OBSTETRICAL AND GYNECOLOGY 5 MARKS STUDYING MATERIALS
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About This Presentation
OBSTETRICAL AND GYNECOLOGY 5 MARKS STUDYING MATERIALS
Slide Content
OBSTERICAL AND GYNECOLOGICAL NURSING
5 MARKS QUESTION AND ANSWER
1. Placenta Previa
Definition: A condition in which the placenta is implanted in the lower uterine segment and partially or completely covers the cervical
os.
Types:
o Complete: Placenta entirely covers the os.
o Partial: Placenta partially covers the os.
o Marginal: Placental edge reaches the margin of the os.
o Low-lying: Placenta implanted in lower segment but not reaching os.
Risk factors: Multiparity, multiple pregnancy, previous cesarean section, maternal age >35 years, uterine scarring.
Clinical features:
o Painless, recurrent, bright red antepartum hemorrhage.
o Malpresentation of fetus (breech, transverse).
o Soft, relaxed uterus.
Complications: Maternal shock, anemia, postpartum hemorrhage, prematurity, fetal distress/death.
Management:
o Hospitalization and bed rest.
o Blood transfusion if needed.
o Avoid vaginal examination.
o Elective cesarean section if placenta previa persists at term.
2. Levels of Neonatal Care
Definition: Neonatal care is classified into different levels based on the facilities and expertise available.
Levels:
o Level I (Basic care):
Care for normal healthy newborns.
Includes routine postnatal care, breastfeeding support, immunization.
o Level II (Special care):
Care for moderately ill newborns >1500g or >32 weeks.
Management of mild respiratory distress, phototherapy, IV fluids.
Specialized nurses and pediatricians available.
o Level III (Neonatal Intensive Care Unit – NICU):
Care for very sick neonates <1500g or <32 weeks.
Advanced monitoring, ventilators, surfactant therapy, parenteral nutrition.
Continuous nursing care and neonatologist supervision.
o Level IV (Advanced NICU – in some systems):
Surgical care for congenital anomalies.
ECMO (Extracorporeal Membrane Oxygenation).
Importance: Reduces neonatal morbidity and mortality, ensures specialized support for high-risk babies.
3. Caesarean Section
Definition: Surgical delivery of the fetus through an incision made in the abdominal wall (laparotomy) and uterus (hysterotomy).
Indications:
o Maternal: Cephalopelvic disproportion (CPD), obstructed labor, placenta previa, severe preeclampsia, previous cesarean.
o Fetal: Fetal distress, malpresentations (breech, transverse lie), multiple pregnancy complications.
Types:
o Lower Segment Cesarean Section (LSCS) – most common.
o Classical Cesarean Section (vertical incision on uterus, rarely used).
Procedure steps:
o Abdominal incision → Uterine incision → Delivery of baby → Removal of placenta → Suturing.
Complications:
o Maternal: Hemorrhage, infection, injury to bladder/bowel, thromboembolism.
o Fetal: Respiratory distress, accidental injury.
Nursing care: Preoperative preparation, postoperative monitoring (vital signs, bleeding, wound care), early ambulation, breastfeeding
support.
5 MARKS QUESTION AND ANSWER
1. Placenta Previa
Definition: A condition in which the placenta is implanted in the lower uterine segment and partially or completely covers the cervical
os.
Types:
o Complete: Placenta entirely covers the os.
o Partial: Placenta partially covers the os.
o Marginal: Placental edge reaches the margin of the os.
o Low-lying: Placenta implanted in lower segment but not reaching os.
Risk factors: Multiparity, multiple pregnancy, previous cesarean section, maternal age >35 years, uterine scarring.
Clinical features:
o Painless, recurrent, bright red antepartum hemorrhage.
o Malpresentation of fetus (breech, transverse).
o Soft, relaxed uterus.
Complications: Maternal shock, anemia, postpartum hemorrhage, prematurity, fetal distress/death.
Management:
o Hospitalization and bed rest.
o Blood transfusion if needed.
o Avoid vaginal examination.
o Elective cesarean section if placenta previa persists at term.
2. Levels of Neonatal Care
Definition: Neonatal care is classified into different levels based on the facilities and expertise available.
Levels:
o Level I (Basic care):
Care for normal healthy newborns.
Includes routine postnatal care, breastfeeding support, immunization.
o Level II (Special care):
Care for moderately ill newborns >1500g or >32 weeks.
Management of mild respiratory distress, phototherapy, IV fluids.
Specialized nurses and pediatricians available.
o Level III (Neonatal Intensive Care Unit – NICU):
Care for very sick neonates <1500g or <32 weeks.
Advanced monitoring, ventilators, surfactant therapy, parenteral nutrition.
Continuous nursing care and neonatologist supervision.
o Level IV (Advanced NICU – in some systems):
Surgical care for congenital anomalies.
ECMO (Extracorporeal Membrane Oxygenation).
Importance: Reduces neonatal morbidity and mortality, ensures specialized support for high-risk babies.
3. Caesarean Section
Definition: Surgical delivery of the fetus through an incision made in the abdominal wall (laparotomy) and uterus (hysterotomy).
Indications:
o Maternal: Cephalopelvic disproportion (CPD), obstructed labor, placenta previa, severe preeclampsia, previous cesarean.
o Fetal: Fetal distress, malpresentations (breech, transverse lie), multiple pregnancy complications.
Types:
o Lower Segment Cesarean Section (LSCS) – most common.
o Classical Cesarean Section (vertical incision on uterus, rarely used).
Procedure steps:
o Abdominal incision → Uterine incision → Delivery of baby → Removal of placenta → Suturing.
Complications:
o Maternal: Hemorrhage, infection, injury to bladder/bowel, thromboembolism.
o Fetal: Respiratory distress, accidental injury.
Nursing care: Preoperative preparation, postoperative monitoring (vital signs, bleeding, wound care), early ambulation, breastfeeding
support.
4. Multiple Pregnancy
Definition: Pregnancy in which more than one fetus develops simultaneously in the uterus.
Types:
o Dizygotic (Fraternal): Fertilization of two separate ova by two sperm.
o Monozygotic (Identical): Division of single fertilized ovum into two embryos.
Risk factors: Family history of twins, advanced maternal age, use of fertility drugs/assisted reproductive technology, multiparity.
Complications:
o Maternal: Hyperemesis gravidarum, anemia, preeclampsia, preterm labor, polyhydramnios, postpartum hemorrhage.
o Fetal: Prematurity, growth restriction, congenital anomalies, twin-to-twin transfusion syndrome (TTTS).
Diagnosis: Ultrasound, clinical signs (large uterine size, palpation of multiple fetal poles, multiple fetal heart sounds).
Management:
o Regular antenatal care and ultrasound monitoring.
o Iron, folic acid, nutritional support.
o Hospital delivery with facilities for cesarean section and NICU
5. Puerperal Sepsis
Definition: Infection of the genital tract occurring at any time between rupture of membranes or labor and the 42nd day postpartum,
characterized by fever, pelvic pain, abnormal vaginal discharge, and delayed involution of the uterus.
Causative organisms: Streptococcus, Staphylococcus, E. coli, anaerobes.
Risk factors: Prolonged labor, premature rupture of membranes, frequent vaginal examinations, poor aseptic technique, cesarean
delivery.
Clinical features:
o Fever (>38°C) within 10 days postpartum.
o Offensive, purulent lochia.
o Lower abdominal pain, uterine tenderness.
o Tachycardia, malaise, septicemia in severe cases.
Complications: Septicemia, peritonitis, septic shock, infertility, maternal death.
Prevention:
o Strict aseptic technique in labor and delivery.
o Prophylactic antibiotics in high-risk cases.
o Proper perineal hygiene.
Management:
o Broad-spectrum IV antibiotics.
o Drainage of abscess if present.
o Fluid replacement and supportive care.
o Removal of retained products if any.
1-Fetal Circulation
Definition: The system of blood circulation in the fetus that allows oxygen and nutrients from the placenta to reach the fetus while
bypassing the lungs (which are non-functional before birth).
Key Features:
o Placenta: Site of gas exchange.
o Umbilical vein: Carries oxygenated blood from placenta to fetus.
o Ductus venosus: Shunts blood from umbilical vein to inferior vena cava (bypasses liver).
o Foramen ovale: Opening between right and left atria, allowing blood to bypass lungs.
o Ductus arteriosus: Connects pulmonary artery to descending aorta (bypasses pulmonary circulation).
o Umbilical arteries: Carry deoxygenated blood from fetus back to placenta.
Circulatory Pathway:
Placenta → Umbilical vein → Ductus venosus → Inferior vena cava → Right atrium → Foramen ovale → Left atrium → Left
ventricle → Aorta → Body → Umbilical arteries → Placenta.
At Birth: Umbilical cord is clamped → lungs expand → shunts close → normal postnatal circulation begins.
2. Breast Complications in Puerperium
Engorgement:
o Swelling, heaviness, pain due to milk accumulation.
o Management: Frequent breastfeeding, breast support, warm compress before feeding, cold compress after.
Cracked Nipples:
Definition: Pregnancy in which more than one fetus develops simultaneously in the uterus.
Types:
o Dizygotic (Fraternal): Fertilization of two separate ova by two sperm.
o Monozygotic (Identical): Division of single fertilized ovum into two embryos.
Risk factors: Family history of twins, advanced maternal age, use of fertility drugs/assisted reproductive technology, multiparity.
Complications:
o Maternal: Hyperemesis gravidarum, anemia, preeclampsia, preterm labor, polyhydramnios, postpartum hemorrhage.
o Fetal: Prematurity, growth restriction, congenital anomalies, twin-to-twin transfusion syndrome (TTTS).
Diagnosis: Ultrasound, clinical signs (large uterine size, palpation of multiple fetal poles, multiple fetal heart sounds).
Management:
o Regular antenatal care and ultrasound monitoring.
o Iron, folic acid, nutritional support.
o Hospital delivery with facilities for cesarean section and NICU
5. Puerperal Sepsis
Definition: Infection of the genital tract occurring at any time between rupture of membranes or labor and the 42nd day postpartum,
characterized by fever, pelvic pain, abnormal vaginal discharge, and delayed involution of the uterus.
Causative organisms: Streptococcus, Staphylococcus, E. coli, anaerobes.
Risk factors: Prolonged labor, premature rupture of membranes, frequent vaginal examinations, poor aseptic technique, cesarean
delivery.
Clinical features:
o Fever (>38°C) within 10 days postpartum.
o Offensive, purulent lochia.
o Lower abdominal pain, uterine tenderness.
o Tachycardia, malaise, septicemia in severe cases.
Complications: Septicemia, peritonitis, septic shock, infertility, maternal death.
Prevention:
o Strict aseptic technique in labor and delivery.
o Prophylactic antibiotics in high-risk cases.
o Proper perineal hygiene.
Management:
o Broad-spectrum IV antibiotics.
o Drainage of abscess if present.
o Fluid replacement and supportive care.
o Removal of retained products if any.
1-Fetal Circulation
Definition: The system of blood circulation in the fetus that allows oxygen and nutrients from the placenta to reach the fetus while
bypassing the lungs (which are non-functional before birth).
Key Features:
o Placenta: Site of gas exchange.
o Umbilical vein: Carries oxygenated blood from placenta to fetus.
o Ductus venosus: Shunts blood from umbilical vein to inferior vena cava (bypasses liver).
o Foramen ovale: Opening between right and left atria, allowing blood to bypass lungs.
o Ductus arteriosus: Connects pulmonary artery to descending aorta (bypasses pulmonary circulation).
o Umbilical arteries: Carry deoxygenated blood from fetus back to placenta.
Circulatory Pathway:
Placenta → Umbilical vein → Ductus venosus → Inferior vena cava → Right atrium → Foramen ovale → Left atrium → Left
ventricle → Aorta → Body → Umbilical arteries → Placenta.
At Birth: Umbilical cord is clamped → lungs expand → shunts close → normal postnatal circulation begins.
2. Breast Complications in Puerperium
Engorgement:
o Swelling, heaviness, pain due to milk accumulation.
o Management: Frequent breastfeeding, breast support, warm compress before feeding, cold compress after.
Cracked Nipples:
o Due to improper latching or dryness.
o Painful, risk of infection.
o Management: Correct feeding technique, nipple creams, avoid harsh soaps.
Mastitis:
o Inflammation of breast, often caused by Staphylococcus aureus.
o Symptoms: Pain, swelling, redness, fever.
o Management: Antibiotics, analgesics, continued breastfeeding, warm compress.
Breast Abscess:
o Collection of pus following untreated mastitis.
o Symptoms: Localized painful swelling, fever, fluctuant lump.
o Management: Incision and drainage + antibiotics.
Inverted Nipples:
o Congenital or due to scarring, leading to difficulty in breastfeeding.
o Management: Nipple exercises, breast shells, correct positioning.
3. Adaptation of Newborn
Respiratory Adaptation:
o First breath occurs within seconds of birth.
o Lungs expand, pulmonary circulation increases, closure of foramen ovale and ductus arteriosus.
Cardiovascular Adaptation:
o Increased systemic vascular resistance.
o Closure of fetal shunts (ductus venosus, foramen ovale, ductus arteriosus).
Thermal Adaptation:
o Newborn shifts from warm intrauterine environment to cooler outside world.
o Heat regulation through brown fat metabolism.
Metabolic Adaptation:
o Glucose levels fall initially; baby depends on glycogen stores.
Renal Adaptation:
o Immature kidney function; limited ability to concentrate urine.
Gastrointestinal Adaptation:
o Passage of meconium within 24 hrs.
Immunological Adaptation:
o Passive immunity from maternal IgG antibodies.
4. Hyperemesis Gravidarum
Definition: Severe, persistent nausea and vomiting during pregnancy leading to dehydration, electrolyte imbalance, weight loss, and
ketosis.
Etiology:
o High levels of hCG.
o Multiple pregnancy, molar pregnancy.
o Psychological factors, endocrine disturbances (thyroid).
Clinical Features:
o Excessive vomiting.
o Dehydration, weight loss, tachycardia, hypotension.
o Ketosis (acetone breath, ketonuria).
o Electrolyte imbalance (hypokalemia, hyponatremia).
Complications:
o Wernicke’s encephalopathy (due to Vitamin B1 deficiency).
o Liver and kidney dysfunction.
Management:
o Hospitalization and IV fluids.
o Electrolyte correction.
o Antiemetics (metoclopramide, ondansetron).
o Vitamin supplementation (B1, B6).
o Gradual oral feeding as tolerated.
5. Placental Separation
o Painful, risk of infection.
o Management: Correct feeding technique, nipple creams, avoid harsh soaps.
Mastitis:
o Inflammation of breast, often caused by Staphylococcus aureus.
o Symptoms: Pain, swelling, redness, fever.
o Management: Antibiotics, analgesics, continued breastfeeding, warm compress.
Breast Abscess:
o Collection of pus following untreated mastitis.
o Symptoms: Localized painful swelling, fever, fluctuant lump.
o Management: Incision and drainage + antibiotics.
Inverted Nipples:
o Congenital or due to scarring, leading to difficulty in breastfeeding.
o Management: Nipple exercises, breast shells, correct positioning.
3. Adaptation of Newborn
Respiratory Adaptation:
o First breath occurs within seconds of birth.
o Lungs expand, pulmonary circulation increases, closure of foramen ovale and ductus arteriosus.
Cardiovascular Adaptation:
o Increased systemic vascular resistance.
o Closure of fetal shunts (ductus venosus, foramen ovale, ductus arteriosus).
Thermal Adaptation:
o Newborn shifts from warm intrauterine environment to cooler outside world.
o Heat regulation through brown fat metabolism.
Metabolic Adaptation:
o Glucose levels fall initially; baby depends on glycogen stores.
Renal Adaptation:
o Immature kidney function; limited ability to concentrate urine.
Gastrointestinal Adaptation:
o Passage of meconium within 24 hrs.
Immunological Adaptation:
o Passive immunity from maternal IgG antibodies.
4. Hyperemesis Gravidarum
Definition: Severe, persistent nausea and vomiting during pregnancy leading to dehydration, electrolyte imbalance, weight loss, and
ketosis.
