Maternal and Newborn Nursing
Organise this domain around the four Ps (powers, passage, passenger, psyche) and the timeline of pregnancy, labour, postpartum and newborn adaptation.
Antepartum: Know normal physiological changes (increased blood volume, mild anaemia, supine hypotension from vena cava compression - teach left lateral tilt). Recognise warning signs: vaginal bleeding, severe headache with visual changes (pre-eclampsia), decreased fetal movement, rupture of membranes. Pre-eclampsia is hypertension plus proteinuria after 20 weeks; the priority is preventing seizures (magnesium sulfate) and monitoring reflexes and respiratory rate for magnesium toxicity, with calcium gluconate as antidote.
Intrapartum: Fetal heart rate interpretation - late decelerations suggest uteroplacental insufficiency (reposition, oxygen, stop oxytocin, notify); variable decelerations suggest cord compression (reposition).
Postpartum: The most dangerous complication is haemorrhage. A boggy uterus with heavy bleeding calls for fundal massage and bladder emptying first. Monitor for infection and thromboembolism; early ambulation helps.
Newborn: APGAR at 1 and 5 minutes (Appearance, Pulse, Grimace, Activity, Respiration). Keep the newborn warm (thermoregulation is immature), initiate breastfeeding early, and give vitamin K as ordered.
Traps
- Choosing delivery or surgery when a nursing repositioning manoeuvre is the first step.
- Mixing up magnesium toxicity (loss of deep tendon reflexes, respiratory depression) with pre-eclampsia itself.
- Forgetting that postpartum haemorrhage priority is uterine tone, not documentation.
Rule of thumb
Any pregnant patient with bleeding, severe headache, or reduced fetal movement is urgent - escalate immediately.