Obg Unit 1

ACADEMIC YEAR : 2017 [Type text] REGULATION : 2008-2009
RAAK NURSING AND PARAMEDICAL COLLEGE

PUDUCHERRY
PREFACE OF THE COURSE FILE
BATCH : 2013 - 2017
COURSE : Bsc. Nursing
YEAR / SEMESTER : IV Year / VIII semester
REGULATION : 2008 – 2009 / on wards
SUBJECT CODE : T 81 (1)
NAME OF THE SUBJECT : OBSTETRICAL AND GYNECOLOGICAL NURSING
[ UNIT – I ]
FACULTY INCHARGE : Miss. Nandhini. M
( QUESTION BANK )
PREPARED BY APPROVED BY
SIGNATURE HOD CO-

ORDINATOR
NAME
DESIGNATION
PRINCIPAL
RNPC/B.SC.NSG/ OBSTETRICAL AND GYNECOLOGICAL NURSING/Ms. NANDHINI .M/NURSING

TUTOR/IV YEAR/VIII SEMESTER/UNIT-I QUESTION BANK 1 OF 1 [Type text] Page 1
RAAK NURSING AND PARAMEDICAL COLLEGE, PUDUCHERRY

MIDWIFERY AND OBSTETRICAL NURSING
UNIT – I
TYPE – 100 % THEORY
( QUESTION BANK )
. INTRODUCTION TO MIDWIFERY AND OBSTETRICAL NURSING :

Introduction to concepts of midwifery and obstetrical nursing –Trends in midwifery
and obstetrical nursing –Historical perspectives and current trends Legal and ethical
aspects –Pre-conception care and preparing for parenthood –Role of nurse in
midwifery and obstetrical care –National policy and legislation in relation to
maternal health and welfare –Maternal , morbidity ,mortality and fertility rates –
Perinatal, morbidity and mortality rates
I. Essay Questions (15 marks )

1. a) Discuss role of nurse in midwifery and obstetrical care[DEC 2016]
MIDWIFE :
An individual who has successfully completed a midwifery education program

recognized by the country where it is located and has secured the required qualifications to be
registered and / or legally licensed to practice midwifery.
 The midwife has a unique role in care of mothers and babies.

 To give the necessary supervision, care and advice to women during pregnancy, labour
and the postpartum period.
 To conduct deliveries on her own responsibility and to care for the mother and the
newborn.
 To promote normal birth and detect complications in mother and child, access to medical
or other appropriate assistance and the carry out emergency measures.

 To involve in health counselling and education, not only for the woman, but also within
the family and community.
 To involve antenatal education and preparation for parenthood.
 To promote women's health, sexual or reproductive health and childcare.
ANTENATAL PERIOD :
Antenatal visits are done by midwife in the community area and clinics.
Health history, obstetric history ,physical examination is carried out by midwife.
Abdominal examination and various test are done and record are kept for further visits
The midwife should treat mothers in a caring, skilled manner and should consider their attitudes
and traditional beliefs. Prenatal care duties includes :
Examination of pregnant women.
i. Supervision and Education of pregnant women

ii. identification of high risk mothers
iii. Referral of high risk mothers to hospital
iv. Training of students at different level
v. Supervision of co-workers.
INTRANATAL PERIOD :
During labor midwife should,

i. Assure and comfort the pregnant mother
ii. Observe , record expectant mother’s progress
iii. Perform abdominal and vaginal examination.
iv. Deliver the child
v. Postpartum supervision and care
vi. Provision of emergency treatment until physician arrives
vii. Supportive care ( leads to positive outcomes) during child.
POST NATAL PERIOD :
AIM :
 To detect health problems of the mother and the babyat an early stage.
 To encourage breast feeding.
 To provide families a good start
 Prevent complication and restoration of mother’s health
 Provide family planning instructions.

