Maternal, neonatal and reproductive health nursing
This domain tests intrapartum surveillance, recognition of obstetric emergencies and immediate newborn care. Most items hinge on interpreting fetal heart patterns, blood pressure thresholds in pre-eclampsia, or quantifying postpartum blood loss.
Fetal surveillance
- Baseline rate 110-160/min, variability 6-25/min, accelerations, and decelerations classified as early (head compression, benign), variable (cord compression) or late (uteroplacental insufficiency).
- Late and prolonged decelerations with reduced variability need intrauterine resuscitation: stop oxytocin, left lateral position, intravenous fluid, oxygen if hypoxic, and urgent obstetric review.
Hypertensive disorders
- Pre-eclampsia: BP 140/90 mmHg or more with proteinuria or organ dysfunction. Severe features include BP 160/110 or more, headaches, visual disturbance, epigastric pain, raised liver enzymes, low platelets.
- Magnesium sulfate: loading dose typically 4 g IV over about 20 minutes, then 1-2 g/h. Monitor patellar reflexes, respiratory rate and urine output. Antidote is calcium gluconate 1 g IV.
Postpartum haemorrhage
More than 500 mL after vaginal birth or 1000 mL after caesarean. Cause by the four Ts: tone, trauma, tissue, thrombin. Act with uterine massage, oxytocin 10 IU, tranexamic acid 1 g IV within 3 hours, fluids and escalation.
Newborn
APGAR at 1 and 5 minutes (appearance, pulse, grimace, activity, respiration), skin-to-skin contact, delayed cord clamping where stable, vitamin K prophylaxis, thermoregulation, and early feeding.
Worked example
A labouring woman on oxytocin shows repetitive late decelerations with minimal variability. Reasoning: this is a category III-type pattern suggesting fetal hypoxia from placental insufficiency, so the priority is intrauterine resuscitation and stopping the infusion, not documenting and continuing to observe.
Traps that cost marks
Confusing early with late decelerations; giving magnesium without checking reflexes and respiratory rate; visually underestimating blood loss.