Obstetrics and Gynaecological Nursing
What this domain tests
Antenatal, intrapartum, postpartum and gynaecological nursing: risk identification, maternal monitoring, labour stages, emergency management, contraception and screening.
Core rules
- Naegele's rule: first day of LMP + 7 days − 3 months + 1 year.
- Antenatal danger signs: vaginal bleeding, severe headache or blurred vision, convulsions, fever, reduced fetal movements, leaking.
- Preeclampsia: BP ≥140/90 mmHg after 20 weeks plus proteinuria or organ dysfunction. Magnesium sulfate is for eclampsia or severe preeclampsia; monitor respiratory rate, patellar reflex and urine output.
- Labour: first stage (latent and active), second (full dilatation to birth), third (placental delivery), fourth (first postpartum hour). Signs of placental separation include lengthening cord, gush of blood and rising uterine fundus.
- PPH: the commonest cause is uterine atony; massage the uterus, empty the bladder, give oxytocin, then other uterotonics; remember the four Ts (tone, trauma, tissue, thrombin).
- Gynaecology: cervical screening with Pap or HPV testing; emergency contraception; postpartum IUCD.
Worked example
LMP 10 April 2024. Add 7 days = 17 April; subtract 3 months = 17 January; add 1 year = 17 January 2025. EDD is 17 January 2025. If the cycle is longer than 28 days, adjust by adding the extra days.
Traps
Calculating EDD from the last day of menstruation; giving magnesium without checking reflexes; attributing all PPH to atony and missing retained placenta; and treating preeclampsia with diuretics or ACE inhibitors. Do not confuse the third stage with the fourth stage.