Obstetrics and Gynaecological Nursing
What this domain tests
Antenatal dating and risk assessment, the stages and mechanics of labour, intrapartum fetal surveillance, postpartum haemorrhage, hypertensive disorders of pregnancy, puerperal sepsis, contraception, gynaecological cancers and menopause.
Core rules
- Naegele's rule: first day of the last menstrual period minus 3 months plus 7 days (plus 1 year).
- GTPAL: gravida, term, preterm, abortions, living children - distinct from gravida/para.
- Stages of labour: first (latent to about 4–6 cm, active to full dilatation), second (full dilatation to birth), third (birth to expulsion of placenta, up to 30 minutes), fourth (first 1–2 hours postpartum).
- Fetal heart rate: baseline 110–160/min; late decelerations indicate uteroplacental insufficiency and need repositioning, oxygen and stopping oxytocin; variable decelerations indicate cord compression.
- Preeclampsia: BP ≥140/90 mmHg after 20 weeks with proteinuria or organ dysfunction. Magnesium sulphate prevents seizures.
- Magnesium sulphate monitoring: patellar reflex present, respiratory rate at least 12–16/min, urine output at least 30 mL/hour; therapeutic level roughly 4–7 mEq/L. Antidote is 10% calcium gluconate.
- PPH: more than 500 mL after vaginal birth or 1000 mL after caesarean; uterine atony is the commonest cause, managed by uterine massage and oxytocin.
Worked example
LMP 10 March 2024. Subtract 3 months → 10 December 2023; add 7 days → 17 December 2023; add 1 year → 17 December 2024 expected date of delivery. Confirm the cycle is a regular 28-day cycle before applying the rule.
Traps that cost marks
- Losing the deep tendon reflex as the first sign of magnesium toxicity rather than respiratory depression.
- Confusing GTPAL with gravida/para counts.
- Treating late decelerations as cord compression.
- Missing that a woman on magnesium sulphate needs hourly output and reflex checks, not just BP monitoring.