Maternal and Neonatal Nursing (Midwifery and Postpartum Care)
This domain tests antenatal, intrapartum, postpartum, and neonatal care: hypertensive disorders, hemorrhage, infection, breastfeeding, neonatal adaptation, jaundice, and thermoregulation.
Core rules
- Postpartum hemorrhage is most often caused by uterine atony. Assess tone, tissue, trauma, and thrombin; massage the fundus, empty the bladder, and give uterotonics as ordered.
- In preeclampsia, monitor blood pressure, symptoms, reflexes, urine output, and platelets. Magnesium sulfate toxicity is monitored by respiratory rate, deep tendon reflexes, and urine output; calcium gluconate is the antidote.
- Do not use ACE inhibitors or ARBs in pregnancy; use agents safe in pregnancy such as labetalol or nifedipine per protocol.
- Group B streptococcus prophylaxis is given in labour when indicated.
- Newborns lose heat easily: dry, cover, skin-to-skin, and monitor temperature.
- Assess jaundice by age, gestation, feeding, and bilirubin level; do not assume all jaundice is benign.
Worked example
Thirty minutes after vaginal delivery, a woman has heavy bleeding, a boggy uterus, heart rate 120, and blood pressure 90/60. Massage the fundus, empty the bladder, start oxytocin per protocol, obtain IV access, send bloods and crossmatch, and call for help. Reason: uterine atony is the leading cause of early postpartum hemorrhage; early mechanical and pharmacologic treatment prevents shock.
Traps
- Treating hypertension in pregnancy with an ACE inhibitor.
- Missing magnesium toxicity: absent reflexes, slow breathing, oliguria.
- Assuming jaundice is always physiological without checking bilirubin and risk factors.
- Forgetting that a full bladder prevents uterine contraction.