of suspected transfusion reactions
Stop a severe reaction, assess ABCs, retain IV access without flushing residual blood, verify identity and notify the medical/transfusion teams.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Umbilical cord prolapse

Prolonged fetal bradycardia after membrane rupture

Extremely difficult

The situation

Immediately after membrane rupture, the fetal rate drops persistently and examination identifies a prolapsed cord.

What should catch your attention

Membrane rupture
Persistent bradycardia
Cord recognized

Your immediate priority

Activate immediate cord-prolapse rescue and trained compression-relief measures while preparing urgent birth.

01Membrane rupture
02Activate immediate cord-prolapse rescue and trained compression-relief measures while preparing urgent birth.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Activate immediate cord-prolapse rescue and trained compression-relief measures while preparing urgent birth. [1]
Why it matters Compression can interrupt blood flow to the baby and requires time-sensitive intervention.
2
Call and identify urgency
Summon the obstetric and neonatal team immediately when a prolapsed cord is recognized or strongly suspected. [1]
Why it matters Compression can interrupt blood flow to the baby and requires time-sensitive intervention.
3
Relieve compression within competency
Use the local emergency cord-prolapse protocol for trained positioning and elevation of the presenting part while preparing urgent birth. [1]
Why it matters Temporary measures aim to reduce compression until definitive delivery.
4
Maintain the rescue plan
Record times, fetal findings and actions and continue the prescribed relief and monitoring through transfer. [1]
Why it matters Compression can recur during movement and the receiving team needs an exact handover.

What to look for next

Maintain the rescue during transfer. Follow fetal and maternal findings continuously until the obstetric team completes definitive management.

Avoid this shortcut

Do not push the cord back. Do not push the cord back into the uterus or handle it unnecessarily, and do not delay calling for help.

A clear way to hand it over

“I am calling about this new concern: prolonged fetal bradycardia after membrane rupture. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English The presenting part is the part of the baby closest to the cervix; a prolapsed cord can be compressed beneath it.

Sources behind the actions 1 primary references

RCOG · Green-top 50: Umbilical cord prolapse
Immediate team response, trained compression relief and urgent definitive delivery.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Shoulder dystocia

Shoulders do not deliver after the head

Extremely difficult

The situation

After the head delivers, the shoulders do not progress. The team recognizes shoulder dystocia and needs coordinated help.

What should catch your attention

Impacted shoulders
Time-critical birth
Team response

Your immediate priority

Call obstetric/neonatal emergency help and assist the trained maneuver sequence.

01Impacted shoulders
02Call obstetric/neonatal emergency help and assist the trained maneuver sequence.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Call obstetric/neonatal emergency help and assist the trained maneuver sequence. [1]
Why it matters Shoulder impaction is a time-critical delivery emergency.
2
Recognize and summon help
When the head delivers but the shoulders do not progress as expected, call experienced obstetric and neonatal help and record the time. [1]
Why it matters Shoulder impaction is a time-critical delivery emergency.
3
Assist trained maneuvers
Follow the local protocol and the clinician leading the delivery for positioning and specified maneuvers. [1]
Why it matters Coordinated appropriate maneuvers seek safe delivery while avoiding harmful traction.
4
Prepare mother and baby care
Support neonatal assessment and maternal examination for bleeding or injury after delivery and document the sequence. [1]
Why it matters Both mother and baby may need immediate evaluation after the emergency.

What to look for next

Record times and maternal/newborn assessment. Track times and response during maneuvers and ensure post-delivery maternal and newborn assessment.

Avoid this shortcut

Do not use fundal pressure or uncontrolled traction. Do not apply fundal pressure or independently pull on the fetal head.

A clear way to hand it over

“I am calling about this new concern: shoulders do not deliver after the head. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English Shoulder dystocia means the shoulders become impacted during birth after the head has delivered.

Sources behind the actions 1 primary references

RCOG · Green-top 42: Shoulder dystocia
Trained delivery maneuvers, team coordination and avoiding fundal pressure.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Hypertensive pregnancy emergency

Eclamptic seizure during labour

Extremely difficult

The situation

A patient with hypertensive warning symptoms has a seizure. Airway, maternal circulation and fetal assessment require coordinated rescue.

