Maternal and Newborn Nursing (Obstetrics)
Maternal and Newborn Nursing asks you to care for two patients simultaneously. The exam tests antenatal risk screening, intrapartum fetal surveillance, postpartum haemorrhage and the hypertensive disorders of pregnancy, plus the newborn's first hours of transition.
Antenatal screening
Folic acid 400 micrograms daily is standard, rising to 4 mg when there is a previous neural tube defect. Gestational diabetes is screened at 24–28 weeks with a 75 g oral glucose tolerance test. Rh-negative mothers receive anti-D immunoglobulin at 28 weeks and within 72 hours of delivery of an Rh-positive infant.
Fetal heart rate interpretation
Baseline is 110–160/min. Early decelerations mirror contractions and reflect head compression; variable decelerations indicate cord compression and call for repositioning; late decelerations signal uteroplacental insufficiency and require left lateral positioning, oxygen, stopping oxytocin and notifying the obstetrician.
Worked example
A woman on magnesium sulfate for severe pre-eclampsia has respirations of 10/min, absent deep tendon reflexes and urine output of 20 mL/h. Reasoning: these are magnesium toxicity signs. Stop the infusion, notify the physician and prepare calcium gluconate 1 g IV as the antidote. Monitoring during infusion is respiratory rate at least 12/min, reflexes present and urine output at least 30 mL/h.
Traps that cost marks
- Giving methylergometrine for postpartum haemorrhage in a pre-eclamptic patient, where it is contraindicated.
- Reading late decelerations as benign head compression.
- Forgetting that the Apgar score is recorded at 1 and 5 minutes but does not decide resuscitation.