Obstetric and Gynaecological Nursing
Obstetric and Gynaecological Nursing tests antenatal, intrapartum and postpartum care, contraception and common gynaecological conditions. Expect calculation items on expected date of delivery and gestational age, emergency prioritisation in haemorrhage and eclampsia, and drug safety.
Antenatal essentials
A normal pregnancy has at least four antenatal visits under Indian norms, with the first before 12 weeks. Naegele's rule: add 7 days to the first day of the last menstrual period, subtract 3 months, add 1 year. Iron–folic acid and calcium supplementation, two doses of tetanus–diphtheria vaccine, and haemoglobin, blood group, HIV, syphilis and urine checks are routine.
Labour and postpartum
First stage: 0–10 cm dilatation. Second stage: full dilatation to delivery. Third stage: delivery of the placenta. Postpartum haemorrhage is blood loss above 500 mL after vaginal birth or 1000 mL after caesarean; uterine atony is the commonest cause, so massage the fundus and give uterotonics. Lochia is red for 3–4 days, then serous, then white.
Pre-eclampsia and eclampsia
BP of 140/90 mmHg or more after 20 weeks with proteinuria defines pre-eclampsia. Magnesium sulphate prevents and treats seizures; monitor respiration, deep tendon reflexes and urine output. Calcium gluconate is the antidote for magnesium toxicity.
Worked example
LMP 10 April 2024. Add 7 days: 17 April. Subtract 3 months: 17 January. Add 1 year: 17 January 2025. Expected date of delivery is 17 January 2025.
Traps
Do not give a pregnant woman a live vaccine or an ACE inhibitor. A woman with painless bleeding in late pregnancy may have placenta praevia-never perform a digital vaginal examination before localising the placenta.