Etiology:
o High levels of hCG.
o Multiple pregnancy, molar pregnancy.
o Psychological factors, endocrine disturbances (thyroid).
Clinical Features:
o Excessive vomiting.
o Dehydration, weight loss, tachycardia, hypotension.
o Ketosis (acetone breath, ketonuria).
o Electrolyte imbalance (hypokalemia, hyponatremia).
Complications:
o Wernicke’s encephalopathy (due to Vitamin B1 deficiency).
o Liver and kidney dysfunction.
Management:
o Hospitalization and IV fluids.
o Electrolyte correction.
o Antiemetics (metoclopramide, ondansetron).
o Vitamin supplementation (B1, B6).
o Gradual oral feeding as tolerated.
5. Placental Separation
Definition: Process by which placenta separates from the uterine wall after birth of the baby, during the third stage of labor.
Mechanism:
o Schultze method (80%): Separation begins at center, placenta delivered shiny fetal surface first (“shiny Schultze”).
o Matthews Duncan method (20%): Separation begins at margin, placenta delivered maternal surface first (“dirty Duncan”).
Signs of Separation:
o Uterus becomes firm, globular, rises in abdomen.
o Sudden gush of blood.
o Umbilical cord lengthens outside vulva.
Management:
o Wait for natural separation.
o Controlled cord traction with uterine support (Brandt–Andrews method).
o Inspect placenta and membranes for completeness after expulsion.
Complications:
o Retained placenta, postpartum hemorrhage, shock, infection
1. Fetal Skull
Definition: The fetal skull is the bony structure of the head that protects the brain and plays an important role in labor and delivery.
Regions:
o Vault: Large dome-shaped part, compressible.
o Base: Firm and ossified, non-compressible.
o Face: Small portion, immovable.
Bones: 2 frontal, 2 parietal, 2 temporal, 1 occipital, 1 sphenoid, 1 ethmoid.
Sutures:
o Sagittal (between parietal bones),
o Coronal (between frontal & parietal),
o Lambdoid (between parietal & occipital).
Fontanelles:
o Anterior fontanelle (bregma, diamond-shaped, closes by 18 months).
o Posterior fontanelle (lambda, triangular, closes by 6–8 weeks).
Diameters important in obstetrics:
o Suboccipito-bregmatic (9.5 cm) – engaged in vertex presentation.
o Biparietal (9.5 cm) – transverse diameter.
o Occipitofrontal (11.5 cm).
Clinical significance: Knowledge of diameters, sutures, and fontanelles helps in labor management, molding, and identifying fetal
position.
2. Postnatal Exercises
Definition: Exercises performed by the mother after delivery to restore muscle tone, improve circulation, and promote recovery.
Benefits:
o Strengthens abdominal and pelvic floor muscles.
o Prevents prolapse and incontinence.
o Improves posture and circulation.
o Aids in weight reduction and psychological well-being.
Types:
o Breathing exercises – deep breathing, abdominal breathing.
o Pelvic floor (Kegel’s) exercises – contraction and relaxation of perineal muscles.
o Abdominal tightening – strengthens abdominal wall.
o Leg raising and stretching – improves circulation, prevents thrombosis.
o Walking – gradual mobilization.
Precautions:
o Start gently after 24–48 hrs in normal delivery (later after cesarean).
o Avoid overexertion.
o Gradually increase intensity.
3. Hyperemesis Gravidarum
Definition: Severe, persistent vomiting in pregnancy leading to dehydration, weight loss, electrolyte imbalance, and ketosis.
Mechanism:
o Schultze method (80%): Separation begins at center, placenta delivered shiny fetal surface first (“shiny Schultze”).
o Matthews Duncan method (20%): Separation begins at margin, placenta delivered maternal surface first (“dirty Duncan”).
Signs of Separation:
o Uterus becomes firm, globular, rises in abdomen.
o Sudden gush of blood.
o Umbilical cord lengthens outside vulva.
Management:
o Wait for natural separation.
o Controlled cord traction with uterine support (Brandt–Andrews method).
o Inspect placenta and membranes for completeness after expulsion.
Complications:
o Retained placenta, postpartum hemorrhage, shock, infection
1. Fetal Skull
Definition: The fetal skull is the bony structure of the head that protects the brain and plays an important role in labor and delivery.
Regions:
o Vault: Large dome-shaped part, compressible.
o Base: Firm and ossified, non-compressible.
o Face: Small portion, immovable.
Bones: 2 frontal, 2 parietal, 2 temporal, 1 occipital, 1 sphenoid, 1 ethmoid.
Sutures:
o Sagittal (between parietal bones),
o Coronal (between frontal & parietal),
o Lambdoid (between parietal & occipital).
Fontanelles:
o Anterior fontanelle (bregma, diamond-shaped, closes by 18 months).
o Posterior fontanelle (lambda, triangular, closes by 6–8 weeks).
Diameters important in obstetrics:
o Suboccipito-bregmatic (9.5 cm) – engaged in vertex presentation.
o Biparietal (9.5 cm) – transverse diameter.
o Occipitofrontal (11.5 cm).
Clinical significance: Knowledge of diameters, sutures, and fontanelles helps in labor management, molding, and identifying fetal
position.
2. Postnatal Exercises
Definition: Exercises performed by the mother after delivery to restore muscle tone, improve circulation, and promote recovery.
Benefits:
o Strengthens abdominal and pelvic floor muscles.
o Prevents prolapse and incontinence.
o Improves posture and circulation.
o Aids in weight reduction and psychological well-being.
Types:
o Breathing exercises – deep breathing, abdominal breathing.
o Pelvic floor (Kegel’s) exercises – contraction and relaxation of perineal muscles.
o Abdominal tightening – strengthens abdominal wall.
o Leg raising and stretching – improves circulation, prevents thrombosis.
o Walking – gradual mobilization.
Precautions:
o Start gently after 24–48 hrs in normal delivery (later after cesarean).
o Avoid overexertion.
o Gradually increase intensity.
3. Hyperemesis Gravidarum
Definition: Severe, persistent vomiting in pregnancy leading to dehydration, weight loss, electrolyte imbalance, and ketosis.
Etiology:
o High levels of hCG and estrogen.
o Multiple pregnancy, molar pregnancy.
o Psychological stress, thyroid dysfunction.
Clinical Features:
o Excessive vomiting, dehydration, dry tongue.
o Weight loss, tachycardia, hypotension.
o Electrolyte imbalance (hypokalemia, hyponatremia).
o Ketonuria, acetone breath.
Complications:
o Wernicke’s encephalopathy (vitamin B1 deficiency).
o Renal & liver dysfunction.
o Risk of abortion.
Management:
o Hospitalization with IV fluids.
o Correction of electrolyte imbalance.
o Antiemetics (ondansetron, metoclopramide).
o Vitamin supplementation (B1, B6).
o Gradual oral refeeding.
4. Intrauterine Contraceptive Devices (IUCDs)
Definition: Small devices inserted into the uterus to prevent pregnancy.
Types:
o Non-medicated: Lippes Loop.
o Copper-bearing (CuT 380A, CuT 375, Multiload) – copper ions impair sperm motility & viability.
o Hormone-releasing (Mirena, Progestasert) – release levonorgestrel or progesterone, thickens cervical mucus & inhibits
ovulation.
Mechanism of Action:
o Prevent fertilization by impairing sperm transport.
o Copper ions are spermicidal.
o Hormonal IUCDs cause endometrial changes and prevent implantation.
Advantages:
o Long-term (3–10 years).
o Highly effective and reversible.
o Safe during lactation.
Complications:
o Pain, bleeding, pelvic infection, perforation, expulsion.
Contraindications:
o Pelvic inflammatory disease, undiagnosed uterine bleeding, genital cancer, pregnancy.
5. Amniocentesis
Definition: A prenatal diagnostic procedure in which amniotic fluid is aspirated from the amniotic sac using a needle, usually between
15–18 weeks of gestation.
Indications:
o Genetic diagnosis (Down syndrome, sickle cell disease, thalassemia).
o Detection of neural tube defects (α-fetoprotein levels).
o Assessment of fetal lung maturity (L/S ratio).
o Rh incompatibility (bilirubin level in amniotic fluid).
Procedure:
o Performed under ultrasound guidance.
o A fine needle is inserted through the abdominal wall into the uterus.
o 15–20 ml of amniotic fluid withdrawn.
Risks/Complications:
o Miscarriage (<1%).
o Leakage of fluid.
o Infection, needle injury to fetus, preterm labor.
Nursing Responsibilities:
o Obtain informed consent.
o Explain procedure to mother.
o Monitor vital signs and fetal heart rate.
o Observe for vaginal bleeding, leakage of fluid, or pain after procedure.
o High levels of hCG and estrogen.
o Multiple pregnancy, molar pregnancy.
o Psychological stress, thyroid dysfunction.
Clinical Features:
o Excessive vomiting, dehydration, dry tongue.
o Weight loss, tachycardia, hypotension.
o Electrolyte imbalance (hypokalemia, hyponatremia).
o Ketonuria, acetone breath.
Complications:
o Wernicke’s encephalopathy (vitamin B1 deficiency).
o Renal & liver dysfunction.
o Risk of abortion.
Management:
o Hospitalization with IV fluids.
o Correction of electrolyte imbalance.
o Antiemetics (ondansetron, metoclopramide).
o Vitamin supplementation (B1, B6).
o Gradual oral refeeding.
4. Intrauterine Contraceptive Devices (IUCDs)
Definition: Small devices inserted into the uterus to prevent pregnancy.
Types:
o Non-medicated: Lippes Loop.
o Copper-bearing (CuT 380A, CuT 375, Multiload) – copper ions impair sperm motility & viability.
o Hormone-releasing (Mirena, Progestasert) – release levonorgestrel or progesterone, thickens cervical mucus & inhibits
ovulation.
Mechanism of Action:
o Prevent fertilization by impairing sperm transport.
o Copper ions are spermicidal.
o Hormonal IUCDs cause endometrial changes and prevent implantation.
Advantages:
o Long-term (3–10 years).
o Highly effective and reversible.
o Safe during lactation.
Complications:
o Pain, bleeding, pelvic infection, perforation, expulsion.
Contraindications:
o Pelvic inflammatory disease, undiagnosed uterine bleeding, genital cancer, pregnancy.
5. Amniocentesis
Definition: A prenatal diagnostic procedure in which amniotic fluid is aspirated from the amniotic sac using a needle, usually between
15–18 weeks of gestation.
Indications:
o Genetic diagnosis (Down syndrome, sickle cell disease, thalassemia).
o Detection of neural tube defects (α-fetoprotein levels).
o Assessment of fetal lung maturity (L/S ratio).
o Rh incompatibility (bilirubin level in amniotic fluid).
Procedure:
o Performed under ultrasound guidance.
o A fine needle is inserted through the abdominal wall into the uterus.
o 15–20 ml of amniotic fluid withdrawn.
Risks/Complications:
o Miscarriage (<1%).
o Leakage of fluid.
o Infection, needle injury to fetus, preterm labor.
Nursing Responsibilities:
o Obtain informed consent.
o Explain procedure to mother.
o Monitor vital signs and fetal heart rate.
o Observe for vaginal bleeding, leakage of fluid, or pain after procedure.
1. Functions of Placenta
Definition: Placenta is a temporary organ that develops during pregnancy, connecting the fetus to the uterine wall. It is the life-line of the fetus
ensuring growth, nutrition, and survival until birth.
Functions:
1. Respiratory function
o Placenta acts as the lung of the fetus.
o Oxygen diffuses from maternal blood to fetal blood, CO₂ diffuses in reverse direction.
2. Nutritive function
o Supplies glucose, amino acids, fatty acids, vitamins, minerals, and electrolytes.
o Ensures growth and development of fetus.
3. Excretory function
o Removes waste products like urea, uric acid, creatinine into maternal blood for excretion.
4. Endocrine function
o Secretes hormones:
hCG → maintains corpus luteum.
Progesterone → maintains pregnancy, prevents uterine contractions.
Estrogen → uterine growth, breast changes.
hPL → regulates maternal metabolism to favor fetal nutrition.
5. Barrier function
o Protects fetus from many bacteria and large molecules.
o Some viruses (HIV, Rubella) and drugs (alcohol, nicotine) can cross.
6. Immunological function
o Transfers maternal IgG antibodies → provides passive immunity to the fetus.
Conclusion: Placenta is a vital multifunctional organ that supports the fetus until delivery.
2. Cord Abnormalities
Definition: Umbilical cord connects fetus to placenta, normally 50 cm long with 2 arteries and 1 vein. Abnormalities cause maternal-fetal
complications.
Types of abnormalities:
1. Length abnormalities
o Too short (<35 cm) → obstructed labor, abruption, cord rupture.
o Too long (>100 cm) → entanglement, cord prolapse, knots.
2. Knot abnormalities
o True knot: tight knot compresses vessels → fetal distress/death.
o False knot: vessel redundancy → no clinical problem.
3. Number abnormalities
o Single umbilical artery → associated with congenital anomalies.
4. Insertion abnormalities
o Marginal or velamentous insertion → prone to rupture and bleeding.
5. Cord prolapse
o Cord slips into vagina before fetus → acute emergency with fetal hypoxia.
Conclusion: Timely diagnosis and management of cord abnormalities are essential to prevent fetal morbidity and mortality.
3. Antenatal Exercises
Definition: Specially designed exercises for pregnant women to promote maternal health, flexibility, and prepare body for labor and delivery.
Benefits:
Improves circulation, prevents varicose veins.
Strengthens pelvic muscles.
Definition: Placenta is a temporary organ that develops during pregnancy, connecting the fetus to the uterine wall. It is the life-line of the fetus
ensuring growth, nutrition, and survival until birth.
Functions:
1. Respiratory function
o Placenta acts as the lung of the fetus.
o Oxygen diffuses from maternal blood to fetal blood, CO₂ diffuses in reverse direction.
2. Nutritive function
o Supplies glucose, amino acids, fatty acids, vitamins, minerals, and electrolytes.
o Ensures growth and development of fetus.
3. Excretory function
o Removes waste products like urea, uric acid, creatinine into maternal blood for excretion.
4. Endocrine function
o Secretes hormones:
hCG → maintains corpus luteum.
Progesterone → maintains pregnancy, prevents uterine contractions.
Estrogen → uterine growth, breast changes.
hPL → regulates maternal metabolism to favor fetal nutrition.
5. Barrier function
o Protects fetus from many bacteria and large molecules.
o Some viruses (HIV, Rubella) and drugs (alcohol, nicotine) can cross.
6. Immunological function
o Transfers maternal IgG antibodies → provides passive immunity to the fetus.
Conclusion: Placenta is a vital multifunctional organ that supports the fetus until delivery.
2. Cord Abnormalities
Definition: Umbilical cord connects fetus to placenta, normally 50 cm long with 2 arteries and 1 vein. Abnormalities cause maternal-fetal
complications.
Types of abnormalities:
1. Length abnormalities
o Too short (<35 cm) → obstructed labor, abruption, cord rupture.
o Too long (>100 cm) → entanglement, cord prolapse, knots.
2. Knot abnormalities
o True knot: tight knot compresses vessels → fetal distress/death.
o False knot: vessel redundancy → no clinical problem.
3. Number abnormalities
o Single umbilical artery → associated with congenital anomalies.
4. Insertion abnormalities
o Marginal or velamentous insertion → prone to rupture and bleeding.
5. Cord prolapse
o Cord slips into vagina before fetus → acute emergency with fetal hypoxia.
Conclusion: Timely diagnosis and management of cord abnormalities are essential to prevent fetal morbidity and mortality.
3. Antenatal Exercises
Definition: Specially designed exercises for pregnant women to promote maternal health, flexibility, and prepare body for labor and delivery.
Benefits:
Improves circulation, prevents varicose veins.
Strengthens pelvic muscles.
Reduces backache and constipation.
Helps in easier and shorter labor.
Improves mental well-being.
Types:
Breathing exercises → deep breathing, relaxation.
Pelvic rocking → relieves backache, improves posture.
