Maternal, Newborn, and Reproductive Health Nursing
This domain tests antenatal, intrapartum, postpartum and newborn care, including risk recognition and emergency response.
Core rules and concepts
- GTPAL: gravida, term births, preterm births, abortions, living children. Gravida counts all pregnancies including the current one.
- Pre-eclampsia: blood pressure of 140/90 mmHg or more after 20 weeks with proteinuria or organ dysfunction. Magnesium sulphate prevents seizures; monitor reflexes, respiratory rate and urine output for toxicity.
- Stages of labour: first stage from onset to full dilatation; second stage to birth; third stage to placental delivery; fourth stage the first hour after birth.
- Fetal monitoring: baseline 110–160/min. Early decelerations reflect head compression; variable decelerations reflect cord compression; late decelerations reflect uteroplacental insufficiency.
- Postpartum haemorrhage: uterine atony is the commonest cause; massage the fundus and give oxytocin.
- Apgar: heart rate, respiratory effort, muscle tone, reflex irritability and colour at one and five minutes.
Worked example
During oxytocin infusion, the fetal heart trace shows repetitive late decelerations. Stop the oxytocin, reposition the mother left lateral, give oxygen and an IV fluid bolus, and notify the obstetric team. Late decelerations indicate placental insufficiency, so the priority is to improve uterine blood flow and prepare for possible delivery.
Traps that cost marks
- Confusing variable and late decelerations.
- Missing magnesium toxicity signs: absent reflexes, respiratory depression, oliguria.
- Forgetting that atony is the commonest cause of postpartum haemorrhage.
- Counting the current pregnancy incorrectly in GTPAL.