Obstetric and Gynaecological Nursing
Obstetric and gynaecological nursing covers antenatal care, labour, postpartum complications and common gynaecological conditions. The exam favours emergency recognition, safe motherhood programmes and drug monitoring.
Core rules
- Antenatal: WHO recommends eight contacts; in India, PMSMA clinics are held on the 9th of each month. Give iron–folic acid, tetanus–diphtheria toxoid and screen for anaemia, hypertension and gestational diabetes.
- Labour has four stages: first (latent and active), second (full dilatation to birth), third (placenta), fourth (first hour). Use a partograph to detect prolonged labour.
- Postpartum haemorrhage: >500 mL after vaginal birth or >1000 mL after caesarean. Causes are the four Ts: tone (atony), tissue, trauma, thrombin.
- Pre-eclampsia: BP ≥140/90 after 20 weeks plus proteinuria or organ dysfunction. Magnesium sulfate treats eclampsia; monitor reflexes, respiration and urine output.
Worked example
Thirty minutes after vaginal birth the uterus is boggy and blood loss is 700 mL. The nurse first massages the uterus, empties the bladder and starts prescribed oxytocin. Reasoning: uterine atony is the commonest cause of PPH; massage and uterotonics act before invasive measures.
Traps
Using the caesarean threshold for vaginal PPH; giving magnesium sulfate without checking respiratory rate and reflexes; misdating pregnancy from the last menstrual period alone.