Kegel’s (pelvic floor exercises) → strengthens perineum, prevents prolapse & incontinence.
Squatting exercises → widens pelvic outlet, facilitates normal delivery.
Walking and light stretching → maintains overall fitness.
Precautions: Avoid heavy exercise, stop if pain/dizziness, contraindicated in high-risk pregnancy (placenta previa, preeclampsia).
Conclusion: Antenatal exercises ensure safe pregnancy and better postnatal recovery.
4. Fetal Distress
Definition: Clinical and biochemical signs indicating fetus is compromised and not well oxygenated.
Causes:
Placental insufficiency.
Cord prolapse or compression.
Obstructed/prolonged labor.
Maternal anemia, hypertension, preeclampsia.
Clinical Signs:
FHR abnormalities (<110 or >160 bpm).
Irregular heart sounds or late decelerations.
Meconium-stained liquor.
Decreased fetal movements.
Diagnosis:
Non-stress test.
Cardiotocography.
Fetal blood sampling (pH, lactate).
Management:
Position mother in left lateral position.
Stop oxytocin infusion.
Give oxygen.
Correct maternal hypotension with IV fluids.
Expedite delivery (forceps/cesarean) if distress persists.
Conclusion: Prompt recognition and intervention reduce perinatal morbidity and mortality.
5. Hydatidiform Mole
Definition: A type of gestational trophoblastic disease with abnormal proliferation of trophoblastic tissue and swelling of chorionic villi.
Types:
Helps in easier and shorter labor.
Improves mental well-being.
Types:
Breathing exercises → deep breathing, relaxation.
Pelvic rocking → relieves backache, improves posture.
Kegel’s (pelvic floor exercises) → strengthens perineum, prevents prolapse & incontinence.
Squatting exercises → widens pelvic outlet, facilitates normal delivery.
Walking and light stretching → maintains overall fitness.
Precautions: Avoid heavy exercise, stop if pain/dizziness, contraindicated in high-risk pregnancy (placenta previa, preeclampsia).
Conclusion: Antenatal exercises ensure safe pregnancy and better postnatal recovery.
4. Fetal Distress
Definition: Clinical and biochemical signs indicating fetus is compromised and not well oxygenated.
Causes:
Placental insufficiency.
Cord prolapse or compression.
Obstructed/prolonged labor.
Maternal anemia, hypertension, preeclampsia.
Clinical Signs:
FHR abnormalities (<110 or >160 bpm).
Irregular heart sounds or late decelerations.
Meconium-stained liquor.
Decreased fetal movements.
Diagnosis:
Non-stress test.
Cardiotocography.
Fetal blood sampling (pH, lactate).
Management:
Position mother in left lateral position.
Stop oxytocin infusion.
Give oxygen.
Correct maternal hypotension with IV fluids.
Expedite delivery (forceps/cesarean) if distress persists.
Conclusion: Prompt recognition and intervention reduce perinatal morbidity and mortality.
5. Hydatidiform Mole
Definition: A type of gestational trophoblastic disease with abnormal proliferation of trophoblastic tissue and swelling of chorionic villi.
Types:
Complete mole: No fetus, only abnormal villi.
Partial mole: Fetus may be present but abnormal.
Clinical Features:
Vaginal bleeding (early pregnancy).
Excessive nausea/vomiting.
Uterus larger than expected for gestational age.
Absent fetal heart sounds.
High hCG levels.
“Snowstorm” appearance on ultrasound.
Complications:
Hemorrhage, anemia.
Infection.
Persistent trophoblastic disease.
Choriocarcinoma.
Management:
Evacuation by suction and curettage.
Monitor serum hCG until normal for 1 year.
Contraception advised during follow-up.
Conclusion: Early diagnosis and follow-up are crucial to prevent complications like malignancy.
1. HIV Prenatal Care Management
Definition: HIV (Human Immunodeficiency Virus) infection in pregnancy requires specialized prenatal care to reduce maternal complications
and prevent Mother-to-Child Transmission (MTCT).
Goals:
Protect health of mother.
Prevent transmission of HIV to fetus.
Ensure safe labor and postnatal care.
Management:
1. Counseling & Testing
o Early antenatal HIV screening (ELISA/rapid tests).
o Pre-test and post-test counseling.
2. Antiretroviral Therapy (ART)
o All HIV-positive mothers must continue lifelong ART (e.g., Tenofovir + Lamivudine + Efavirenz).
o Reduces viral load and MTCT risk.
3. Antenatal Care
o Treat opportunistic infections.
o Manage anemia, malnutrition, and TB if present.
o Regular monitoring of CD4 count and viral load.
4. Intrapartum Care
o Elective cesarean section if viral load is high.
o Avoid prolonged labor, rupture of membranes, unnecessary instrumentation.
o Universal precautions for health workers.
5. Postnatal Care
o Neonate: prophylactic ART (Nevirapine/Syrup AZT).
o Breastfeeding: exclusive breastfeeding recommended if safe alternatives are not available.
o Mixed feeding avoided (↑ transmission risk).
o Family planning advice.
Conclusion: With ART and proper obstetric care, MTCT of HIV can be reduced to <2%.
Partial mole: Fetus may be present but abnormal.
Clinical Features:
Vaginal bleeding (early pregnancy).
Excessive nausea/vomiting.
Uterus larger than expected for gestational age.
Absent fetal heart sounds.
High hCG levels.
“Snowstorm” appearance on ultrasound.
Complications:
Hemorrhage, anemia.
Infection.
Persistent trophoblastic disease.
Choriocarcinoma.
Management:
Evacuation by suction and curettage.
Monitor serum hCG until normal for 1 year.
Contraception advised during follow-up.
Conclusion: Early diagnosis and follow-up are crucial to prevent complications like malignancy.
1. HIV Prenatal Care Management
Definition: HIV (Human Immunodeficiency Virus) infection in pregnancy requires specialized prenatal care to reduce maternal complications
and prevent Mother-to-Child Transmission (MTCT).
Goals:
Protect health of mother.
Prevent transmission of HIV to fetus.
Ensure safe labor and postnatal care.
Management:
1. Counseling & Testing
o Early antenatal HIV screening (ELISA/rapid tests).
o Pre-test and post-test counseling.
2. Antiretroviral Therapy (ART)
o All HIV-positive mothers must continue lifelong ART (e.g., Tenofovir + Lamivudine + Efavirenz).
o Reduces viral load and MTCT risk.
3. Antenatal Care
o Treat opportunistic infections.
o Manage anemia, malnutrition, and TB if present.
o Regular monitoring of CD4 count and viral load.
4. Intrapartum Care
o Elective cesarean section if viral load is high.
o Avoid prolonged labor, rupture of membranes, unnecessary instrumentation.
o Universal precautions for health workers.
5. Postnatal Care
o Neonate: prophylactic ART (Nevirapine/Syrup AZT).
o Breastfeeding: exclusive breastfeeding recommended if safe alternatives are not available.
o Mixed feeding avoided (↑ transmission risk).
o Family planning advice.
Conclusion: With ART and proper obstetric care, MTCT of HIV can be reduced to <2%.
2. Fertilization
Definition: Fusion of male sperm and female ovum to form a zygote, the first stage of human development.
Site: Ampullary region of fallopian tube.
Process:
1. Capacitation of sperm: Biochemical changes in sperm after entering female tract.
2. Acrosomal reaction: Enzymes released from acrosome to penetrate zona pellucida.
3. Fusion of membranes: Sperm head fuses with ovum membrane.
4. Cortical reaction: Prevents entry of more sperm (blocks polyspermy).
5. Formation of zygote: Male and female pronuclei unite → diploid zygote formed.
Significance:
Restores diploid chromosome number (46).
Determines sex of baby (sperm decides X or Y).
Initiates cell division and embryonic development.
Conclusion: Fertilization marks the beginning of new life and is essential for reproduction.
3. Functions of Traditional Birth Attendant (TBA)
Definition: TBAs are community-based women who assist in childbirth, especially in rural/remote areas where trained health personnel are not
available.
Functions:
1. During Pregnancy
o Provide health education on diet, hygiene, antenatal check-up.
o Encourage immunization (TT) and iron/folic acid intake.
2. During Labor & Delivery
o Provide emotional and physical support to mother.
o Maintain cleanliness and use clean delivery kit.
o Assist normal vaginal delivery.
o Identify danger signs and refer complicated cases.
3. Postnatal Care
o Assist in breastfeeding initiation.
o Advise on maternal nutrition and rest.
o Care of cord and perineum.
o Identify postpartum complications and refer.
4. Community Role
o Promote family planning.
o Spread awareness on maternal and child health.
Conclusion: TBAs play an important supportive role in safe motherhood, especially in resource-poor settings.
4. Hyperemesis Gravidarum
Definition: Severe, persistent vomiting in pregnancy leading to dehydration, electrolyte imbalance, weight loss, and ketosis.
Causes:
High hCG levels (molar pregnancy, multiple gestation).
Endocrine factors (thyroid dysfunction).
Psychological stress.
Definition: Fusion of male sperm and female ovum to form a zygote, the first stage of human development.
Site: Ampullary region of fallopian tube.
Process:
1. Capacitation of sperm: Biochemical changes in sperm after entering female tract.
2. Acrosomal reaction: Enzymes released from acrosome to penetrate zona pellucida.
3. Fusion of membranes: Sperm head fuses with ovum membrane.
4. Cortical reaction: Prevents entry of more sperm (blocks polyspermy).
5. Formation of zygote: Male and female pronuclei unite → diploid zygote formed.
Significance:
Restores diploid chromosome number (46).
Determines sex of baby (sperm decides X or Y).
Initiates cell division and embryonic development.
Conclusion: Fertilization marks the beginning of new life and is essential for reproduction.
3. Functions of Traditional Birth Attendant (TBA)
Definition: TBAs are community-based women who assist in childbirth, especially in rural/remote areas where trained health personnel are not
available.
Functions:
1. During Pregnancy
o Provide health education on diet, hygiene, antenatal check-up.
o Encourage immunization (TT) and iron/folic acid intake.
2. During Labor & Delivery
o Provide emotional and physical support to mother.
o Maintain cleanliness and use clean delivery kit.
o Assist normal vaginal delivery.
o Identify danger signs and refer complicated cases.
3. Postnatal Care
o Assist in breastfeeding initiation.
o Advise on maternal nutrition and rest.
o Care of cord and perineum.
o Identify postpartum complications and refer.
4. Community Role
o Promote family planning.
o Spread awareness on maternal and child health.
Conclusion: TBAs play an important supportive role in safe motherhood, especially in resource-poor settings.
4. Hyperemesis Gravidarum
Definition: Severe, persistent vomiting in pregnancy leading to dehydration, electrolyte imbalance, weight loss, and ketosis.
Causes:
High hCG levels (molar pregnancy, multiple gestation).
Endocrine factors (thyroid dysfunction).
Psychological stress.
Clinical Features:
Excessive vomiting.
Dehydration, weight loss.
Electrolyte imbalance (low potassium, sodium).
Ketonuria, acetone breath.
Tachycardia, hypotension.
Complications:
Wernicke’s encephalopathy (vitamin B1 deficiency).
Renal and liver impairment.
Fetal growth restriction if prolonged.
Management:
Hospitalization.
IV fluids and electrolyte replacement.
Antiemetics (metoclopramide, ondansetron).
Vitamin supplementation (B1, B6).
Gradual oral feeding once tolerated.
Conclusion: Early recognition and supportive care prevent complications for mother and fetus.
5. Abnormalities of the Amniotic Fluid
Normal: Amniotic fluid cushions fetus, aids growth, allows movement.
Abnormalities:
1. Polyhydramnios (Excess fluid >2000 ml)
o Causes: Maternal diabetes, multiple pregnancy, fetal anomalies (anencephaly, esophageal atresia).
o Complications: Preterm labor, malpresentations, cord prolapse.
2. Oligohydramnios (Low fluid <300 ml)
o Causes: Renal agenesis, intrauterine growth restriction (IUGR), rupture of membranes.
o Complications: Pulmonary hypoplasia, deformities, fetal distress.
3. Amniotic fluid embolism
o Rare but fatal → amniotic fluid enters maternal circulation → shock, DIC.
4. Abnormal color
o Meconium-stained liquor → fetal distress.
o Blood-stained → abruption or trauma.
Conclusion: Monitoring and timely management of amniotic fluid disorders are essential for fetal survival.
1. Diagnosis of Pregnancy
Definition: Diagnosis of pregnancy involves confirming the presence of a developing fetus within the uterus by clinical, biochemical, and
imaging methods.
Types
1. Presumptive Signs (Subjective)
o Amenorrhea (absence of menstruation).
o Nausea and vomiting (morning sickness).
o Breast changes (tingling, tenderness, enlargement).
o Fatigue, frequent urination.
o Quickening (first fetal movements felt by mother ~18–20 weeks).
2. Probable Signs (Objective)
o Abdominal enlargement.
Excessive vomiting.
Dehydration, weight loss.
Electrolyte imbalance (low potassium, sodium).
Ketonuria, acetone breath.
Tachycardia, hypotension.
Complications:
Wernicke’s encephalopathy (vitamin B1 deficiency).
Renal and liver impairment.
Fetal growth restriction if prolonged.
Management:
Hospitalization.
IV fluids and electrolyte replacement.
Antiemetics (metoclopramide, ondansetron).
Vitamin supplementation (B1, B6).
Gradual oral feeding once tolerated.
Conclusion: Early recognition and supportive care prevent complications for mother and fetus.
5. Abnormalities of the Amniotic Fluid
Normal: Amniotic fluid cushions fetus, aids growth, allows movement.
Abnormalities:
1. Polyhydramnios (Excess fluid >2000 ml)
o Causes: Maternal diabetes, multiple pregnancy, fetal anomalies (anencephaly, esophageal atresia).
o Complications: Preterm labor, malpresentations, cord prolapse.
2. Oligohydramnios (Low fluid <300 ml)
o Causes: Renal agenesis, intrauterine growth restriction (IUGR), rupture of membranes.
o Complications: Pulmonary hypoplasia, deformities, fetal distress.
3. Amniotic fluid embolism
o Rare but fatal → amniotic fluid enters maternal circulation → shock, DIC.
4. Abnormal color
o Meconium-stained liquor → fetal distress.
o Blood-stained → abruption or trauma.
Conclusion: Monitoring and timely management of amniotic fluid disorders are essential for fetal survival.
1. Diagnosis of Pregnancy
Definition: Diagnosis of pregnancy involves confirming the presence of a developing fetus within the uterus by clinical, biochemical, and
imaging methods.
Types
1. Presumptive Signs (Subjective)
o Amenorrhea (absence of menstruation).
o Nausea and vomiting (morning sickness).
o Breast changes (tingling, tenderness, enlargement).
o Fatigue, frequent urination.
o Quickening (first fetal movements felt by mother ~18–20 weeks).
2. Probable Signs (Objective)
o Abdominal enlargement.
o Uterine changes: Hegar’s sign (softening of uterus), Goodell’s sign (soft cervix).
o Chadwick’s sign (bluish discoloration of vagina).
o Positive pregnancy tests (hCG in urine/blood).
3. Positive Signs (Diagnostic)
o Detection of fetal heart sounds (by Doppler at 10–12 weeks).
o Visualization of fetus by ultrasound.
o Palpation of fetal parts/movements by examiner.
Conclusion: Combination of clinical signs and modern investigations (USG, hCG) provides reliable diagnosis of pregnancy at an early stage.
2. Immediate Assessment of Newborn
Definition: Systematic evaluation of a newborn immediately after birth to detect life-threatening conditions and ensure smooth transition to
extrauterine life.
Steps
1. Immediate Care at Birth
o Clear airway: suction mouth and nose.
o Dry and keep baby warm (prevent hypothermia).
o Provide tactile stimulation if not breathing.
2. APGAR Scoring (at 1 and 5 minutes)
o Appearance (color).
o Pulse (heart rate).
o Grimace (reflex irritability).
o Activity (muscle tone).
o Respiration (cry).
o Score ≥7 = normal, 4–6 = moderate distress, ≤3 = severe distress.