What should catch your attention

Seizure
Hypertensive context
Two-patient care

Your immediate priority

Activate obstetric emergency support, protect airway/safety and assist authorized magnesium and pressure treatment.

01Seizure
02Activate obstetric emergency support, protect airway/safety and assist authorized magnesium and pressure treatment.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Activate obstetric emergency support, protect airway/safety and assist authorized magnesium and pressure treatment. [1]
Why it matters Preeclampsia can affect multiple organs and can occur after birth.
2
Check warning findings
Assess pressure correctly and report severe headache, vision change, upper-abdominal pain, reduced urine, seizure or respiratory symptoms. [1]
Why it matters Preeclampsia can affect multiple organs and can occur after birth.
3
Activate urgent treatment
Call the maternity emergency team and assist prescribed antihypertensive and magnesium treatment with the required monitoring. [1]
Why it matters Control of severe pressure and seizure prevention/treatment require an authorized maternity plan.
4
Monitor complications
Track consciousness, breathing, pressure, urine and ordered laboratory findings and communicate fluid or treatment concerns. [1]
Why it matters Kidney, liver, platelet and respiratory complications can change treatment safety.

What to look for next

Track maternal recovery and fetal assessment. Continue the prescribed pressure and magnesium-safety observations and escalate neurological or respiratory decline immediately.

Avoid this shortcut

Do not place objects in the mouth or restrain convulsions. Do not independently choose an antihypertensive, fluid bolus or magnesium dose, or dismiss symptoms because the baby has already been born.

A clear way to hand it over

“I am calling about this new concern: eclamptic seizure during labour. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English Preeclampsia is a pregnancy-related multisystem disorder often involving hypertension; eclampsia means associated seizures.

Sources behind the actions 2 primary references

NICE · NG133: Hypertension in pregnancy
Severe hypertension, magnesium safety, eclampsia and postpartum monitoring.
CDC · Urgent maternal warning signs
Serious pregnancy/postpartum symptoms requiring prompt medical attention.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Postpartum hemorrhage

Heavy bleeding follows birth

Extremely difficult

The situation

Soon after birth, blood loss increases rapidly and the patient becomes pale and tachycardic. The cause is not yet confirmed.

What should catch your attention

Increasing loss
Perfusion change
Cause uncertain

Your immediate priority

Activate PPH response, quantify loss and assist the authorized treatment bundle and cause assessment.

01Increasing loss
02Activate PPH response, quantify loss and assist the authorized treatment bundle and cause assessment.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Activate PPH response, quantify loss and assist the authorized treatment bundle and cause assessment. [1]
Why it matters Visible loss can be underestimated and serious deterioration should not wait for a fixed volume.
2
Recognize and call early
Assess bleeding, uterine findings within competency, circulation and birth/procedure details; activate the maternity hemorrhage response. [1]
Why it matters Visible loss can be underestimated and serious deterioration should not wait for a fixed volume.
3
Assist the treatment bundle
Bring the hemorrhage equipment and support authorized uterine assessment/massage, uterotonics, tranexamic acid, IV support and examination for the cause as indicated. [1]
Why it matters Treatment targets both circulation and causes such as tone, trauma, retained tissue or coagulation problems.
4
Track response and definitive care
Record quantified loss, medicines and times and prepare prescribed blood products or surgical escalation. [1]
Why it matters Ongoing bleeding needs reassessment and may require procedures beyond nursing measures.

What to look for next

Track ongoing loss and response. Track bleeding, uterine response, perfusion, urine and ordered laboratory findings; escalate continued loss immediately.

Avoid this shortcut

Do not wait for a fixed volume before escalating deterioration. Do not assume every hemorrhage is uterine atony or administer uterotonics without considering the drug-specific order and contraindications.

A clear way to hand it over

“I am calling about this new concern: heavy bleeding follows birth. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English Uterine atony means the uterus is not contracting firmly enough after birth; it is one possible bleeding cause.

Sources behind the actions 1 primary references

WHO · Consolidated postpartum haemorrhage guideline (2025)
Early recognition, treatment bundle, cause assessment and escalation for ongoing bleeding.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Pregnancy-related thromboembolism

Collapse with severe breathing difficulty during labour

Extremely difficult

The situation

A labouring patient suddenly becomes severely breathless and hypotensive. Several obstetric and cardiopulmonary emergencies are possible.

