Obstetric and Gynaecological Nursing
Obstetric and Gynaecological Nursing
This domain covers antenatal care, labour, postnatal care and common gynaecological conditions. Calculation of the expected date of delivery, partograph interpretation and emergency management of postpartum haemorrhage are high-yield.
Core rules
- Naegele's rule: expected date of delivery = first day of last menstrual period + 9 months + 7 days, adjusting the year.
- Antenatal care: register in the first trimester; give folic acid 400 micrograms, iron–folic acid and tetanus–diphtheria immunisation; minimum four visits.
- Stages of labour: first stage from onset to full cervical dilatation; second from full dilatation to birth; third from birth to delivery of placenta; fourth is the first hour after delivery.
- Postpartum haemorrhage: more than 500 mL after vaginal birth or 1000 mL after caesarean. Uterine atony is the commonest cause; massage the uterus and give oxytocin.
- Pre-eclampsia: BP at least 140/90 mmHg with proteinuria after 20 weeks. Magnesium sulphate prevents and treats eclampsia; monitor reflexes, respiration and urine output.
Worked example
Last menstrual period 10 March 2025. Add 9 months → 10 December 2025; add 7 days → 17 December 2025. Expected date of delivery is 17 December 2025. If the month number exceeds 12, carry one year forward.
Traps
- Magnesium sulphate toxicity: loss of deep tendon reflexes, respiratory depression, oliguria. Antidote is calcium gluconate.
- Active management of the third stage reduces postpartum haemorrhage.
- Do not give magnesium sulphate if reflexes are absent.