3. Physical Assessment
o Check gestational maturity, birth weight, head circumference.
o Examine for congenital anomalies.
o Monitor temperature, respiration, heart rate.
4. Other Interventions
o Clamp and cut cord.
o Eye care (antibiotic drops).
o Vitamin K injection.
o Initiate breastfeeding within 1 hour.
Conclusion: Early assessment and prompt interventions reduce neonatal morbidity and mortality.
3. Role of Nurse in Obstetrical Care
Definition: The nurse plays a vital role in promoting safe motherhood by providing antenatal, intranatal, and postnatal care.
During Antenatal Period
Health education on diet, hygiene, rest, immunization (TT).
Monitor maternal health (weight, BP, urine, fetal growth).
Detect and refer high-risk pregnancies (PIH, diabetes, anemia).
Provide psychological support.
During Intranatal Period
Prepare and maintain asepsis in labor room.
Monitor progress of labor (partograph).
Provide emotional support and pain relief measures.
Assist in delivery and manage complications.
Immediate care of newborn.
o Chadwick’s sign (bluish discoloration of vagina).
o Positive pregnancy tests (hCG in urine/blood).
3. Positive Signs (Diagnostic)
o Detection of fetal heart sounds (by Doppler at 10–12 weeks).
o Visualization of fetus by ultrasound.
o Palpation of fetal parts/movements by examiner.
Conclusion: Combination of clinical signs and modern investigations (USG, hCG) provides reliable diagnosis of pregnancy at an early stage.
2. Immediate Assessment of Newborn
Definition: Systematic evaluation of a newborn immediately after birth to detect life-threatening conditions and ensure smooth transition to
extrauterine life.
Steps
1. Immediate Care at Birth
o Clear airway: suction mouth and nose.
o Dry and keep baby warm (prevent hypothermia).
o Provide tactile stimulation if not breathing.
2. APGAR Scoring (at 1 and 5 minutes)
o Appearance (color).
o Pulse (heart rate).
o Grimace (reflex irritability).
o Activity (muscle tone).
o Respiration (cry).
o Score ≥7 = normal, 4–6 = moderate distress, ≤3 = severe distress.
3. Physical Assessment
o Check gestational maturity, birth weight, head circumference.
o Examine for congenital anomalies.
o Monitor temperature, respiration, heart rate.
4. Other Interventions
o Clamp and cut cord.
o Eye care (antibiotic drops).
o Vitamin K injection.
o Initiate breastfeeding within 1 hour.
Conclusion: Early assessment and prompt interventions reduce neonatal morbidity and mortality.
3. Role of Nurse in Obstetrical Care
Definition: The nurse plays a vital role in promoting safe motherhood by providing antenatal, intranatal, and postnatal care.
During Antenatal Period
Health education on diet, hygiene, rest, immunization (TT).
Monitor maternal health (weight, BP, urine, fetal growth).
Detect and refer high-risk pregnancies (PIH, diabetes, anemia).
Provide psychological support.
During Intranatal Period
Prepare and maintain asepsis in labor room.
Monitor progress of labor (partograph).
Provide emotional support and pain relief measures.
Assist in delivery and manage complications.
Immediate care of newborn.
During Postnatal Period
Monitor mother’s vitals, lochia, uterine involution.
Support breastfeeding.
Educate about contraception and personal hygiene.
Early detection of postpartum complications (PPH, sepsis).
Conclusion: Nurses act as caregivers, educators, and advocates ensuring safe outcomes for both mother and baby.
4. Forceps Delivery
Definition: Operative vaginal delivery where obstetric forceps are applied to fetal head to assist in vaginal birth.
Indications
Maternal: Exhaustion, prolonged 2nd stage, cardiac disease (to avoid maternal strain).
Fetal: Fetal distress, malpositions (occipito-posterior), after-coming head of breech.
Types of Forceps
Low forceps – applied when fetal head is low in pelvis.
Outlet forceps – when head visible at perineum.
Mid-cavity forceps – higher application, more difficult.
Procedure
Adequate anesthesia and episiotomy.
Forceps blades applied around fetal head.
Gentle traction during uterine contractions to assist delivery.
Complications
Maternal: Perineal tears, PPH, infection.
Fetal: Facial injuries, cephalhematoma, skull fracture (rare).
Conclusion: When performed by skilled personnel with proper indications, forceps delivery is a safe
alternative to cesarean section.
5. MCH Programme (Maternal and Child Health Programme)
Definition: A national program aimed at promoting health of mothers and children through preventive,
promotive, and curative services.
Objectives
Reduce maternal, infant, and child mortality.
Provide comprehensive health care to mother and child.
Improve nutritional status.
Promote family planning and safe motherhood.
Monitor mother’s vitals, lochia, uterine involution.
Support breastfeeding.
Educate about contraception and personal hygiene.
Early detection of postpartum complications (PPH, sepsis).
Conclusion: Nurses act as caregivers, educators, and advocates ensuring safe outcomes for both mother and baby.
4. Forceps Delivery
Definition: Operative vaginal delivery where obstetric forceps are applied to fetal head to assist in vaginal birth.
Indications
Maternal: Exhaustion, prolonged 2nd stage, cardiac disease (to avoid maternal strain).
Fetal: Fetal distress, malpositions (occipito-posterior), after-coming head of breech.
Types of Forceps
Low forceps – applied when fetal head is low in pelvis.
Outlet forceps – when head visible at perineum.
Mid-cavity forceps – higher application, more difficult.
Procedure
Adequate anesthesia and episiotomy.
Forceps blades applied around fetal head.
Gentle traction during uterine contractions to assist delivery.
Complications
Maternal: Perineal tears, PPH, infection.
Fetal: Facial injuries, cephalhematoma, skull fracture (rare).
Conclusion: When performed by skilled personnel with proper indications, forceps delivery is a safe
alternative to cesarean section.
5. MCH Programme (Maternal and Child Health Programme)
Definition: A national program aimed at promoting health of mothers and children through preventive,
promotive, and curative services.
Objectives
Reduce maternal, infant, and child mortality.
Provide comprehensive health care to mother and child.
Improve nutritional status.
Promote family planning and safe motherhood.
Components
1. Maternal Care
o Antenatal checkups, TT immunization, iron-folic acid.
o Skilled attendance during delivery.
o Postnatal care and family planning services.
2. Child Care
o Immunization (Universal Immunization Programme).
o Growth monitoring and nutrition supplementation.
o Management of common childhood illnesses.
o School health programs.
3. Special Programs
o Janani Suraksha Yojana (JSY).
o Reproductive and Child Health (RCH).
o Integrated Child Development Services (ICDS).
Conclusion: MCH programs are crucial for improving maternal and child survival rates and building a
healthier future generation.
1. Effects of TORCH Infections on Childbearing
Definition: TORCH stands for Toxoplasmosis, Other infections (Syphilis, Varicella, Hepatitis B, HIV), Rubella, Cytomegalovirus (CMV),
and Herpes simplex virus (HSV). These infections cause congenital anomalies when transmitted from mother to fetus.
Effects
Toxoplasmosis: Hydrocephalus, chorioretinitis, intracranial calcifications.
Other (Syphilis, HIV, Varicella, Hepatitis B): Stillbirth, prematurity, congenital syphilis (hepatosplenomegaly, rash, bone
deformities).
Rubella: Congenital Rubella Syndrome – cataract, deafness, congenital heart disease, microcephaly.
Cytomegalovirus: Microcephaly, hepatosplenomegaly, jaundice, hearing loss.
Herpes simplex: Neonatal encephalitis, skin vesicles, high mortality if untreated.
Conclusion: TORCH infections can cause miscarriage, stillbirth, or severe congenital malformations; prevention includes vaccination (Rubella),
safe practices, antenatal screening, and early treatment.
2. Emergency Contraception
Definition: Methods used to prevent pregnancy after unprotected sexual intercourse, ideally within 72–120 hours.
Methods
1. Emergency contraceptive pills (ECPs)
o Levonorgestrel 1.5 mg (within 72 hrs).
o Ulipristal acetate (up to 120 hrs).
o Combined estrogen + progesterone (Yuzpe regimen).
2. Copper-T IUCD
o Most effective, inserted within 5 days of unprotected intercourse.
3. Mifepristone (antiprogesterone).
Mechanism
Inhibits ovulation.
Prevents fertilization.
1. Maternal Care
o Antenatal checkups, TT immunization, iron-folic acid.
o Skilled attendance during delivery.
o Postnatal care and family planning services.
2. Child Care
o Immunization (Universal Immunization Programme).
o Growth monitoring and nutrition supplementation.
o Management of common childhood illnesses.
o School health programs.
3. Special Programs
o Janani Suraksha Yojana (JSY).
o Reproductive and Child Health (RCH).
o Integrated Child Development Services (ICDS).
Conclusion: MCH programs are crucial for improving maternal and child survival rates and building a
healthier future generation.
1. Effects of TORCH Infections on Childbearing
Definition: TORCH stands for Toxoplasmosis, Other infections (Syphilis, Varicella, Hepatitis B, HIV), Rubella, Cytomegalovirus (CMV),
and Herpes simplex virus (HSV). These infections cause congenital anomalies when transmitted from mother to fetus.
Effects
Toxoplasmosis: Hydrocephalus, chorioretinitis, intracranial calcifications.
Other (Syphilis, HIV, Varicella, Hepatitis B): Stillbirth, prematurity, congenital syphilis (hepatosplenomegaly, rash, bone
deformities).
Rubella: Congenital Rubella Syndrome – cataract, deafness, congenital heart disease, microcephaly.
Cytomegalovirus: Microcephaly, hepatosplenomegaly, jaundice, hearing loss.
Herpes simplex: Neonatal encephalitis, skin vesicles, high mortality if untreated.
Conclusion: TORCH infections can cause miscarriage, stillbirth, or severe congenital malformations; prevention includes vaccination (Rubella),
safe practices, antenatal screening, and early treatment.
2. Emergency Contraception
Definition: Methods used to prevent pregnancy after unprotected sexual intercourse, ideally within 72–120 hours.
Methods
1. Emergency contraceptive pills (ECPs)
o Levonorgestrel 1.5 mg (within 72 hrs).
o Ulipristal acetate (up to 120 hrs).
o Combined estrogen + progesterone (Yuzpe regimen).
2. Copper-T IUCD
o Most effective, inserted within 5 days of unprotected intercourse.
3. Mifepristone (antiprogesterone).
Mechanism
Inhibits ovulation.
Prevents fertilization.
Prevents implantation.
Conclusion: Emergency contraception is safe, effective, and prevents unwanted pregnancy but does not protect against STIs.
3. Newborn Congenital Malformations
Definition: Structural or functional abnormalities present at birth due to genetic, environmental, or unknown causes.
Common Malformations
CNS: Neural tube defects (spina bifida, anencephaly, hydrocephalus).
Cardiac: Ventricular septal defect (VSD), atrial septal defect (ASD), Tetralogy of Fallot.
GI tract: Cleft lip/palate, esophageal atresia, imperforate anus.
Musculoskeletal: Club foot, congenital dislocation of hip.
Genitourinary: Hypospadias, polycystic kidney.
Causes
Genetic factors.
TORCH infections.
Teratogenic drugs (thalidomide, isotretinoin).
Poor maternal nutrition (folic acid deficiency).
Conclusion: Early detection (ultrasound, screening), prevention (folic acid, vaccination), and surgical correction improve outcomes.
4. Fetal Circulation
Definition: The circulation system of the fetus in utero which differs from postnatal life due to presence of shunts.
Pathway
1. Oxygenated blood from placenta → umbilical vein.
2. Blood bypasses liver via ductus venosus → inferior vena cava → right atrium.
3. Right atrium → left atrium via foramen ovale (bypasses lungs).
4. Right ventricle → pulmonary artery → shunted into aorta via ductus arteriosus.
5. Deoxygenated blood returns to placenta via umbilical arteries.
Special Features
Foramen ovale.
Ductus arteriosus.
Ductus venosus.
Conclusion: These shunts ensure that well-oxygenated blood from the placenta reaches vital organs like the brain; they close after birth.
5. Rupture of Uterus
Definition: A life-threatening obstetric emergency where the uterine wall tears during pregnancy or labor.
Causes
Obstructed labor.
Previous cesarean scar rupture.
Overuse of oxytocin/prostaglandins.
Conclusion: Emergency contraception is safe, effective, and prevents unwanted pregnancy but does not protect against STIs.
3. Newborn Congenital Malformations
Definition: Structural or functional abnormalities present at birth due to genetic, environmental, or unknown causes.
Common Malformations
CNS: Neural tube defects (spina bifida, anencephaly, hydrocephalus).
Cardiac: Ventricular septal defect (VSD), atrial septal defect (ASD), Tetralogy of Fallot.
GI tract: Cleft lip/palate, esophageal atresia, imperforate anus.
Musculoskeletal: Club foot, congenital dislocation of hip.
Genitourinary: Hypospadias, polycystic kidney.
Causes
Genetic factors.
TORCH infections.
Teratogenic drugs (thalidomide, isotretinoin).
Poor maternal nutrition (folic acid deficiency).
Conclusion: Early detection (ultrasound, screening), prevention (folic acid, vaccination), and surgical correction improve outcomes.
4. Fetal Circulation
Definition: The circulation system of the fetus in utero which differs from postnatal life due to presence of shunts.
Pathway
1. Oxygenated blood from placenta → umbilical vein.
2. Blood bypasses liver via ductus venosus → inferior vena cava → right atrium.
3. Right atrium → left atrium via foramen ovale (bypasses lungs).
4. Right ventricle → pulmonary artery → shunted into aorta via ductus arteriosus.
5. Deoxygenated blood returns to placenta via umbilical arteries.
Special Features
Foramen ovale.
Ductus arteriosus.
Ductus venosus.
Conclusion: These shunts ensure that well-oxygenated blood from the placenta reaches vital organs like the brain; they close after birth.
5. Rupture of Uterus
Definition: A life-threatening obstetric emergency where the uterine wall tears during pregnancy or labor.
Causes
Obstructed labor.
Previous cesarean scar rupture.
Overuse of oxytocin/prostaglandins.
Trauma, instrumental delivery.
Clinical Features
Severe abdominal pain.
Vaginal bleeding.
Loss of uterine contractions.
Fetal parts easily felt (abnormal contour).
Maternal shock, absent fetal heart sounds.
Management
Immediate resuscitation (IV fluids, blood transfusion).
Emergency laparotomy.
Repair of uterus or hysterectomy depending on severity.
Conclusion: Uterine rupture is preventable by good antenatal care, careful monitoring of labor, and avoiding injudicious use of uterotonics.
1. Cardiotocograph (CTG)
Definition:
A monitoring tool that simultaneously records fetal heart rate (FHR) and uterine contractions on graph paper.
Types:
External CTG: Uses Doppler ultrasound and tocodynamometer.
Internal CTG: Uses scalp electrode and intrauterine pressure catheter.
Interpretation (Features Studied):
Baseline FHR (110–160 bpm).
Variability (5–25 bpm normal).
Accelerations (good sign of fetal well-being).
Decelerations (early, variable, late – late suggests fetal hypoxia).
Uses:
Antenatal monitoring in high-risk pregnancy.
Intrapartum fetal surveillance.
Conclusion:
CTG is a reliable, non-invasive tool for assessing fetal well-being and detecting fetal distress early.
2. Abnormalities of Placenta
Structural Abnormalities:
Placenta previa – placenta lies low in uterus, covering os.
Placenta accreta/increta/percreta – abnormal adherence/invasion.
Succenturiate lobe – extra lobe.
Circumvallate placenta – raised edges.
Functional Abnormalities:
Clinical Features
Severe abdominal pain.
Vaginal bleeding.
Loss of uterine contractions.
Fetal parts easily felt (abnormal contour).
Maternal shock, absent fetal heart sounds.
Management
Immediate resuscitation (IV fluids, blood transfusion).
Emergency laparotomy.
Repair of uterus or hysterectomy depending on severity.
Conclusion: Uterine rupture is preventable by good antenatal care, careful monitoring of labor, and avoiding injudicious use of uterotonics.