What should catch your attention

Sudden collapse
Respiratory failure
Pregnancy context

Your immediate priority

Activate maternal emergency resuscitation and specialist assessment with pregnancy-specific support.

01Sudden collapse
02Activate maternal emergency resuscitation and specialist assessment with pregnancy-specific support.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Activate maternal emergency resuscitation and specialist assessment with pregnancy-specific support. [1]
Why it matters Pregnancy-related thrombosis can cause life-threatening cardiopulmonary deterioration.
2
Recognize the new pattern
Report sudden dyspnea, chest pain, collapse or unilateral leg symptoms and the pregnancy/postpartum and bleeding history. [1]
Why it matters Pregnancy-related thrombosis can cause life-threatening cardiopulmonary deterioration.
3
Support urgent assessment
Activate the appropriate response, support ABCs and prepare ordered investigations and specialist-directed treatment. [1]
Why it matters Diagnostic and anticoagulation decisions must consider pregnancy and current bleeding risks.
4
Monitor and hand over
Track respiratory and perfusion trends and document timing, delivery/procedure and medicine exposures. [1]
Why it matters Clinical changes and treatment risks must stay visible through transfers.

What to look for next

Track airway and perfusion. Escalate hypoxia, hypotension or collapse immediately and monitor response to the authorized plan.

Avoid this shortcut

Do not assume a single diagnosis before rescue. Do not massage a symptomatic leg or independently select an anticoagulant or thrombolytic.

A clear way to hand it over

“I am calling about this new concern: collapse with severe breathing difficulty during labour. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English Venous thromboembolism includes a vein clot and a clot that travels to the lungs.

Sources behind the actions 2 primary references

RCOG · Green-top 37b: Acute pregnancy-related thromboembolism
Urgent pregnancy-specific investigation and specialist-directed treatment with bleeding considerations.
CDC · Urgent maternal warning signs
Serious pregnancy/postpartum symptoms requiring prompt medical attention.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Hypertensive pregnancy emergency

Respiratory depression while receiving magnesium

Extremely difficult

The situation

A patient on magnesium becomes very drowsy with slow breathing and reduced reflex response. Urine output has also fallen.

What should catch your attention

Possible toxicity
Respiratory compromise
Low urine

Your immediate priority

Stop delivery according to the toxicity protocol, call emergency help and prepare authorized reversal/support.

01Possible toxicity
02Stop delivery according to the toxicity protocol, call emergency help and prepare authorized reversal/support.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Stop delivery according to the toxicity protocol, call emergency help and prepare authorized reversal/support. [1]
Why it matters Preeclampsia can affect multiple organs and can occur after birth.
2
Check warning findings
Assess pressure correctly and report severe headache, vision change, upper-abdominal pain, reduced urine, seizure or respiratory symptoms. [1]
Why it matters Preeclampsia can affect multiple organs and can occur after birth.
3
Activate urgent treatment
Call the maternity emergency team and assist prescribed antihypertensive and magnesium treatment with the required monitoring. [1]
Why it matters Control of severe pressure and seizure prevention/treatment require an authorized maternity plan.
4
Monitor complications
Track consciousness, breathing, pressure, urine and ordered laboratory findings and communicate fluid or treatment concerns. [1]
Why it matters Kidney, liver, platelet and respiratory complications can change treatment safety.

What to look for next

Monitor ventilation and ordered magnesium/renal findings. Continue the prescribed pressure and magnesium-safety observations and escalate neurological or respiratory decline immediately.

Avoid this shortcut

Do not wait for a laboratory result before reporting respiratory compromise. Do not independently choose an antihypertensive, fluid bolus or magnesium dose, or dismiss symptoms because the baby has already been born.

A clear way to hand it over

“I am calling about this new concern: respiratory depression while receiving magnesium. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English Preeclampsia is a pregnancy-related multisystem disorder often involving hypertension; eclampsia means associated seizures.

