Obstetric and Gynaecological Nursing
Obstetric and gynaecological nursing tests antenatal risk detection, labour monitoring, emergency drills and reproductive health. PGIMER favours the 'next action' format, so know the thresholds that trigger referral and the drug regimens used in the labour room.
Core thresholds
- Antenatal care: WHO recommends eight contacts; high-risk indicators include age under 18 or over 35, grand multiparity, previous caesarean, hypertension, anaemia and malpresentation.
- Pre-eclampsia: blood pressure of 140/90 mmHg or more with proteinuria after 20 weeks. Severe features include 160/110 mmHg, platelets below 100,000, raised liver enzymes and visual disturbance.
- Postpartum haemorrhage: 500 mL or more after vaginal birth, 1000 mL or more after caesarean. First actions are uterine massage plus oxytocin, then tranexamic acid, misoprostol and balloon tamponade.
- Active management of the third stage: oxytocin within one minute, controlled cord traction, uterine massage.
Worked example
A woman on magnesium sulphate for eclampsia has a respiratory rate of 11/min, absent knee jerk and urine output of 20 mL/hour. These are magnesium toxicity signs. Stop the infusion, call for help, give oxygen and administer calcium gluconate 10 mL of 10% IV slowly. Reasoning: magnesium depresses neuromuscular transmission; the three bedside checks are deep tendon reflex, respiratory rate above 16 and urine output above 30 mL/hour.
Monitoring in labour
The partograph plots cervical dilatation, descent, fetal heart rate, contractions and maternal vitals; crossing the action line means referral. Normal fetal heart rate is 110–160 beats/min.
Traps
Using magnesium sulphate as a first-line antihypertensive (it is not), forgetting that oxytocin is the first-line uterotonic, and performing a vaginal examination in suspected placenta praevia before it is excluded by ultrasound.