1. Cardiotocograph (CTG)
Definition:
A monitoring tool that simultaneously records fetal heart rate (FHR) and uterine contractions on graph paper.
Types:
External CTG: Uses Doppler ultrasound and tocodynamometer.
Internal CTG: Uses scalp electrode and intrauterine pressure catheter.
Interpretation (Features Studied):
Baseline FHR (110–160 bpm).
Variability (5–25 bpm normal).
Accelerations (good sign of fetal well-being).
Decelerations (early, variable, late – late suggests fetal hypoxia).
Uses:
Antenatal monitoring in high-risk pregnancy.
Intrapartum fetal surveillance.
Conclusion:
CTG is a reliable, non-invasive tool for assessing fetal well-being and detecting fetal distress early.
2. Abnormalities of Placenta
Structural Abnormalities:
Placenta previa – placenta lies low in uterus, covering os.
Placenta accreta/increta/percreta – abnormal adherence/invasion.
Succenturiate lobe – extra lobe.
Circumvallate placenta – raised edges.
Functional Abnormalities:
Placental insufficiency → intrauterine growth restriction (IUGR).
Other Abnormalities:
Infarcts, calcification.
Cysts, hematomas.
Clinical Importance:
Can cause antepartum hemorrhage, preterm labor, fetal growth restriction.
3. Bishop’s Score
Definition:
A pre-labor scoring system used to assess cervical favorability and predict the likelihood of successful induction of labor.
Parameters (scored 0–2/3 each):
1. Cervical dilatation.
2. Effacement (length).
3. Station of presenting part.
4. Cervical consistency.
5. Cervical position.
Interpretation:
Score ≤4: Unfavorable cervix.
Score 5–8: Moderately favorable.
Score ≥9: Highly favorable, induction likely successful.
4. Placenta Previa
Definition:
Condition where placenta is implanted in the lower uterine segment, partially or completely covering the cervical os.
Types:
1. Complete – covers whole os.
2. Partial – partially covers os.
3. Marginal – reaches margin of os.
4. Low-lying – in lower segment but not reaching os.
Clinical Features:
Painless vaginal bleeding in late pregnancy (third trimester).
Soft, non-tender uterus.
Malpresentation common.
Management:
Hospitalization, bed rest.
Blood transfusion if required.
Cesarean section if major previa or bleeding uncontrolled.
5. Mechanism of Occipito-Posterior (OP) Position
Other Abnormalities:
Infarcts, calcification.
Cysts, hematomas.
Clinical Importance:
Can cause antepartum hemorrhage, preterm labor, fetal growth restriction.
3. Bishop’s Score
Definition:
A pre-labor scoring system used to assess cervical favorability and predict the likelihood of successful induction of labor.
Parameters (scored 0–2/3 each):
1. Cervical dilatation.
2. Effacement (length).
3. Station of presenting part.
4. Cervical consistency.
5. Cervical position.
Interpretation:
Score ≤4: Unfavorable cervix.
Score 5–8: Moderately favorable.
Score ≥9: Highly favorable, induction likely successful.
4. Placenta Previa
Definition:
Condition where placenta is implanted in the lower uterine segment, partially or completely covering the cervical os.
Types:
1. Complete – covers whole os.
2. Partial – partially covers os.
3. Marginal – reaches margin of os.
4. Low-lying – in lower segment but not reaching os.
Clinical Features:
Painless vaginal bleeding in late pregnancy (third trimester).
Soft, non-tender uterus.
Malpresentation common.
Management:
Hospitalization, bed rest.
Blood transfusion if required.
Cesarean section if major previa or bleeding uncontrolled.
5. Mechanism of Occipito-Posterior (OP) Position
Definition:
A malposition in which the fetal occiput lies towards the maternal sacrum instead of symphysis pubis.
Mechanism of Labor in OP Position:
1. Engagement: Usually delayed; sagittal suture in oblique/transverse diameter.
2. Descent: Slow and difficult.
3. Internal rotation: Normally, occiput rotates 3/8th circle anteriorly to come under pubic symphysis. In OP, rotation may be
incomplete, leading to:
o Persistent OP (occiput remains posterior).
o Deep transverse arrest.
4. Flexion: Incomplete → larger diameters present.
5. Delivery: May need assisted delivery (forceps, vacuum, C-section).
Clinical Significance:
Longer, painful labor.
Increased risk of operative delivery.
1. Management of Diabetes Complicating Pregnancy
Introduction:
Diabetes in pregnancy may be pre-gestational (Type 1/2) or gestational diabetes mellitus (GDM).
Leads to maternal and fetal complications if not controlled.
Classification:
Gestational Diabetes Mellitus (GDM) – first detected in pregnancy.
Pre-gestational Diabetes – pre-existing before conception.
Complications:
Mother: Polyhydramnios, preeclampsia, obstructed labor, infections, ketoacidosis.
Fetus: Macrosomia, congenital anomalies, stillbirth, neonatal hypoglycemia.
Management:
Antenatal: Diet control, exercise, insulin therapy (oral hypoglycemics avoided), blood sugar monitoring.
Intrapartum: Monitor blood glucose, insulin infusion, avoid prolonged labor.
Postnatal: Insulin dose reduced, breastfeeding encouraged, follow-up for Type 2 diabetes risk.
Nursing Care:
Educate mother about diet and insulin.
Monitor blood glucose regularly.
Observe for signs of hypoglycemia/hyperglycemia.
Support emotional needs.
Conclusion:
Proper glycemic control and nursing care reduce complications and improve maternal–fetal outcomes.
2. Minor Disorders of Pregnancy and Management
Introduction:
Minor ailments are common in pregnancy due to hormonal, metabolic, and mechanical changes.
Though not life-threatening, they cause discomfort.
A malposition in which the fetal occiput lies towards the maternal sacrum instead of symphysis pubis.
Mechanism of Labor in OP Position:
1. Engagement: Usually delayed; sagittal suture in oblique/transverse diameter.
2. Descent: Slow and difficult.
3. Internal rotation: Normally, occiput rotates 3/8th circle anteriorly to come under pubic symphysis. In OP, rotation may be
incomplete, leading to:
o Persistent OP (occiput remains posterior).
o Deep transverse arrest.
4. Flexion: Incomplete → larger diameters present.
5. Delivery: May need assisted delivery (forceps, vacuum, C-section).
Clinical Significance:
Longer, painful labor.
Increased risk of operative delivery.
1. Management of Diabetes Complicating Pregnancy
Introduction:
Diabetes in pregnancy may be pre-gestational (Type 1/2) or gestational diabetes mellitus (GDM).
Leads to maternal and fetal complications if not controlled.
Classification:
Gestational Diabetes Mellitus (GDM) – first detected in pregnancy.
Pre-gestational Diabetes – pre-existing before conception.
Complications:
Mother: Polyhydramnios, preeclampsia, obstructed labor, infections, ketoacidosis.
Fetus: Macrosomia, congenital anomalies, stillbirth, neonatal hypoglycemia.
Management:
Antenatal: Diet control, exercise, insulin therapy (oral hypoglycemics avoided), blood sugar monitoring.
Intrapartum: Monitor blood glucose, insulin infusion, avoid prolonged labor.
Postnatal: Insulin dose reduced, breastfeeding encouraged, follow-up for Type 2 diabetes risk.
Nursing Care:
Educate mother about diet and insulin.
Monitor blood glucose regularly.
Observe for signs of hypoglycemia/hyperglycemia.
Support emotional needs.
Conclusion:
Proper glycemic control and nursing care reduce complications and improve maternal–fetal outcomes.
2. Minor Disorders of Pregnancy and Management
Introduction:
Minor ailments are common in pregnancy due to hormonal, metabolic, and mechanical changes.
Though not life-threatening, they cause discomfort.
Classification & Examples:
Early pregnancy: Nausea, vomiting, constipation, heartburn, frequency of micturition.
Later pregnancy: Backache, varicose veins, edema, leg cramps, hemorrhoids.
Complications:
May disturb nutrition, rest, and psychological well-being.
Neglected cases can progress to major disorders.
Management:
Nausea/Vomiting: Small frequent meals, avoid spicy food, ginger, vitamin B6.
Constipation: High-fiber diet, fluids, mild laxatives.
Heartburn: Small meals, avoid lying down immediately after eating.
Backache: Postural advice, pelvic exercises, supportive belt.
Leg cramps: Calcium, magnesium supplements, gentle massage.
Varicose veins: Leg elevation, stockings.
Nursing Care:
Health education about lifestyle modifications.
Emotional support.
Referral if symptoms persist or worsen.
Conclusion:
Most minor disorders can be relieved with simple measures and nursing guidance, ensuring comfort during pregnancy.
3. Permanent Methods of Contraception
Introduction:
Methods of contraception that provide permanent infertility.
Chosen by couples who have completed family.
Classification:
Female sterilization: Tubectomy, laparoscopy, minilap, hysteroscopic occlusion.
Male sterilization: Vasectomy (conventional or no-scalpel).
Complications:
Surgical risks: bleeding, infection, injury to organs.
Psychological regret if decision made early.
Management:
Proper counseling and informed consent.
Pre-operative preparation and aseptic surgery.
Post-operative care and follow-up.
Nursing Care:
Provide pre- and post-operative education.
Monitor vital signs, wound healing.
Counsel about permanence and non-reversibility.
Support emotionally.
Early pregnancy: Nausea, vomiting, constipation, heartburn, frequency of micturition.
Later pregnancy: Backache, varicose veins, edema, leg cramps, hemorrhoids.
Complications:
May disturb nutrition, rest, and psychological well-being.
Neglected cases can progress to major disorders.
Management:
Nausea/Vomiting: Small frequent meals, avoid spicy food, ginger, vitamin B6.
Constipation: High-fiber diet, fluids, mild laxatives.
Heartburn: Small meals, avoid lying down immediately after eating.
Backache: Postural advice, pelvic exercises, supportive belt.
Leg cramps: Calcium, magnesium supplements, gentle massage.
Varicose veins: Leg elevation, stockings.
Nursing Care:
Health education about lifestyle modifications.
Emotional support.
Referral if symptoms persist or worsen.
Conclusion:
Most minor disorders can be relieved with simple measures and nursing guidance, ensuring comfort during pregnancy.
3. Permanent Methods of Contraception
Introduction:
Methods of contraception that provide permanent infertility.
Chosen by couples who have completed family.
Classification:
Female sterilization: Tubectomy, laparoscopy, minilap, hysteroscopic occlusion.
Male sterilization: Vasectomy (conventional or no-scalpel).
Complications:
Surgical risks: bleeding, infection, injury to organs.
Psychological regret if decision made early.
Management:
Proper counseling and informed consent.
Pre-operative preparation and aseptic surgery.
Post-operative care and follow-up.
Nursing Care:
Provide pre- and post-operative education.
Monitor vital signs, wound healing.
Counsel about permanence and non-reversibility.
Support emotionally.
Conclusion:
Permanent contraception is safe, effective, and vital for population control when chosen responsibly.
4. Breastfeeding
Introduction:
Breastfeeding is the natural method of feeding newborns, recommended exclusively for first 6 months.
WHO: Early initiation within 1 hour of birth.
Classification:
Exclusive breastfeeding – only breast milk.
Partial breastfeeding – breast milk + other feeds.
Complementary feeding – breast milk + solid foods after 6 months.
Advantages:
Infant: Complete nutrition, immunity, prevents infections, bonding.
Mother: Uterine involution, reduced postpartum bleeding, natural contraception (lactational amenorrhea), reduced breast/ovarian
cancer risk.
Complications (if not practiced properly):
Engorgement, cracked nipples, mastitis, poor weight gain in baby.
Management:
Proper latching technique.
Frequent feeding on demand.
Treat complications with warm compress, nipple care, antibiotics if needed.
Nursing Care:
Educate mother about correct positioning.
Provide psychological support.
Encourage exclusive breastfeeding.
Conclusion:
Breastfeeding is the best nourishment for infants and promotes maternal–infant health.
5. Partograph
Introduction:
A graphical tool used to monitor progress of labor and maternal–fetal condition.
Developed by WHO to prevent obstructed labor and maternal deaths.
Components:
Fetal condition: Heart rate, amniotic fluid, molding.
Maternal condition: Pulse, BP, temperature, urine output.
Progress of labor: Cervical dilatation, descent of head, uterine contractions.
Classification/Sections:
Permanent contraception is safe, effective, and vital for population control when chosen responsibly.
4. Breastfeeding
Introduction:
Breastfeeding is the natural method of feeding newborns, recommended exclusively for first 6 months.
WHO: Early initiation within 1 hour of birth.
Classification:
Exclusive breastfeeding – only breast milk.
Partial breastfeeding – breast milk + other feeds.
Complementary feeding – breast milk + solid foods after 6 months.
Advantages:
Infant: Complete nutrition, immunity, prevents infections, bonding.
Mother: Uterine involution, reduced postpartum bleeding, natural contraception (lactational amenorrhea), reduced breast/ovarian
cancer risk.
Complications (if not practiced properly):
Engorgement, cracked nipples, mastitis, poor weight gain in baby.
Management:
Proper latching technique.
Frequent feeding on demand.
Treat complications with warm compress, nipple care, antibiotics if needed.
Nursing Care:
Educate mother about correct positioning.
Provide psychological support.
Encourage exclusive breastfeeding.
Conclusion:
Breastfeeding is the best nourishment for infants and promotes maternal–infant health.
5. Partograph
Introduction:
A graphical tool used to monitor progress of labor and maternal–fetal condition.
Developed by WHO to prevent obstructed labor and maternal deaths.
Components:
Fetal condition: Heart rate, amniotic fluid, molding.
Maternal condition: Pulse, BP, temperature, urine output.
Progress of labor: Cervical dilatation, descent of head, uterine contractions.
Classification/Sections:
Alert line.
Action line.
Graph for observations.
Complications if not used:
Delay in recognizing obstructed labor.
Maternal exhaustion, fetal distress, uterine rupture.
Management:
Plot cervical dilatation hourly.
Record contractions every 30 min.
Act immediately if progress crosses action line.
Nursing Care:
Continuous maternal and fetal monitoring.
Inform doctor promptly if deviations occur.
Provide reassurance, hydration, pain relief.
Conclusion:
Partograph is a simple, low-cost, effective tool to reduce maternal and perinatal morbidity by ensuring timely intervention.
1. Abruptio Placenta
Introduction:
Premature separation of a normally situated placenta after 20 weeks and before delivery of fetus.
It is an obstetric emergency.
Causes/Risk Factors:
Hypertension, trauma, smoking, multiparity, polyhydramnios, short cord.
Clinical Features:
Vaginal bleeding (concealed/revealed).
Abdominal pain, tense/tender uterus, shock disproportionate to blood loss.
Fetal distress or death.
Complications:
Mother: Hemorrhagic shock, DIC, renal failure, death.
Fetus: Prematurity, asphyxia, stillbirth.
Management:
Admit immediately.
IV fluids, blood transfusion, oxygen.
Monitor mother and fetus.
Termination of pregnancy – vaginal delivery if stable, C-section if indicated.
Conclusion:
Early detection and prompt management reduce maternal and fetal mortality.
Action line.
Graph for observations.
Complications if not used:
Delay in recognizing obstructed labor.
Maternal exhaustion, fetal distress, uterine rupture.
Management:
Plot cervical dilatation hourly.
Record contractions every 30 min.
Act immediately if progress crosses action line.
Nursing Care:
Continuous maternal and fetal monitoring.
Inform doctor promptly if deviations occur.
Provide reassurance, hydration, pain relief.
Conclusion:
Partograph is a simple, low-cost, effective tool to reduce maternal and perinatal morbidity by ensuring timely intervention.
1. Abruptio Placenta
Introduction:
Premature separation of a normally situated placenta after 20 weeks and before delivery of fetus.
It is an obstetric emergency.
Causes/Risk Factors:
Hypertension, trauma, smoking, multiparity, polyhydramnios, short cord.
Clinical Features:
Vaginal bleeding (concealed/revealed).
Abdominal pain, tense/tender uterus, shock disproportionate to blood loss.
Fetal distress or death.
Complications:
Mother: Hemorrhagic shock, DIC, renal failure, death.
