Maternal and Newborn (Obstetric) Nursing
The Maternal and Newborn domain tests antenatal risk recognition, safe intrapartum care, postpartum emergency response and immediate newborn assessment. Egyptian services follow MOHP safe-motherhood protocols, and items commonly target the leading causes of maternal death: postpartum haemorrhage, pre-eclampsia and eclampsia, sepsis and obstructed labour.
Antenatal care
First visit before 12 weeks: confirm pregnancy, calculate the expected date of delivery with Naegele's rule (first day of last menstrual period minus 3 months, plus 7 days, plus 1 year), record blood group and Rh, haemoglobin, and screen for hepatitis B, HIV and syphilis. Offer glucose tolerance testing at 24–28 weeks and tetanus toxoid. Teach danger signs: bleeding, severe headache or blurred vision, reduced fetal movement, leaking fluid and fever.
Intrapartum monitoring
- First stage: latent to full dilatation; monitor contractions, fetal heart rate every 30 minutes (every 15 minutes in the second stage) and plot progress on a partograph.
- Second stage: full dilatation to birth; coach pushing and protect the perineum.
- Third stage: birth to placental delivery; give 10 IU oxytocin IM within one minute of birth and use controlled cord traction.
- Fourth stage: first 1–2 hours; observe bleeding and uterine tone.
Postpartum haemorrhage
The most common cause is uterine atony. Act as a bundle: call for help, massage the uterus, start an oxytocin infusion, empty the bladder, secure IV access with crystalloid, give tranexamic acid 1 g IV within three hours, then misoprostol or carboprost as prescribed, and prepare for theatre if bleeding continues.
Pre-eclampsia and eclampsia
Hypertension of 140/90 or more plus proteinuria or organ dysfunction after 20 weeks. Severe features: BP 160/110 or more, headache, visual changes, epigastric pain, clonus. Magnesium sulphate is the drug of choice for seizure prophylaxis and treatment; monitor respirations, reflexes and urine output, with calcium gluconate as the antidote.
Worked example
Thirty minutes after a spontaneous vaginal birth, a woman has a boggy uterus, blood loss of 700 mL, pulse 122/min and BP 92/58 mmHg. What is the priority? Reasoning: atony with early shock. Massage the fundus, give oxytocin, empty the bladder, start IV fluids and tranexamic acid, and call the obstetric team. Waiting for the next vital-sign round or giving an oral iron tablet addresses nothing acute.
Traps that cost marks
- Treating pregnancy hypertension with ACE inhibitors or ARBs.
- Giving NSAIDs to a woman with pre-eclampsia or renal risk.
- Misreading lochia: saturating a pad in under an hour is haemorrhage, not normal.