Maternal and Newborn Nursing (Antenatal, Intrapartum, Postpartum, Neonatal Care)
This domain covers antenatal, intrapartum, postpartum and neonatal care, emphasising the leading causes of maternal death in Cambodia: postpartum haemorrhage, eclampsia, sepsis and obstructed labour, plus newborn asphyxia and infection.
Antenatal care
Book early and complete at least eight contacts. At each visit check blood pressure, weight, fundal height, fetal heart, urine protein and haemoglobin; give tetanus toxoid, iron–folate, and HIV and syphilis screening; counsel on danger signs - bleeding, severe headache, blurred vision, reduced fetal movement, fever and leaking fluid.
Labour and birth
Plot every observation on a partograph. Perform active management of the third stage: oxytocin 10 IU intramuscularly within one minute of birth, controlled cord traction and uterine massage. Place the newborn on the mother's abdomen, dry and cover, delay cord clamping 1–3 minutes, and initiate breastfeeding within one hour.
Worked example
Two hours after a spontaneous vaginal birth a woman has a boggy uterus, heavy vaginal bleeding and pulse 120. Reasoning: uterine atony is the most likely cause. Action: call for help, massage the fundus, empty the bladder, give oxytocin 10 IU IM plus 20 IU in 500 mL intravenous fluid, start fluids and monitor vital signs and lochia. If bleeding continues, check for retained placenta and genital tract tears. Ergometrine is contraindicated in hypertension.
Traps
Giving magnesium sulfate without checking respiratory rate, deep tendon reflexes and hourly urine output; withholding oxytocin because the birth was normal; wrapping the newborn before skin-to-skin contact; discharging before breastfeeding and bleeding are assessed.