Fetus: Prematurity, asphyxia, stillbirth.
Management:
Admit immediately.
IV fluids, blood transfusion, oxygen.
Monitor mother and fetus.
Termination of pregnancy – vaginal delivery if stable, C-section if indicated.
Conclusion:
Early detection and prompt management reduce maternal and fetal mortality.
2. Episiotomy
Introduction:
A surgical incision made in the perineum to enlarge vaginal opening during second stage of labor.
Indications:
Rigid perineum, instrumental delivery, fetal distress, shoulder dystocia, big baby.
Types:
Mediolateral (common), Median, J-shaped.
Complications:
Bleeding, infection, extension to anal sphincter, pain, dyspareunia.
Management/Nursing Care:
Perineal preparation, infiltration with local anesthesia.
Incision given at crowning.
Sutured after delivery.
Postnatal care: Sitz bath, analgesics, perineal hygiene.
Conclusion:
Episiotomy prevents perineal tears but should be used judiciously.
3. RCH Programme (Reproductive and Child Health Programme)
Introduction:
Launched in 1997, integrated maternal and child health with family planning.
Goal: Reduce maternal, infant mortality and improve reproductive health.
Components:
1. Maternal health (antenatal, postnatal care, safe delivery).
2. Child health (immunization, growth monitoring, nutrition).
3. Family planning services.
4. Prevention of RTI/STD including HIV/AIDS.
5. Adolescent reproductive health.
Achievements:
Institutional deliveries increased.
MMR and IMR reduced.
Family planning acceptance improved.
Conclusion:
RCH programme is a comprehensive approach ensuring maternal and child well-being.
4. Rh Incompatibility
Introduction:
Introduction:
A surgical incision made in the perineum to enlarge vaginal opening during second stage of labor.
Indications:
Rigid perineum, instrumental delivery, fetal distress, shoulder dystocia, big baby.
Types:
Mediolateral (common), Median, J-shaped.
Complications:
Bleeding, infection, extension to anal sphincter, pain, dyspareunia.
Management/Nursing Care:
Perineal preparation, infiltration with local anesthesia.
Incision given at crowning.
Sutured after delivery.
Postnatal care: Sitz bath, analgesics, perineal hygiene.
Conclusion:
Episiotomy prevents perineal tears but should be used judiciously.
3. RCH Programme (Reproductive and Child Health Programme)
Introduction:
Launched in 1997, integrated maternal and child health with family planning.
Goal: Reduce maternal, infant mortality and improve reproductive health.
Components:
1. Maternal health (antenatal, postnatal care, safe delivery).
2. Child health (immunization, growth monitoring, nutrition).
3. Family planning services.
4. Prevention of RTI/STD including HIV/AIDS.
5. Adolescent reproductive health.
Achievements:
Institutional deliveries increased.
MMR and IMR reduced.
Family planning acceptance improved.
Conclusion:
RCH programme is a comprehensive approach ensuring maternal and child well-being.
4. Rh Incompatibility
Introduction:
Occurs when Rh-negative mother carries Rh-positive fetus, leading to maternal antibody production.
Causes hemolytic disease of newborn (HDN).
Pathophysiology:
Fetal RBC enter maternal circulation → mother produces anti-D antibodies → cross placenta → destroy fetal RBC.
Clinical Features in Fetus/Newborn:
Hemolysis, anemia, jaundice, hydrops fetalis, stillbirth.
Complications:
Kernicterus, neonatal death.
Management:
Antenatal: Screen Rh-negative mothers (indirect Coombs test).
Give anti-D immunoglobulin at 28 weeks and within 72 hrs of delivery (if baby is Rh-positive).
In severe cases: Intrauterine transfusion, early delivery.
Neonatal: Phototherapy, exchange transfusion.
Conclusion:
Timely prophylaxis with anti-D prevents Rh incompatibility complications.
5. Minor Disorders During Pregnancy
Introduction:
Common physiological discomforts due to hormonal and mechanical changes in pregnancy.
Usually not dangerous but cause distress.
Examples & Management:
Nausea/Vomiting: Small frequent meals, avoid spicy food, vitamin B6.
Constipation: High-fiber diet, fluids, mild laxatives.
Heartburn: Small meals, avoid lying down after eating.
Backache: Proper posture, exercises, supportive belt.
Varicose veins: Leg elevation, elastic stockings.
Leg cramps: Calcium, gentle massage, stretching.
Frequency of micturition: Reassure, encourage fluids.
Conclusion:
Most minor disorders are managed by simple lifestyle changes and nursing advice, ensuring maternal comfort.
1. Mechanism of Breech Presentation
Introduction:
Breech presentation is when the fetal buttocks or feet present first in the birth canal instead of the head. It occurs in about 3–4% of term
pregnancies.
Definition:
Malpresentation in which the fetal pelvis (buttocks/feet) is the presenting part.
Causes:
Causes hemolytic disease of newborn (HDN).
Pathophysiology:
Fetal RBC enter maternal circulation → mother produces anti-D antibodies → cross placenta → destroy fetal RBC.
Clinical Features in Fetus/Newborn:
Hemolysis, anemia, jaundice, hydrops fetalis, stillbirth.
Complications:
Kernicterus, neonatal death.
Management:
Antenatal: Screen Rh-negative mothers (indirect Coombs test).
Give anti-D immunoglobulin at 28 weeks and within 72 hrs of delivery (if baby is Rh-positive).
In severe cases: Intrauterine transfusion, early delivery.
Neonatal: Phototherapy, exchange transfusion.
Conclusion:
Timely prophylaxis with anti-D prevents Rh incompatibility complications.
5. Minor Disorders During Pregnancy
Introduction:
Common physiological discomforts due to hormonal and mechanical changes in pregnancy.
Usually not dangerous but cause distress.
Examples & Management:
Nausea/Vomiting: Small frequent meals, avoid spicy food, vitamin B6.
Constipation: High-fiber diet, fluids, mild laxatives.
Heartburn: Small meals, avoid lying down after eating.
Backache: Proper posture, exercises, supportive belt.
Varicose veins: Leg elevation, elastic stockings.
Leg cramps: Calcium, gentle massage, stretching.
Frequency of micturition: Reassure, encourage fluids.
Conclusion:
Most minor disorders are managed by simple lifestyle changes and nursing advice, ensuring maternal comfort.
1. Mechanism of Breech Presentation
Introduction:
Breech presentation is when the fetal buttocks or feet present first in the birth canal instead of the head. It occurs in about 3–4% of term
pregnancies.
Definition:
Malpresentation in which the fetal pelvis (buttocks/feet) is the presenting part.
Causes:
Prematurity
Multiple pregnancy
Polyhydramnios/oligohydramnios
Uterine anomalies/fibroids
Placenta previa
Fetal anomalies (hydrocephalus, anencephaly)
Signs & Symptoms:
Palpation: Hard round head felt at uterine fundus.
Fetal heart sounds heard above the umbilicus.
Vaginal exam: Soft, irregular presenting part (buttocks/feet).
Diagnostic Evaluation:
Abdominal palpation (Leopold’s maneuvers)
Vaginal examination
Ultrasound (confirms type of breech & fetal wellbeing)
Mechanism of Breech Delivery:
1. Engagement of breech → Descent → Internal rotation of buttocks
2. Delivery of buttocks → Trunk → Shoulders rotate and deliver
3. After-coming head delivers by flexion.
Management:
External cephalic version (before labor, >36 weeks)
Vaginal breech delivery (if favorable pelvis & experienced obstetrician)
Cesarean section (most common & safest)
Nursing Care Plan:
Monitor maternal vitals & FHR
Prepare for C-section if indicated
Emotional support to mother
Prepare neonatal resuscitation team (risk of asphyxia)
2. Drugs in Obstetrics
Introduction:
Drugs are used in obstetrics to induce labor, control pain, manage complications, and prevent infections.
Definition:
Pharmacological agents used during pregnancy, labor, delivery, and puerperium to safeguard mother & fetus.
Categories & Examples:
Uterotonics: Oxytocin, Misoprostol, Ergometrine (for induction & PPH control)
Tocolytics: Nifedipine, Terbutaline, Magnesium sulfate (for preterm labor, eclampsia)
Analgesics/Anesthetics: Pethidine, Epidural anesthesia
Antihypertensives: Labetalol, Hydralazine (for PIH)
Antibiotics: Ampicillin, Metronidazole (for infections)
Corticosteroids: Dexamethasone, Betamethasone (for fetal lung maturity)
Nursing Care Plan:
Administer drugs as prescribed
Monitor maternal vitals and fetal heart rate
Multiple pregnancy
Polyhydramnios/oligohydramnios
Uterine anomalies/fibroids
Placenta previa
Fetal anomalies (hydrocephalus, anencephaly)
Signs & Symptoms:
Palpation: Hard round head felt at uterine fundus.
Fetal heart sounds heard above the umbilicus.
Vaginal exam: Soft, irregular presenting part (buttocks/feet).
Diagnostic Evaluation:
Abdominal palpation (Leopold’s maneuvers)
Vaginal examination
Ultrasound (confirms type of breech & fetal wellbeing)
Mechanism of Breech Delivery:
1. Engagement of breech → Descent → Internal rotation of buttocks
2. Delivery of buttocks → Trunk → Shoulders rotate and deliver
3. After-coming head delivers by flexion.
Management:
External cephalic version (before labor, >36 weeks)
Vaginal breech delivery (if favorable pelvis & experienced obstetrician)
Cesarean section (most common & safest)
Nursing Care Plan:
Monitor maternal vitals & FHR
Prepare for C-section if indicated
Emotional support to mother
Prepare neonatal resuscitation team (risk of asphyxia)
2. Drugs in Obstetrics
Introduction:
Drugs are used in obstetrics to induce labor, control pain, manage complications, and prevent infections.
Definition:
Pharmacological agents used during pregnancy, labor, delivery, and puerperium to safeguard mother & fetus.
Categories & Examples:
Uterotonics: Oxytocin, Misoprostol, Ergometrine (for induction & PPH control)
Tocolytics: Nifedipine, Terbutaline, Magnesium sulfate (for preterm labor, eclampsia)
Analgesics/Anesthetics: Pethidine, Epidural anesthesia
Antihypertensives: Labetalol, Hydralazine (for PIH)
Antibiotics: Ampicillin, Metronidazole (for infections)
Corticosteroids: Dexamethasone, Betamethasone (for fetal lung maturity)
Nursing Care Plan:
Administer drugs as prescribed
Monitor maternal vitals and fetal heart rate
Watch for adverse effects (uterine hyperstimulation, hypotension, toxicity)
Provide patient education
3. Cord Prolapse
Introduction:
Umbilical cord prolapse is an obstetric emergency where the umbilical cord descends through the cervix ahead of the presenting part.
Definition:
Condition where the umbilical cord lies below the presenting fetal part after rupture of membranes.
Causes:
Malpresentation (breech, transverse lie)
Prematurity
Polyhydramnios
Multiple gestation
Artificial rupture of membranes with high presenting part
Signs & Symptoms:
Visible/palpable cord at vaginal introitus
Sudden fetal bradycardia or variable decelerations
Maternal history of fluid gush followed by distress
Diagnostic Evaluation:
Vaginal examination
Continuous FHR monitoring
Ultrasound for confirmation
Management:
Immediate call for help (obstetric emergency)
Relieve cord compression (knee–chest or Trendelenburg position, elevate presenting part with hand)
Cover exposed cord with warm sterile saline gauze
Give oxygen to mother
Prepare for emergency cesarean section
Nursing Care Plan:
Maintain left lateral/knee-chest position
Monitor FHR continuously
Provide psychological support
Prepare OT and neonatal resuscitation
4. Phototherapy
Introduction:
Used in neonates to treat hyperbilirubinemia (neonatal jaundice).
Definition:
Treatment with visible light (blue spectrum 430–490 nm) that converts unconjugated bilirubin into water-soluble forms excreted in bile and
urine.
Causes (Indications):
Provide patient education
3. Cord Prolapse
Introduction:
Umbilical cord prolapse is an obstetric emergency where the umbilical cord descends through the cervix ahead of the presenting part.
Definition:
Condition where the umbilical cord lies below the presenting fetal part after rupture of membranes.
Causes:
Malpresentation (breech, transverse lie)
Prematurity
Polyhydramnios
Multiple gestation
Artificial rupture of membranes with high presenting part
Signs & Symptoms:
Visible/palpable cord at vaginal introitus
Sudden fetal bradycardia or variable decelerations
Maternal history of fluid gush followed by distress
Diagnostic Evaluation:
Vaginal examination
Continuous FHR monitoring
Ultrasound for confirmation
Management:
Immediate call for help (obstetric emergency)
Relieve cord compression (knee–chest or Trendelenburg position, elevate presenting part with hand)
Cover exposed cord with warm sterile saline gauze
Give oxygen to mother
Prepare for emergency cesarean section
Nursing Care Plan:
Maintain left lateral/knee-chest position
Monitor FHR continuously
Provide psychological support
Prepare OT and neonatal resuscitation
4. Phototherapy
Introduction:
Used in neonates to treat hyperbilirubinemia (neonatal jaundice).
Definition:
Treatment with visible light (blue spectrum 430–490 nm) that converts unconjugated bilirubin into water-soluble forms excreted in bile and
urine.
Causes (Indications):
Physiological jaundice
Hemolytic disease (Rh incompatibility, ABO incompatibility)
Prematurity-related jaundice
Breastfeeding jaundice
Signs & Symptoms (indicating need):
Yellowish discoloration of skin, sclera, mucosa
High serum bilirubin levels
Diagnostic Evaluation:
Serum bilirubin measurement
Coombs test
LFT if needed
Management:
Expose maximum skin to phototherapy light
Cover eyes and genitals
Maintain hydration
Turn baby every 2–3 hrs
Monitor bilirubin levels and adverse effects (rash, diarrhea, hyperthermia, dehydration)
Nursing Care Plan:
Strict monitoring of temperature, weight, bilirubin
Protect eyes/genitals
Encourage breastfeeding
Support parents emotionally
5. Fetal Circulation
Introduction:
The fetal circulatory system differs from postnatal circulation due to placenta-based oxygenation.
Definition:
Circulation pattern in the fetus that allows oxygen & nutrients from placenta to bypass non-functional lungs.
Pathway (Mechanism):
1. Oxygenated blood from placenta → Umbilical vein → Ductus venosus → Inferior vena cava → Right atrium
2. Blood shunted via foramen ovale → Left atrium → Left ventricle → Aorta → Brain & upper body
3. Deoxygenated blood → Right atrium → Right ventricle → Pulmonary artery → Ductus arteriosus → Aorta → Lower body →
Umbilical arteries → Placenta
Special Structures:
Ductus venosus
Foramen ovale
Ductus arteriosus
Umbilical vein & arteries
Management/Nursing Importance:
Understanding circulation is crucial for neonatal care
Closure of fetal shunts occurs after birth with lung expansion
Nursing Care Plan (in context of newborns with circulation issues, e.g., congenital defects):
Hemolytic disease (Rh incompatibility, ABO incompatibility)
Prematurity-related jaundice
Breastfeeding jaundice
Signs & Symptoms (indicating need):
Yellowish discoloration of skin, sclera, mucosa
High serum bilirubin levels
Diagnostic Evaluation:
Serum bilirubin measurement
Coombs test
LFT if needed
Management:
Expose maximum skin to phototherapy light
Cover eyes and genitals
Maintain hydration
Turn baby every 2–3 hrs
Monitor bilirubin levels and adverse effects (rash, diarrhea, hyperthermia, dehydration)
Nursing Care Plan:
Strict monitoring of temperature, weight, bilirubin
Protect eyes/genitals
Encourage breastfeeding
Support parents emotionally
5. Fetal Circulation
Introduction:
The fetal circulatory system differs from postnatal circulation due to placenta-based oxygenation.
Definition:
Circulation pattern in the fetus that allows oxygen & nutrients from placenta to bypass non-functional lungs.