Sources behind the actions 2 primary references

NICE · NG133: Hypertension in pregnancy
Severe hypertension, magnesium safety, eclampsia and postpartum monitoring.
CDC · Urgent maternal warning signs
Serious pregnancy/postpartum symptoms requiring prompt medical attention.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Severe allergic reaction

Anaphylaxis during intrapartum antibiotic administration

Extremely difficult

The situation

After an antibiotic starts, a labouring patient develops airway swelling and shock. The fetal trace also changes.

What should catch your attention

Maternal anaphylaxis
Shock
Fetal effect

Your immediate priority

Activate the maternal anaphylaxis pathway and prioritize effective maternal rescue with authorized epinephrine and airway support.

01Maternal anaphylaxis
02Activate the maternal anaphylaxis pathway and prioritize effective maternal rescue with authorized epinephrine and airway support.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Activate the maternal anaphylaxis pathway and prioritize effective maternal rescue with authorized epinephrine and airway support. [1]
Why it matters A rash may be absent; life-threatening allergy is identified by organ compromise.
2
Recognize severe compromise
Stop the suspected trigger when possible; call emergency help for sudden airway, breathing or circulation problems after an exposure. [1]
Why it matters A rash may be absent; life-threatening allergy is identified by organ compromise.
3
Use the emergency protocol
Give intramuscular epinephrine/adrenaline under the authorized pathway, support airway and oxygenation, and position safely without standing the patient. [1]
Why it matters Epinephrine addresses dangerous airway and circulatory effects; antihistamines do not replace it.
4
Prepare continued care
Arrange ordered fluids, repeat treatment and observation; report the exposure, symptoms and treatment times. [1]
Why it matters Symptoms can persist or recur, requiring monitored follow-up rather than immediate reassurance.

What to look for next

Coordinate continued fetal review. Continuously review breathing, perfusion and response. Escalate ongoing compromise and arrange allergy documentation and follow-up after stabilization.

Avoid this shortcut

Do not delay maternal treatment to interpret the trace first. Do not wait for a rash, use antihistamines as sole emergency treatment or let a hypotensive person walk.

A clear way to hand it over

“I am calling about this new concern: anaphylaxis during intrapartum antibiotic administration. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English Anaphylaxis is a serious systemic allergic reaction; adrenaline and epinephrine are two names for the same medicine.

Sources behind the actions 1 primary references

Resuscitation Council UK · Emergency treatment of anaphylactic reactions
IM adrenaline/epinephrine first-line, positioning, emergency support and observation; antihistamines do not treat airway or circulatory compromise.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Maternal infection & sepsis

Maternal sepsis deteriorates during an urgent transfer

Extremely difficult

The situation

A labouring patient with infection becomes hypotensive and confused while transfer to higher-level care is being arranged.

What should catch your attention

Organ dysfunction
Transfer vulnerability
Obstetric source possible

Your immediate priority

Activate immediate resuscitation where the patient is and reassess the trained transport and source-control plan.

01Organ dysfunction
02Activate immediate resuscitation where the patient is and reassess the trained transport and source-control plan.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Activate immediate resuscitation where the patient is and reassess the trained transport and source-control plan. [1]
Why it matters Maternal sepsis may occur without a high fever and may deteriorate quickly.
2
Recognize illness beyond fever
Assess pregnancy/birth timing, possible source, breathing, perfusion, mental state and urine. [1]
Why it matters Maternal sepsis may occur without a high fever and may deteriorate quickly.
3
Arrange prompt treatment
Call the obstetric/emergency team and prepare ordered cultures and antimicrobials without unnecessary delay. [1]
Why it matters Infection with organ dysfunction needs rapid coordinated care.
4
Reassess and address the source
Support the individualized resuscitation plan and prepare specialist source-control assessment. [1]
Why it matters Fluid tolerance and obstetric source management require pregnancy-specific judgment.

What to look for next

Track response and destination readiness. Track perfusion, breathing, urine and the response after each prescribed intervention.

Avoid this shortcut

Do not move without adequate rescue support. Do not rely on fever alone or use an unreviewed standard fluid load.

A clear way to hand it over

“I am calling about this new concern: maternal sepsis deteriorates during an urgent transfer. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English Sepsis is organ dysfunction caused by a harmful response to infection.

