Maternal and Newborn Health / Midwifery-Related Care
Domain 4 - Maternal and Newborn Health / Midwifery-Related Care
This domain tests antenatal, intrapartum, postnatal and newborn care to the standard expected of a registered nurse or midwife in Fiji, where most births occur in divisional hospitals but many women first present late at health centres or nursing stations.
Core rules
- Booking antenatal care should begin in the first trimester, with regular visits thereafter, screening for anaemia, blood group and rhesus, syphilis, HIV and hepatitis B, blood pressure and urine protein, tetanus immunisation, and intermittent preventive treatment where indicated.
- Danger signs requiring immediate referral: bleeding, severe headache or blurred vision, epigastric pain, fever, reduced fetal movements, draining liquor, convulsions, severe pallor.
- Pre-eclampsia: BP 140/90 or above with proteinuria or organ dysfunction; severe features at 160/110 or above. Treat with antihypertensives and magnesium sulphate for seizure prophylaxis and treatment.
- Labour is monitored with a partograph: cervical dilatation, descent, contractions, fetal heart rate, maternal vitals, urine and progress. Alert and referral lines mean action, not observation.
- Active management of the third stage: oxytocin 10 IU IM within one minute of birth, controlled cord traction, uterine massage.
- Postpartum haemorrhage: massage the uterus, empty the bladder, give oxytocin, secure two IV lines with warmed fluids, give tranexamic acid 1 g IV within three hours, add ergometrine 0.2 mg IM only if not hypertensive, then refer for surgical management.
- Newborn: dry, stimulate, cover, assess breathing, Apgar at 1 and 5 minutes, skin-to-skin contact, early breastfeeding within one hour, vitamin K, eye care, and thermal protection.
Worked example
Thirty minutes after a normal birth the woman has a boggy uterus, pulse 112, BP 95/60 and moderate blood loss. Reasoning: uterine atony is the commonest cause. Act in sequence: call for help, rub up a contraction, empty the bladder, give oxytocin 10 IU IM, site two large-bore cannulas, take bloods and crossmatch, give tranexamic acid 1 g IV, monitor vitals and lochia, weigh swabs, and prepare for transfer. Ergometrine is withheld if she is hypertensive or pre-eclamptic.
Traps
- Giving ergometrine to a hypertensive or pre-eclamptic woman.
- Failing to monitor respirations, reflexes and urine output during magnesium sulphate therapy.
- Waiting for 'more bleeding' before calling for help.
- Separating mother and baby and delaying the first feed.
- Ignoring a partograph that has crossed the alert line.