Pathway (Mechanism):
1. Oxygenated blood from placenta → Umbilical vein → Ductus venosus → Inferior vena cava → Right atrium
2. Blood shunted via foramen ovale → Left atrium → Left ventricle → Aorta → Brain & upper body
3. Deoxygenated blood → Right atrium → Right ventricle → Pulmonary artery → Ductus arteriosus → Aorta → Lower body →
Umbilical arteries → Placenta
Special Structures:
Ductus venosus
Foramen ovale
Ductus arteriosus
Umbilical vein & arteries
Management/Nursing Importance:
Understanding circulation is crucial for neonatal care
Closure of fetal shunts occurs after birth with lung expansion
Nursing Care Plan (in context of newborns with circulation issues, e.g., congenital defects):
Monitor respiratory effort & circulation
Support oxygenation
Prepare for surgical correction if defect persists
1. Postnatal Exercises
Introduction:
Postnatal (puerperal) exercises are important to restore maternal health, strengthen muscles, and promote psychological well-being after
delivery.
Definition:
Systematic exercises started after childbirth to improve muscle tone, circulation, and overall recovery.
Causes/Need for Exercises:
Weak abdominal & pelvic floor muscles
Back pain, constipation, urinary incontinence
Risk of thrombosis due to immobility
Promote psychological well-being
Signs & Symptoms Indicating Need:
Flabby abdomen
Poor posture
Urinary incontinence
General fatigue
Diagnostic Evaluation:
Physical assessment of abdominal/pelvic muscles
Obstetric history review (C-section/normal delivery)
Doctor’s clearance
Management (Exercises):
Deep breathing, Kegel’s pelvic floor exercises
Abdominal tightening, leg raising, back strengthening
Walking and posture correction
Avoid strain after C-section until wound heals
Nursing Care Plan:
Educate mother on benefits of postnatal exercise
Demonstrate safe techniques
Monitor wound healing before starting
Encourage gradual progress & adequate rest
2. Placental Separation
Introduction:
Placental separation is a critical event in the third stage of labor where the placenta detaches from the uterine wall.
Definition:
The physiological process of detachment and expulsion of placenta and membranes after delivery of the baby.
Support oxygenation
Prepare for surgical correction if defect persists
1. Postnatal Exercises
Introduction:
Postnatal (puerperal) exercises are important to restore maternal health, strengthen muscles, and promote psychological well-being after
delivery.
Definition:
Systematic exercises started after childbirth to improve muscle tone, circulation, and overall recovery.
Causes/Need for Exercises:
Weak abdominal & pelvic floor muscles
Back pain, constipation, urinary incontinence
Risk of thrombosis due to immobility
Promote psychological well-being
Signs & Symptoms Indicating Need:
Flabby abdomen
Poor posture
Urinary incontinence
General fatigue
Diagnostic Evaluation:
Physical assessment of abdominal/pelvic muscles
Obstetric history review (C-section/normal delivery)
Doctor’s clearance
Management (Exercises):
Deep breathing, Kegel’s pelvic floor exercises
Abdominal tightening, leg raising, back strengthening
Walking and posture correction
Avoid strain after C-section until wound heals
Nursing Care Plan:
Educate mother on benefits of postnatal exercise
Demonstrate safe techniques
Monitor wound healing before starting
Encourage gradual progress & adequate rest
2. Placental Separation
Introduction:
Placental separation is a critical event in the third stage of labor where the placenta detaches from the uterine wall.
Definition:
The physiological process of detachment and expulsion of placenta and membranes after delivery of the baby.
Causes:
Uterine contraction and retraction
Decreased placental site surface area
Retroplacental hematoma formation
Signs & Symptoms (Signs of Separation):
Gush of blood
Lengthening of the umbilical cord
Uterus becomes firm, globular, and rises in abdomen
Placenta visible at vulva
Diagnostic Evaluation:
Clinical observation (Calkin’s & Ahlfeld’s signs)
Palpation of uterine fundus
Visual inspection after expulsion
Management:
Active management (controlled cord traction, oxytocin)
Watch for PPH
Inspect placenta for completeness
Nursing Care Plan:
Monitor maternal vitals and blood loss
Provide uterotonic drugs as prescribed
Maintain asepsis
Reassure mother
3. Partogram
Introduction:
Partogram is a graphical tool used during labor to monitor progress and maternal/fetal wellbeing.
Definition:
A chart that records cervical dilatation, fetal heart rate, uterine contractions, and maternal condition during labor.
Causes/Indications for Use:
Monitor progress of labor
Detect prolonged/obstructed labor
Prevent maternal/fetal complications
Signs & Symptoms (When Needed):
Labor in progress
Risk of delay (slow dilation, weak contractions)
Diagnostic Evaluation:
Vaginal examination for cervical dilatation
Monitoring uterine contractions
FHR recording
Maternal vitals
Uterine contraction and retraction
Decreased placental site surface area
Retroplacental hematoma formation
Signs & Symptoms (Signs of Separation):
Gush of blood
Lengthening of the umbilical cord
Uterus becomes firm, globular, and rises in abdomen
Placenta visible at vulva
Diagnostic Evaluation:
Clinical observation (Calkin’s & Ahlfeld’s signs)
Palpation of uterine fundus
Visual inspection after expulsion
Management:
Active management (controlled cord traction, oxytocin)
Watch for PPH
Inspect placenta for completeness
Nursing Care Plan:
Monitor maternal vitals and blood loss
Provide uterotonic drugs as prescribed
Maintain asepsis
Reassure mother
3. Partogram
Introduction:
Partogram is a graphical tool used during labor to monitor progress and maternal/fetal wellbeing.
Definition:
A chart that records cervical dilatation, fetal heart rate, uterine contractions, and maternal condition during labor.
Causes/Indications for Use:
Monitor progress of labor
Detect prolonged/obstructed labor
Prevent maternal/fetal complications
Signs & Symptoms (When Needed):
Labor in progress
Risk of delay (slow dilation, weak contractions)
Diagnostic Evaluation:
Vaginal examination for cervical dilatation
Monitoring uterine contractions
FHR recording
Maternal vitals
Management:
Regular plotting of labor progress
Early detection of abnormal labor
Timely decision for augmentation or cesarean
Nursing Care Plan:
Record findings accurately
Communicate deviations to doctor
Ensure hydration, emotional support
Prepare for interventions if labor deviates from normal
4. Adaptation of Newborn
Introduction:
At birth, the newborn must adapt from intrauterine (placental) to extrauterine (independent) life.
Definition:
Physiological and behavioral changes that occur in the newborn to maintain respiration, circulation, temperature, and feeding after birth.
Causes/Need for Adaptation:
Transition from fetal to neonatal circulation
Initiation of independent respiration
Temperature regulation
Nutritional adaptation
Signs & Symptoms of Normal Adaptation:
Strong cry, good muscle tone
Regular respirations (30–60/min)
Pink skin color
Normal heart rate (120–160/min)
Diagnostic Evaluation:
Apgar score at 1 & 5 minutes
Physical examination
Monitoring vital signs
Management:
Immediate drying & warmth
Airway clearance & oxygen if needed
Early breastfeeding
Cord care & monitoring for complications
Nursing Care Plan:
Maintain warmth, airway, circulation
Monitor vitals and Apgar score
Support early bonding
Educate mother on newborn care
5. HIV in Pregnancy
Regular plotting of labor progress
Early detection of abnormal labor
Timely decision for augmentation or cesarean
Nursing Care Plan:
Record findings accurately
Communicate deviations to doctor
Ensure hydration, emotional support
Prepare for interventions if labor deviates from normal
4. Adaptation of Newborn
Introduction:
At birth, the newborn must adapt from intrauterine (placental) to extrauterine (independent) life.
Definition:
Physiological and behavioral changes that occur in the newborn to maintain respiration, circulation, temperature, and feeding after birth.
Causes/Need for Adaptation:
Transition from fetal to neonatal circulation
Initiation of independent respiration
Temperature regulation
Nutritional adaptation
Signs & Symptoms of Normal Adaptation:
Strong cry, good muscle tone
Regular respirations (30–60/min)
Pink skin color
Normal heart rate (120–160/min)
Diagnostic Evaluation:
Apgar score at 1 & 5 minutes
Physical examination
Monitoring vital signs
Management:
Immediate drying & warmth
Airway clearance & oxygen if needed
Early breastfeeding
Cord care & monitoring for complications
Nursing Care Plan:
Maintain warmth, airway, circulation
Monitor vitals and Apgar score
Support early bonding
Educate mother on newborn care
5. HIV in Pregnancy
Introduction:
HIV infection during pregnancy is a major global health problem affecting mother and child.
Definition:
HIV (Human Immunodeficiency Virus) infection in pregnant women, which can be transmitted to the fetus (vertical transmission).
Causes:
Unprotected sexual contact
Sharing infected needles
Blood transfusion with infected blood
Mother-to-child transmission (pregnancy, delivery, breastfeeding)
Signs & Symptoms:
Asymptomatic in early stages
General weakness, weight loss, recurrent infections
Opportunistic infections
Diagnostic Evaluation:
HIV antibody test (ELISA, Western blot)
CD4 count, Viral load
Screening during antenatal care
Management:
Antiretroviral therapy (ART) for mother
Elective C-section if viral load high
Avoid breastfeeding if alternatives available
Neonatal ART prophylaxis
Nursing Care Plan:
Provide counseling and emotional support
Ensure ART compliance
Educate mother on safe infant feeding practices
Maintain infection control measures
1. Pregnancy Induced Hypertension (PIH)
Introduction:
PIH is a serious pregnancy complication that can endanger both mother and fetus. It usually appears after 20 weeks of gestation.
Definition:
Hypertension (BP ≥140/90 mmHg) occurring after 20 weeks of pregnancy without prior chronic hypertension, with or without
proteinuria/edema.
Causes/Risk Factors:
Primigravida
Multiple pregnancy
Hydatidiform mole
Obesity, family history of hypertension
Renal/vascular disorders
Signs & Symptoms:
Elevated BP
HIV infection during pregnancy is a major global health problem affecting mother and child.
Definition:
HIV (Human Immunodeficiency Virus) infection in pregnant women, which can be transmitted to the fetus (vertical transmission).
Causes:
Unprotected sexual contact
Sharing infected needles
Blood transfusion with infected blood
Mother-to-child transmission (pregnancy, delivery, breastfeeding)
Signs & Symptoms:
Asymptomatic in early stages
General weakness, weight loss, recurrent infections
Opportunistic infections
Diagnostic Evaluation:
HIV antibody test (ELISA, Western blot)
CD4 count, Viral load
Screening during antenatal care
Management:
Antiretroviral therapy (ART) for mother
Elective C-section if viral load high
Avoid breastfeeding if alternatives available
Neonatal ART prophylaxis
Nursing Care Plan:
Provide counseling and emotional support
Ensure ART compliance
Educate mother on safe infant feeding practices
Maintain infection control measures
1. Pregnancy Induced Hypertension (PIH)
Introduction:
PIH is a serious pregnancy complication that can endanger both mother and fetus. It usually appears after 20 weeks of gestation.
Definition:
Hypertension (BP ≥140/90 mmHg) occurring after 20 weeks of pregnancy without prior chronic hypertension, with or without
proteinuria/edema.
Causes/Risk Factors:
Primigravida
Multiple pregnancy
Hydatidiform mole
Obesity, family history of hypertension
Renal/vascular disorders
Signs & Symptoms:
Elevated BP
Proteinuria
Generalized edema (face, hands, feet)
Headache, blurred vision
Epigastric pain, convulsions (if severe = eclampsia)
Diagnostic Evaluation:
BP monitoring
Urine analysis (protein)
Blood tests (CBC, LFT, RFT, coagulation profile)
Fetal growth scan, NST
Management:
Rest in left lateral position
Antihypertensives (Labetalol, Methyldopa)
Magnesium sulfate for seizure prophylaxis
Monitor FHR and maternal vitals
Induction or C-section if severe
Nursing Care Plan:
Monitor BP, urine output, proteinuria
Administer medications as prescribed
Provide seizure precautions
Educate on diet (low salt, high protein)
Emotional support
2. Vasectomy
Introduction:
Vasectomy is a permanent male sterilization method for family planning.
Definition:
A minor surgical procedure in which the vas deferens (sperm duct) is cut and sealed to prevent sperm transport.
Causes/Indications:
Permanent contraception
Completed family size
Medical contraindication for wife to conceive
Signs & Symptoms (Post-procedure effects):
Minor pain and swelling at site
No effect on sexual drive or performance
Sperm absent in semen after 3 months
Diagnostic Evaluation:
Physical examination before surgery
Semen analysis (3 months later to confirm azoospermia)
Management:
Outpatient procedure under local anesthesia
Cutting/sealing vas deferens bilaterally
Contraception required until azoospermia confirmed
Generalized edema (face, hands, feet)
Headache, blurred vision
Epigastric pain, convulsions (if severe = eclampsia)
Diagnostic Evaluation:
BP monitoring
Urine analysis (protein)
Blood tests (CBC, LFT, RFT, coagulation profile)
Fetal growth scan, NST
Management:
Rest in left lateral position
Antihypertensives (Labetalol, Methyldopa)
Magnesium sulfate for seizure prophylaxis
Monitor FHR and maternal vitals
Induction or C-section if severe
Nursing Care Plan:
Monitor BP, urine output, proteinuria
Administer medications as prescribed
Provide seizure precautions
Educate on diet (low salt, high protein)
Emotional support
2. Vasectomy
Introduction:
Vasectomy is a permanent male sterilization method for family planning.
Definition:
A minor surgical procedure in which the vas deferens (sperm duct) is cut and sealed to prevent sperm transport.
Causes/Indications:
Permanent contraception
Completed family size
Medical contraindication for wife to conceive
Signs & Symptoms (Post-procedure effects):
Minor pain and swelling at site
No effect on sexual drive or performance
Sperm absent in semen after 3 months
Diagnostic Evaluation:
Physical examination before surgery
Semen analysis (3 months later to confirm azoospermia)
Management:
Outpatient procedure under local anesthesia
Cutting/sealing vas deferens bilaterally
Contraception required until azoospermia confirmed
Nursing Care Plan:
Provide pre- and post-operative instructions
Advise scrotal support, ice packs for swelling
Educate on continuing contraception until confirmed sterile
Provide psychological support
3. Caesarean Section (C-Section)
Introduction:
C-section is a surgical method of delivering a baby when vaginal delivery is not safe.
Definition:
Surgical delivery of the fetus through an incision in the abdominal wall (laparotomy) and uterus (hysterotomy).
Causes/Indications:
Cephalopelvic disproportion
Fetal distress
Placenta previa, abruptio placentae
Malpresentation (breech, transverse)
Previous C-section with complications
Signs & Symptoms (When indicated):
Abnormal labor progress
Maternal complications
Fetal distress signs (irregular FHR, meconium-stained liquor)
Diagnostic Evaluation:
Antenatal assessment
FHR monitoring
Ultrasound, NST, Doppler studies
Management:
Preoperative: Consent, IV fluids, antibiotics, anesthesia
Surgical: Lower segment C-section (LSCS preferred)
Postoperative: Monitor vitals, wound care, pain relief, breastfeeding support
Nursing Care Plan:
Monitor vital signs & lochia
Provide incision site care
Pain management & early ambulation
Support breastfeeding & bonding
Educate on wound care & family planning
4. Induction of Labour
Introduction:
Induction of labor is used when continuation of pregnancy poses risks to mother or baby.
Definition:
The artificial initiation of uterine contractions before their spontaneous onset, leading to vaginal delivery.
Provide pre- and post-operative instructions
Advise scrotal support, ice packs for swelling
Educate on continuing contraception until confirmed sterile
Provide psychological support
3. Caesarean Section (C-Section)
Introduction:
C-section is a surgical method of delivering a baby when vaginal delivery is not safe.
Definition:
Surgical delivery of the fetus through an incision in the abdominal wall (laparotomy) and uterus (hysterotomy).
