Maternal, Newborn and Reproductive Health / Midwifery
Antenatal care and danger signs
Know the schedule of focused antenatal contacts (WHO recommends eight contacts; Ghana's programme builds on at least four visits with early booking), the routine investigations (haemoglobin, blood group and rhesus, urinalysis, HIV, syphilis, hepatitis B), and the danger signs that demand referral: bleeding, severe headache with blurred vision, convulsions, reduced fetal movement, draining membranes, fever, severe abdominal pain and difficulty breathing.
Labour and birth
Be fluent in the three stages, the partograph (alert and action lines), the mechanism of labour, and active management of the third stage: a uterotonic (oxytocin 10 IU IM), controlled cord traction and uterine massage. Postpartum haemorrhage has four causes - tone, trauma, tissue and thrombin - and atony is the commonest. Newborn assessment uses APGAR at 1 and 5 minutes; APGAR scores do not decide whether to resuscitate - the baby's breathing and heart rate do.
Hypertension and eclampsia
Pre-eclampsia is hypertension after 20 weeks with proteinuria or organ involvement. Magnesium sulphate is the anticonvulsant of choice; monitor respiratory rate (at least 12–16/min), deep tendon reflexes and urine output, and keep calcium gluconate as the antidote.
Traps
Stopping magnesium for a respiratory rate of 18; giving a second dose of a uterotonic before checking the uterus; and treating a low APGAR as an indication to wait rather than to resuscitate.
Worked example - Pritchard regimen
Eclampsia: loading dose 4 g MgSO₄ IV over 10–20 minutes plus 10 g IM (5 g into each buttock), then 5 g IM every 4 hours for 24 hours after the last fit, with monitoring before every dose.