Sources behind the actions 2 primary references

SMFM · Consult Series 67: Maternal sepsis (reaffirmed 2025)
Pregnancy/postpartum infection with organ dysfunction, prompt antimicrobials, individualized resuscitation and source control.
CDC · Urgent maternal warning signs
Serious pregnancy/postpartum symptoms requiring prompt medical attention.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Intrapartum fetal concern

Suspected uterine rupture during labour

Extremely difficult

The situation

A patient with prior uterine surgery develops sudden unusual pain, maternal instability and a severe fetal pattern change. An acute surgical obstetric event is suspected.

What should catch your attention

Prior uterine surgery
Maternal deterioration
Acute fetal change

Your immediate priority

Call immediate obstetric emergency review and prepare urgent definitive birth/surgery and hemorrhage support.

01Prior uterine surgery
02Call immediate obstetric emergency review and prepare urgent definitive birth/surgery and hemorrhage support.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Call immediate obstetric emergency review and prepare urgent definitive birth/surgery and hemorrhage support. [1]
Why it matters A trace must be interpreted with the patient and context; maternal pulse can be mistaken for fetal rate.
2
Check signal and context
Compare maternal and fetal heart rates and assess the trace, contractions, medicines, position and new maternal symptoms within monitoring competency. [1]
Why it matters A trace must be interpreted with the patient and context; maternal pulse can be mistaken for fetal rate.
3
Activate review and conservative measures
Call the senior maternity team, stop oxytocin when directed by the abnormal-pattern protocol and use appropriate position or other ordered measures. [1]
Why it matters Excessive contractions or maternal physiological problems may reduce fetal oxygen supply.
4
Prepare escalation
Record times and response and prepare urgent birth and neonatal support if directed by the obstetric team. [1]
Why it matters Persistent abnormality or an acute obstetric event may require rapid definitive management.

What to look for next

Record the sequence and physiological change. Continuously reassess the pattern and maternal condition and communicate failure to recover promptly.

Avoid this shortcut

Do not treat this as routine oxytocin-related discomfort. Do not give routine oxygen solely for an abnormal fetal trace in a mother who is not hypoxic, or independently restart oxytocin.

A clear way to hand it over

“I am calling about this new concern: suspected uterine rupture during labour. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English A deceleration is a fall in fetal heart rate; a concerning trace needs trained interpretation with the whole situation.

Sources behind the actions 2 primary references

NICE · NG229: Fetal monitoring in labour
Signal verification, excessive contractions, conservative measures and urgent review; no routine maternal oxygen for fetal concerns alone.
NICE · NG235: Intrapartum care
Individual labour care, maternal/fetal assessment and communication.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

Cardiac arrest in pregnancy

Cardiac arrest in advanced pregnancy

Extremely difficult

The situation

A patient in advanced pregnancy collapses with no pulse and abnormal breathing. The maternal emergency team is summoned.

What should catch your attention

Arrest
Advanced pregnancy
Specialized resuscitation needs

Your immediate priority

Start the pregnancy-specific resuscitation response immediately, with trained uterine displacement and obstetric/neonatal rescue preparation as the team directs.

01Arrest
02Start the pregnancy-specific resuscitation response immediately, with trained uterine displacement and obstetric/neonatal rescue preparation as the team directs.
03Check response + communicate

Decision pathway · a learning summary, not a substitute for the full clinical plan

What the RN should do—and why

1
Respond to the situation first
Start the pregnancy-specific resuscitation response immediately, with trained uterine displacement and obstetric/neonatal rescue preparation as the team directs. [1]
Why it matters Maternal circulation must be restored immediately; transfer must not delay CPR.
2
Begin trained arrest care
Recognize arrest, summon the maternal resuscitation team and start effective CPR and defibrillation when indicated. [1]
Why it matters Maternal circulation must be restored immediately; transfer must not delay CPR.
3
Support pregnancy-specific measures
Assist trained manual uterine displacement when indicated, airway management and obstetric/neonatal rescue preparation under the lead clinician. [1]
Why it matters Pregnancy anatomy and physiology change resuscitation needs.
4
Track the coordinated response
Record times and support team-directed cause assessment and resuscitative-delivery preparation when indicated. [1]
Why it matters Time-sensitive decisions require an organized specialist response.

