Maternal & newborn nursing: antenatal, labour, postpartum & the neonate
Telling normal from dangerous across four phases: antenatal assessment, complications of pregnancy, labour and delivery, postpartum, and the healthy newborn.
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Must-know for the exam
✓Painless bright-red bleeding suggests placenta praevia (perform no vaginal exam); painful dark bleeding with a rigid, tender uterus suggests placental abruption.
✓Severe pre-eclampsia is hypertension with proteinuria plus headache, visual changes and epigastric pain; magnesium sulfate is given to prevent eclamptic seizures.
✓Magnesium toxicity shows as loss of deep tendon reflexes, respiratory depression (below 12/min) and reduced urine output — stop the infusion and give calcium gluconate, the antidote.
✓The first action for postpartum haemorrhage from a boggy (soft) uterus is to firmly massage the fundus; uterine atony is the leading cause of PPH.
✓APGAR is scored at 1 and 5 minutes (heart rate, respiration, tone, reflex, colour); it assesses transition and does not itself guide resuscitation.
✓Late decelerations on the fetal monitor suggest uteroplacental insufficiency — reposition the mother to the left side, give oxygen and IV fluids, and stop oxytocin.
How the exam frames maternal & newborn questions
Obstetric and neonatal stems almost always describe a woman or baby at a specific point in the pregnancy journey and test whether you can (1) recognise a finding as NORMAL for that stage or a DANGER sign, (2) judge how urgent it is, and (3) choose the correct PRIORITY nursing action. Because two lives are involved, the 'protect the airway/circulation and act now' option is very often the key, and 'notify the provider' is rarely the FIRST action when a life-saving nursing measure is available.
A dependable frame for any maternity stem:
•PLACE THE PATIENT IN TIME — is she antenatal (and how many weeks), in labour (which stage), or postpartum (how many hours/days)? The same symptom means different things at different points; bright-red bleeding is expected in early labour show but is an emergency in the third trimester.
•NORMAL vs DANGER — compare the finding against what is expected for that stage. Mild ankle oedema late in pregnancy is common; a severe headache with visual changes and epigastric pain is pre-eclampsia until proven otherwise.
•PRIORITISE for TWO patients — protect maternal airway, breathing and circulation first, because a stable mother is what keeps the fetus perfused; then protect the fetus (position, oxygen, stop harmful oxytocin).
•ACT within scope — reposition, give oxygen, apply fundal massage, stop an infusion, and stay with the patient; escalate abnormal findings; and never delay a life-saving nursing action to make a phone call.
Every figure here is a widely used reference value; gestational cut-offs, screening thresholds and drug protocols vary by guideline and facility, so read each number against your own DHA-aligned local policy and the individual patient.
Antenatal care — dating, routine assessment & danger signs
Antenatal questions test the framework of a normal pregnancy and, above all, the DANGER SIGNS that require the woman to be seen urgently.
•DATING — a term pregnancy is about 40 weeks (280 days) from the first day of the last menstrual period (LMP). NAEGELE'S RULE estimates the due date: take the first day of the LMP, subtract 3 months, add 7 days (and adjust the year). Trimesters divide roughly as 1st (weeks 1–12), 2nd (13–27) and 3rd (28–birth).
→Performing a vaginal examination on suspected placenta praevia, which can provoke catastrophic haemorrhage.
→Continuing magnesium sulfate despite absent reflexes or a respiratory rate below 12 — these are toxicity signs, and the antidote is calcium gluconate.
→Reaching for medication before massaging the fundus in postpartum haemorrhage from a boggy uterus.
→Confusing early decelerations (benign head compression) with late decelerations (uteroplacental insufficiency) that demand intervention.
→Assuming a normal blood pressure rules out worsening pre-eclampsia — act on headache, visual changes and epigastric pain.
•GRAVIDA/PARA — gravida is the number of pregnancies (including the current one); para is the number of births past the age of viability. The GTPAL system expands para into Term, Preterm, Abortions/losses and Living children.
•EXPECTED CHANGES — amenorrhoea, nausea ('morning sickness'), breast tenderness, urinary frequency and fatigue early; quickening (first felt fetal movement) around 16–20 weeks; a fundal height in centimetres that roughly matches the weeks of gestation from about 20 weeks. Blood volume rises, producing a physiological dilutional anaemia, and a mild fall in blood pressure in the second trimester is normal.
•ROUTINE SCREENING — blood group and Rh, haemoglobin, rubella immunity, infection screening (including HIV, hepatitis B, syphilis), urinalysis for protein/glucose at each visit, blood-pressure check every visit, and gestational-diabetes screening (commonly around 24–28 weeks). Blood pressure and urine protein at every visit are the cheap tests that catch pre-eclampsia early.
The antenatal DANGER SIGNS the exam wants a woman taught to report immediately: vaginal BLEEDING; severe or persistent HEADACHE, visual disturbance (blurring, flashing lights) or epigastric/right-upper-quadrant pain (pre-eclampsia); sudden facial/hand OEDEMA; a marked reduction in FETAL MOVEMENTS; a GUSH or leak of fluid (possible ruptured membranes); fever; painful urination; and persistent vomiting. Any of these means 'be assessed now', not 'wait for the next visit'.