Causes/Indications:
Cephalopelvic disproportion
Fetal distress
Placenta previa, abruptio placentae
Malpresentation (breech, transverse)
Previous C-section with complications
Signs & Symptoms (When indicated):
Abnormal labor progress
Maternal complications
Fetal distress signs (irregular FHR, meconium-stained liquor)
Diagnostic Evaluation:
Antenatal assessment
FHR monitoring
Ultrasound, NST, Doppler studies
Management:
Preoperative: Consent, IV fluids, antibiotics, anesthesia
Surgical: Lower segment C-section (LSCS preferred)
Postoperative: Monitor vitals, wound care, pain relief, breastfeeding support
Nursing Care Plan:
Monitor vital signs & lochia
Provide incision site care
Pain management & early ambulation
Support breastfeeding & bonding
Educate on wound care & family planning
4. Induction of Labour
Introduction:
Induction of labor is used when continuation of pregnancy poses risks to mother or baby.
Definition:
The artificial initiation of uterine contractions before their spontaneous onset, leading to vaginal delivery.
Causes/Indications:
Post-term pregnancy (>41 weeks)
PIH, preeclampsia, eclampsia
PROM (premature rupture of membranes)
Intrauterine fetal death (IUFD)
Maternal medical disorders (diabetes, hypertension)
Signs & Symptoms (Need for Induction):
Overdue pregnancy
Maternal/fetal distress signs
Unfavorable cervix (assessed by Bishop’s score)
Diagnostic Evaluation:
Bishop’s score assessment
Ultrasound for fetal position/placenta
FHR monitoring
Management:
Medical: Oxytocin infusion, Prostaglandins (Misoprostol, Dinoprostone)
Mechanical: Balloon catheter, membrane stripping
Amniotomy (artificial rupture of membranes)
Continuous maternal and fetal monitoring
Nursing Care Plan:
Monitor contractions and FHR
Administer drugs as prescribed
Support mother emotionally
Prepare for emergency C-section if induction fails
Provide hydration & rest
5. Multiple Pregnancy
Introduction:
A pregnancy with more than one fetus is called multiple pregnancy. It increases risks for both mother and babies.
Definition:
Gestation where two or more fetuses develop simultaneously in the uterus (twins, triplets, etc.).
Causes:
Genetic predisposition
Increased maternal age
Assisted reproductive techniques (IVF, ovulation induction drugs)
Racial & familial tendency
Signs & Symptoms:
Overdistended uterus (larger size than gestational age)
Excessive weight gain
Palpation: Multiple fetal poles
Two fetal heart sounds
Increased nausea, vomiting, anemia
Post-term pregnancy (>41 weeks)
PIH, preeclampsia, eclampsia
PROM (premature rupture of membranes)
Intrauterine fetal death (IUFD)
Maternal medical disorders (diabetes, hypertension)
Signs & Symptoms (Need for Induction):
Overdue pregnancy
Maternal/fetal distress signs
Unfavorable cervix (assessed by Bishop’s score)
Diagnostic Evaluation:
Bishop’s score assessment
Ultrasound for fetal position/placenta
FHR monitoring
Management:
Medical: Oxytocin infusion, Prostaglandins (Misoprostol, Dinoprostone)
Mechanical: Balloon catheter, membrane stripping
Amniotomy (artificial rupture of membranes)
Continuous maternal and fetal monitoring
Nursing Care Plan:
Monitor contractions and FHR
Administer drugs as prescribed
Support mother emotionally
Prepare for emergency C-section if induction fails
Provide hydration & rest
5. Multiple Pregnancy
Introduction:
A pregnancy with more than one fetus is called multiple pregnancy. It increases risks for both mother and babies.
Definition:
Gestation where two or more fetuses develop simultaneously in the uterus (twins, triplets, etc.).
Causes:
Genetic predisposition
Increased maternal age
Assisted reproductive techniques (IVF, ovulation induction drugs)
Racial & familial tendency
Signs & Symptoms:
Overdistended uterus (larger size than gestational age)
Excessive weight gain
Palpation: Multiple fetal poles
Two fetal heart sounds
Increased nausea, vomiting, anemia
Diagnostic Evaluation:
Ultrasound (definitive)
Doppler for multiple FHRs
High hCG & AFP levels
Clinical abdominal exam
Management:
Close antenatal monitoring
Nutritional support (high protein, iron, folic acid)
Treat anemia, PIH risk
Mode of delivery: Vaginal (if favorable) or C-section (if complications)
Nursing Care Plan:
Monitor maternal vitals & FHR regularly
Educate on high-risk pregnancy signs
Prepare for possible preterm labor
Support emotional & nutritional needs
Prepare NICU for multiple newborns
1. Amniotic Fluid Embolism (AFE)
Introduction:
AFE is a rare but fatal obstetric emergency occurring during labor or immediately postpartum.
Definition:
The entry of amniotic fluid, fetal cells, or debris into maternal circulation, causing sudden cardiovascular collapse, respiratory failure, and
coagulopathy.
Causes/Risk Factors:
Multiparity
Advanced maternal age
Induction of labor
Cesarean section/uterine trauma
Placental abruption, placenta previa
Signs & Symptoms:
Sudden dyspnea, cyanosis
Hypotension, shock
Seizures, altered consciousness
Bleeding due to DIC
Cardiac arrest in severe cases
Diagnostic Evaluation:
Clinical diagnosis (sudden collapse in labor/puerperium)
ABG: Hypoxemia, metabolic acidosis
Coagulation studies (DIC picture)
Echocardiography (right heart failure)
Management:
Emergency resuscitation (ABC)
Oxygen, intubation, mechanical ventilation
Ultrasound (definitive)
Doppler for multiple FHRs
High hCG & AFP levels
Clinical abdominal exam
Management:
Close antenatal monitoring
Nutritional support (high protein, iron, folic acid)
Treat anemia, PIH risk
Mode of delivery: Vaginal (if favorable) or C-section (if complications)
Nursing Care Plan:
Monitor maternal vitals & FHR regularly
Educate on high-risk pregnancy signs
Prepare for possible preterm labor
Support emotional & nutritional needs
Prepare NICU for multiple newborns
1. Amniotic Fluid Embolism (AFE)
Introduction:
AFE is a rare but fatal obstetric emergency occurring during labor or immediately postpartum.
Definition:
The entry of amniotic fluid, fetal cells, or debris into maternal circulation, causing sudden cardiovascular collapse, respiratory failure, and
coagulopathy.
Causes/Risk Factors:
Multiparity
Advanced maternal age
Induction of labor
Cesarean section/uterine trauma
Placental abruption, placenta previa
Signs & Symptoms:
Sudden dyspnea, cyanosis
Hypotension, shock
Seizures, altered consciousness
Bleeding due to DIC
Cardiac arrest in severe cases
Diagnostic Evaluation:
Clinical diagnosis (sudden collapse in labor/puerperium)
ABG: Hypoxemia, metabolic acidosis
Coagulation studies (DIC picture)
Echocardiography (right heart failure)
Management:
Emergency resuscitation (ABC)
Oxygen, intubation, mechanical ventilation
IV fluids, vasopressors for shock
Blood products for DIC
Prepare for emergency delivery if undelivered
Nursing Care Plan:
Maintain airway, breathing, circulation
Monitor vitals and fetal heart rate
Administer oxygen, fluids, blood products
Provide emotional support to family
Assist in emergency interventions
2. Minor Disorders of Pregnancy
Introduction:
Pregnancy causes several minor physiological discomforts due to hormonal, mechanical, and circulatory changes.
Definition:
Common non-life-threatening symptoms experienced by pregnant women which cause discomfort but not major complications.
Examples (Causes & Symptoms):
Nausea & vomiting (morning sickness) – ↑hCG, estrogen
Heartburn – Progesterone-induced relaxation of LES
Constipation – ↓bowel motility
Backache – Lordosis, ligament relaxation
Leg cramps – Calcium deficiency
Varicose veins, hemorrhoids – Venous congestion
Frequency of micturition – Uterine pressure
Diagnostic Evaluation:
Clinical history & examination
Rule out pathological causes (e.g., UTI, preeclampsia)
Management:
Dietary advice (small frequent meals, fluids, fiber)
Postural exercises, adequate rest
Support stockings for varicose veins
Antacids, laxatives if needed (safe in pregnancy)
Nursing Care Plan:
Assess and educate about normal changes
Teach lifestyle modifications
Provide reassurance and support
Refer if symptoms become severe
3. Preterm Labour
Introduction:
Preterm labor is a major cause of neonatal morbidity and mortality worldwide.
Definition:
Onset of regular uterine contractions with cervical changes before 37 completed weeks of gestation.
Blood products for DIC
Prepare for emergency delivery if undelivered
Nursing Care Plan:
Maintain airway, breathing, circulation
Monitor vitals and fetal heart rate
Administer oxygen, fluids, blood products
Provide emotional support to family
Assist in emergency interventions
2. Minor Disorders of Pregnancy
Introduction:
Pregnancy causes several minor physiological discomforts due to hormonal, mechanical, and circulatory changes.
Definition:
Common non-life-threatening symptoms experienced by pregnant women which cause discomfort but not major complications.
Examples (Causes & Symptoms):
Nausea & vomiting (morning sickness) – ↑hCG, estrogen
Heartburn – Progesterone-induced relaxation of LES
Constipation – ↓bowel motility
Backache – Lordosis, ligament relaxation
Leg cramps – Calcium deficiency
Varicose veins, hemorrhoids – Venous congestion
Frequency of micturition – Uterine pressure
Diagnostic Evaluation:
Clinical history & examination
Rule out pathological causes (e.g., UTI, preeclampsia)
Management:
Dietary advice (small frequent meals, fluids, fiber)
Postural exercises, adequate rest
Support stockings for varicose veins
Antacids, laxatives if needed (safe in pregnancy)
Nursing Care Plan:
Assess and educate about normal changes
Teach lifestyle modifications
Provide reassurance and support
Refer if symptoms become severe
3. Preterm Labour
Introduction:
Preterm labor is a major cause of neonatal morbidity and mortality worldwide.
Definition:
Onset of regular uterine contractions with cervical changes before 37 completed weeks of gestation.
Causes/Risk Factors:
Multiple pregnancy
Polyhydramnios
Genital tract infections
Placenta previa, abruption
Maternal illness (HTN, diabetes)
Smoking, poor nutrition
Signs & Symptoms:
Uterine contractions before 37 weeks
Pelvic pressure, backache
Vaginal discharge or bleeding
Cervical dilatation and effacement
Diagnostic Evaluation:
Vaginal examination (cervical status)
Ultrasound (cervical length, fetal wellbeing)
Fetal fibronectin test
FHR monitoring
Management:
Bed rest, hydration
Tocolytics (Nifedipine, Terbutaline)
Corticosteroids (Betamethasone) for lung maturity
Antibiotics if infection present
NICU preparation for preterm infant
Nursing Care Plan:
Monitor uterine contractions & FHR
Administer medications as prescribed
Provide emotional reassurance
Prepare mother for possible preterm delivery
Support neonatal care
4. Breastfeeding
Introduction:
Breastfeeding is the natural method of feeding infants and provides ideal nutrition and immunity.
Definition:
Process of feeding an infant with mother’s breast milk either directly or expressed.
Causes/Benefits:
Provides complete nutrition
Passive immunity (IgA, antibodies)
Promotes bonding and psychological wellbeing
Reduces risk of infections, allergies, obesity
Benefits mother (uterine involution, reduced cancer risk)
Signs & Symptoms of Successful Breastfeeding:
Baby latches well, suckles effectively
Multiple pregnancy
Polyhydramnios
Genital tract infections
Placenta previa, abruption
Maternal illness (HTN, diabetes)
Smoking, poor nutrition
Signs & Symptoms:
Uterine contractions before 37 weeks
Pelvic pressure, backache
Vaginal discharge or bleeding
Cervical dilatation and effacement
Diagnostic Evaluation:
Vaginal examination (cervical status)
Ultrasound (cervical length, fetal wellbeing)
Fetal fibronectin test
FHR monitoring
Management:
Bed rest, hydration
Tocolytics (Nifedipine, Terbutaline)
Corticosteroids (Betamethasone) for lung maturity
Antibiotics if infection present
NICU preparation for preterm infant
Nursing Care Plan:
Monitor uterine contractions & FHR
Administer medications as prescribed
Provide emotional reassurance
Prepare mother for possible preterm delivery
Support neonatal care
4. Breastfeeding
Introduction:
Breastfeeding is the natural method of feeding infants and provides ideal nutrition and immunity.
Definition:
Process of feeding an infant with mother’s breast milk either directly or expressed.
Causes/Benefits:
Provides complete nutrition
Passive immunity (IgA, antibodies)
Promotes bonding and psychological wellbeing
Reduces risk of infections, allergies, obesity
Benefits mother (uterine involution, reduced cancer risk)
Signs & Symptoms of Successful Breastfeeding:
Baby latches well, suckles effectively
Audible swallowing
Baby satisfied, gains weight steadily
Diagnostic Evaluation:
Observation of feeding technique
Baby’s weight monitoring
Assessment of mother’s breast/nipple condition
Management:
Early initiation (within 1 hr of birth)
Exclusive breastfeeding for 6 months
Proper positioning and latch technique
Encourage frequent feeds on demand
Avoid prelacteal feeds & bottle feeding
Nursing Care Plan:
Teach mother about proper latching/positioning
Support exclusive breastfeeding
Monitor baby’s growth and hydration
Manage breast complications (engorgement, sore nipples)
Provide psychological encouragement
5. Medical Termination of Pregnancy (MTP)
Introduction:
MTP is legally permitted in India under certain conditions to safeguard maternal health and rights.
Definition:
The induced termination of pregnancy by medical or surgical methods before viability (20–24 weeks in India under MTP Act, 1971
amended 2021).
Causes/Indications:
Unwanted pregnancy (contraceptive failure)
Rape/incest
Risk to mother’s physical/mental health
Fetal anomalies incompatible with life
Maternal illness (cardiac disease, cancer, etc.)
Signs & Symptoms:
(Not a disease but clinical condition requiring procedure)
Positive pregnancy test with above indications
Diagnostic Evaluation:
Pregnancy confirmation (USG, urine test)
Gestational age assessment
General health check-up (Hb, BP, HIV, VDRL, etc.)
Management:
Medical: Mifepristone + Misoprostol (up to 9 weeks)
Surgical: Manual vacuum aspiration, D&C, suction evacuation
Antibiotics & analgesics
Post-MTP contraception counseling
Baby satisfied, gains weight steadily
Diagnostic Evaluation:
Observation of feeding technique
Baby’s weight monitoring
Assessment of mother’s breast/nipple condition
Management:
Early initiation (within 1 hr of birth)
Exclusive breastfeeding for 6 months
Proper positioning and latch technique
Encourage frequent feeds on demand
Avoid prelacteal feeds & bottle feeding
Nursing Care Plan:
Teach mother about proper latching/positioning
Support exclusive breastfeeding
Monitor baby’s growth and hydration
Manage breast complications (engorgement, sore nipples)
Provide psychological encouragement
5. Medical Termination of Pregnancy (MTP)
Introduction:
MTP is legally permitted in India under certain conditions to safeguard maternal health and rights.
Definition:
The induced termination of pregnancy by medical or surgical methods before viability (20–24 weeks in India under MTP Act, 1971
amended 2021).
Causes/Indications:
Unwanted pregnancy (contraceptive failure)
Rape/incest
Risk to mother’s physical/mental health
Fetal anomalies incompatible with life
Maternal illness (cardiac disease, cancer, etc.)
Signs & Symptoms:
(Not a disease but clinical condition requiring procedure)
Positive pregnancy test with above indications
Diagnostic Evaluation:
Pregnancy confirmation (USG, urine test)
Gestational age assessment
General health check-up (Hb, BP, HIV, VDRL, etc.)
Management:
Medical: Mifepristone + Misoprostol (up to 9 weeks)
Surgical: Manual vacuum aspiration, D&C, suction evacuation
Antibiotics & analgesics
Post-MTP contraception counseling
Nursing Care Plan:
Provide pre- and post-procedure counseling
Maintain asepsis during procedure
Monitor vitals, bleeding, pain
Emotional support to patient
Educate about family planning methods
Provide pre- and post-procedure counseling
Maintain asepsis during procedure
Monitor vitals, bleeding, pain
Emotional support to patient
Educate about family planning methods
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