What to look for next

Record times and support the designated resuscitation lead. Follow rhythm, effective CPR and the maternal/obstetric response under the designated lead.

Avoid this shortcut

Do not delay CPR for transfer or use a generic plan that ignores pregnancy. Do not delay CPR for moving rooms or independently perform obstetric rescue procedures outside competency.

A clear way to hand it over

“I am calling about this new concern: cardiac arrest in advanced pregnancy. The key findings are __, starting at __. Baseline and relevant medicines/procedures are __. I have __. My assessment is __, and I need __ by __. Current response and outstanding actions are __.”

Use your facility's handover format; fill in the actual findings and times.

In plain English Manual uterine displacement moves the pregnant uterus away from major vessels during resuscitation when indicated.

Sources behind the actions 1 primary references

AHA · 2025 Special circumstances: arrest in pregnancy
Immediate CPR and trained pregnancy-specific uterine displacement and obstetric rescue coordination.

Links and relevant guidance checked October 7, 2026. Publication dates differ; local requirements may differ. These original cases do not imply endorsement by the source organizations.

Now connect the cues to clinical judgment.
Practise an NGN case · Access depends on your plan.

CONNECT UNDERSTANDING TO EXAM PRACTICE

The explanation is clear.
The exam asks you to choose.

Here, we explain the nursing response directly. In an NCLEX®-style question, several options may sound reasonable. You must weigh the cues, priority, timing and safety—not just recognize a familiar phrase.

Practise applying the reasoning, read why alternatives are less appropriate and review your decisions before exam day.

Build question-bank judgmentStudy by topic or system; review the rationale

Work through NGN casesConnect changing cues across a case

Explore standalone NGN itemsPractise decisions in different item formats

Rehearse a full mockPractise pacing and review your decisions

Try adaptive practiceA CAT-style learning simulator

For tutors & preceptors

Turn a scenario into a conversation.

Pause at the cues. Ask learners to identify the change from baseline and the immediate risk.
Explain the action. Ask what is independent nursing care and what requires a protocol or order.
Change one detail. Explore how unsafe swallowing, low pressure or kidney disease alters the plan.
Rehearse the handover. Compare with local policy, check the source and name what must be reassessed.

Explore the free teaching toolkit

Labor & Delivery

The birth plan needs language support

What should catch your attention

What the RN should do—and why

Respond to the situation first

Assess the actual change

Use the maternity pathway

Confirm understanding and follow-up

What to look for next

Avoid this shortcut

A clear way to hand it over

The record and patient disagree about an allergy

What should catch your attention

What the RN should do—and why

Respond to the situation first

Clarify the history

Verify the authorized plan

Document and communicate

What to look for next

Avoid this shortcut

A clear way to hand it over

The monitor may be recording maternal pulse

What should catch your attention

What the RN should do—and why

Respond to the situation first

Check signal and context

Activate review and conservative measures

Prepare escalation

What to look for next

Avoid this shortcut

A clear way to hand it over

Pain relief expectations are unclear

What should catch your attention

What the RN should do—and why

Respond to the situation first

Assess the actual change

Use the maternity pathway

Confirm understanding and follow-up

What to look for next

Avoid this shortcut

A clear way to hand it over

An IV line pulls during position change

What should catch your attention

What the RN should do—and why

Respond to the situation first

Trace and assess

Escalate the unsafe finding

Close the safety loop

What to look for next

Avoid this shortcut

A clear way to hand it over

Reduced fetal movements were not included in handover

What should catch your attention

What the RN should do—and why

Respond to the situation first

Assess the actual change

Use the maternity pathway

Confirm understanding and follow-up

What to look for next

Avoid this shortcut

A clear way to hand it over

Contractions become too frequent during oxytocin

What should catch your attention

What the RN should do—and why

Respond to the situation first

Check signal and context

Activate review and conservative measures

Prepare escalation

What to look for next

Avoid this shortcut

A clear way to hand it over

New fever with maternal and fetal tachycardia

What should catch your attention

What the RN should do—and why

Respond to the situation first

Recognize illness beyond fever

Arrange prompt treatment

Reassess and address the source

What to look for next

Avoid this shortcut