Maternal, Newborn and Reproductive Health Nursing
This domain tests the care of the woman through pregnancy, birth and the postnatal period, and of the newborn in the first hours and days. In Mongolia most births occur in facilities, so the highest-value questions concern postpartum haemorrhage, hypertensive disease of pregnancy, and immediate newborn transition.
Core rules
- Postpartum haemorrhage: 500 mL or more after vaginal birth, 1000 mL or more after caesarean, within 24 hours. Causes follow the four T's: tone (atony, the commonest), trauma, tissue, thrombin.
- Active management of the third stage: oxytocin 10 IU intramuscularly within a minute of birth, controlled cord traction, uterine assessment.
- Pre-eclampsia: BP 140/90 or above after 20 weeks plus proteinuria or organ dysfunction. Severe features include 160/110, headache, visual disturbance, platelets under 100, raised liver enzymes.
- Magnesium sulphate: loading 4-6 g IV, maintenance 1-2 g/h. Monitor respiratory rate (12 or above), patellar reflex and urine output (30 mL/h or more). Antidote: calcium gluconate 1 g IV.
- Newborn: dry immediately, keep warm, assess breathing, delayed cord clamping 1-3 minutes, skin-to-skin contact, exclusive breastfeeding to six months.
Worked example
After a 3.9 kg vaginal birth with a complete placenta, the uterus is boggy and blood loss is estimated at 800 mL; HR 118, BP 95/60. Reasoning: uterine atony with compensated hypovolaemia. Call for help, massage the fundus, empty the bladder, give oxytocin 10 IU IM or as an infusion, give tranexamic acid 1 g IV within three hours of birth, start IV fluids, crossmatch blood, and reassess every 15 minutes. Escalate to balloon tamponade or surgery if bleeding continues.
Traps
Continuing magnesium sulphate when reflexes are absent or respirations fall; assuming a firm fundus excludes concealed bleeding - check for vaginal and vulvar haematoma; using ACE inhibitors in pregnancy; delaying the first newborn assessment while completing paperwork.