Maternal and Newborn Nursing
Domain 3 spans antenatal care, labour and delivery, the puerperium and immediate newborn care. The exam favours emergency sequencing - postpartum haemorrhage, eclampsia, and newborn resuscitation - plus interpretation of the partograph and the Mother–Child Health booklet.
Antenatal and labour essentials
- WHO recommends eight antenatal contacts; Kenyan records include haemoglobin, blood group, HIV, syphilis, urinalysis and blood pressure at each visit.
- The WHO-modified partograph is plotted from 4 cm dilatation; crossing the alert line signals poor progress and the action line triggers intervention.
- First stage: latent to about 4–5 cm, then active to full dilatation. Second stage runs to birth; third stage to placental delivery; the fourth stage is the first two hours, when bleeding is monitored closely.
Third stage and haemorrhage
- Active management: oxytocin 10 IU IM within one minute of birth, controlled cord traction, then uterine massage and tone assessment.
- Causes of postpartum haemorrhage: tone, trauma, tissue, thrombin. First-line response is uterine massage, empty bladder, oxytocin, IV fluids; add tranexamic acid 1 g IV within 3 hours, then misoprostol 800 micrograms sublingually.
- Eclampsia: magnesium sulphate loading (commonly 4 g IV plus 10 g IM). Monitor respirations ≥16/min, present patellar reflexes and urine ≥30 mL/h; antidote is calcium gluconate 1 g IV.
Worked example
Twenty minutes after a spontaneous birth, a woman has a boggy uterus and estimated 600 mL blood loss. Reasoning: call for help and assess, massage the uterus, empty the bladder, give oxytocin 10 IU IM, start Ringer's lactate, and monitor pulse, BP and blood loss. Escalate to tranexamic acid if bleeding continues. The trap is reaching for a second uterotonic before massage and bladder emptying.
Traps
Giving magnesium sulphate as a rapid undiluted bolus; treating a gush of blood as normal lochia; delaying newborn warming while completing paperwork.