Maternal and Child Health Nursing
This domain spans antenatal, intrapartum, postnatal and neonatal care plus paediatrics. Questions are usually about recognising the abnormal and acting within minutes, or about the safety check that prevents a neonatal or maternal injury. Obstetric emergencies are tested through the first three actions, not the diagnosis.
Antenatal care
- Pre-eclampsia is blood pressure 140/90 or above on two occasions at least four hours apart after 20 weeks, with proteinuria or other organ dysfunction. Severe features include 160/110 or above, headache, visual disturbance, epigastric pain, platelets below 100, and raised ALT.
- Severe pre-eclampsia is treated with magnesium sulfate for seizure prophylaxis. Monitor respiratory rate, knee reflexes and hourly urine output. Calcium gluconate is the antidote for magnesium toxicity.
Intrapartum care
- Normal cardiotocograph: baseline 110 to 160, variability 5 to 25, accelerations present, no decelerations.
- Late decelerations begin after the contraction peak and are gradual in onset; they suggest uteroplacental insufficiency. Actions: reposition left lateral, stop oxytocin, give intravenous fluid, apply oxygen if hypoxic, notify the obstetrician, and prepare for expedited delivery.
- Variable decelerations suggest cord compression and usually respond to a change of maternal position.
Postnatal and neonatal care
- Postpartum haemorrhage is 500 mL or more after vaginal birth and 1000 mL or more after caesarean. Causes are tone, trauma, tissue and thrombin. First actions are uterine massage, emptying the bladder, oxytocin, intravenous access and fluid resuscitation.
- APGAR is scored at 1 and 5 minutes on appearance, pulse, grimace, activity and respiration. Resuscitation never waits for the score.
- Neonatal jaundice is pathological if it appears within 24 hours, rises faster than 85 micromol per litre per day, is conjugated, or persists beyond 14 days. Unconjugated hyperbilirubinaemia risks kernicterus.
- Paediatric doses are per kilogram. Weigh the child, use an oral syringe, and check the calculated dose against the maximum adult dose.
Worked example
A cardiotocograph shows baseline 155, reduced variability and recurrent late decelerations after each contraction. What is happening and what do you do? Reasoning: the pattern indicates fetal hypoxia from uteroplacental insufficiency, not cord compression, because the decelerations are late and gradual. Act in this order: call for help, reposition the mother left lateral, stop any oxytocin infusion, give intravenous fluid, apply oxygen if maternal saturation is low, and prepare for expedited delivery. Reassuring the mother and continuing to observe is the wrong answer.
Traps that cost marks
- Allowing oral fluids in a woman who may need emergency caesarean, because of aspiration risk.
- Assuming a 5-minute APGAR of 9 means no further observation is needed.
- Mixing maternal and neonatal observations in the same record.