 Provide health education to mother and family.
 Midwife as a teacher and counselor teaches women about reproductive health and
successful motherhood.
 At PHC level: Identify, train, supervise and support the needed number of health workers.
 Good communication skills
 Compassionate , kind and supportive
 Knowledgeable and skillful
 Involved in education and research.
b) list any two trends in midwifery and obstetrical nursing and explain their advantages.[DEC –
2016]
Changes in social structure, variations in family lifestyle
 It has altered health care priorities for maternal and child health nurses. Today, client
advocacy, an increased focus on health education, and new nursing roles are ways in
which nurses have adapted to these changes.
Cost Containment
 Cost containment refers to systems of health care delivery that focus on reducing the cost
of health care by closely monitoring the cost of personnel, use and brands of supplies,
length of hospital stays, number of procedures carried out, and number of referrals
requested.
Expanded roles for nurses
 Increasing nursing responsibility for assessment and professional judgment and providing
expanded roles for nurse practitioners, such as the nurse-midwife.
Family Centered Care
 More natural childbirth environment where partners, family members may remain in a
homelike environment, and participate in the childbirth experience
 By adopting a view of pregnancy, childbirth as a family event, nurses can be instrumental
in including family members in care and consult family members about a plan of care and
provide clear health teaching so that family members can monitor their own care

Access to Health Care
 Strong predictors of access to quality health care include having health insurance, a
higher income level, and a regular primary care provider or other source of ongoing
health care. Use of clinical preventive services, such as early prenatal care, can serve as
indicators of access to quality health care services. The objectives selected to measure
progress in this area are:
 Increase the proportion of persons with health insurance.
 Increase the proportion of persons who have a specific source of ongoing care.
 Increase the proportion of pregnant women who begin prenatal care in the first trimester
of pregnancy
Shortening Hospital Stays
 Women who have begun preterm labor stay in the hospital while labor is halted and then
are allowed to return home on medication with continued monitoring.
 Routine hospital stay for mothers and newborns after an uncomplicated birth is now 2
days or less.
 Short-term hospital stays require intensive health teaching by the nursing staff and
follow-up by home care or community health nurses.
Increased Use of Alternative Treatment Modalities
 There is a growing tendency to consult alternative forms of therapy, such as acupuncture

or therapeutic touch, in addition to, or instead of, traditional health care providers. Nurses
have an increasing obligation to be aware of complementary or alternative therapies.
Increased Use of Technology
 The field of assisted reproduction (e.g., in vitro fertilization), seeking information on the
Internet, and monitoring fetal heart rates by Doppler ultra sonography are other examples.
 In addition to learning these technologies, maternal and child health nurses must be able
to explain their use and their advantages to clients. Otherwise, clients may find new
technologies more frightening than helpful to them.
2.Discuss legal and ethical aspects related to midwifery and obstetrical nursing
care.[MAY 2012]
LEGAL AND ETHICAL ISSUES

Laws and ethics are often seen as complimentary to each other, but at
same time they are also seen as opposite sides of a coin. Midwives must follow standards
and regulations that range from the national level to the individual area of practice, such
as hospital, labor and delivery unit.
National standards of practice:

National standards provide an expectation of delivery care. The education programs of
midwifery assure that all new nurse midwives can safely deliver care within the scope of
usual midwifery practice.
State license:
Midwifery practice is regulated in the state of practice through license to practice. If a
midwife practices in two state, she must be licensed by both states. State license is meant
to protect the consumers by ensuring that the midwife has appropriate education for the
profession and can provide safe care.
Community standards:
it tells that a midwife’s duty must be evaluated according to the availability of medical
and practical knowledge that would be used in the treatment of similar patients under
similar circumstances, by competent midwives, given the facilities, resource and options
available.
Institutional policies:
The hospital laws govern midwives working in the hospital. The midwife working in the
should review the policies of the units which midwifery care is provided.
Professional negligence:
Medical malpractice is the legal error committed by medical personnel. In legal terms,
this error is tort- a civil wrong that injures a person. If tort is intentional, it becomes a
crime of assault or battery. Negligence, a form of malpractice, is an unintentional tort.
LEGAL ISSUES :
Problem of medication:
Certain problems can occur during giving medication which can result into allegation
against nurses, such as improper dosage of medication, improper client medication,
wrong route of medication and wrong time.
Failure in monitoring of the client:

It is the responsibility of the nurse to monitor the client regularly depending upon the
condition of the client. During antenatal period also monitoring is essential so that any

complication can be prevented. Nurse has to monitor the client during antenatal,
intranatal and postnatal period. Failure of this can result into a legal issue.
Failure in assessing the client:

Based on the assessment care is provided to the patients. She is responsible for assessing
and reporting any minute changes in the client condition. higher levels of assessment skill
have to be maintained by the nurses in all the specialty areas.
Abortion:
Many abortions are performed illegally. Nurse have right to refuse to assist in the
procedure of abortion. If the abortion is performed under the act of medical termination
of pregnancy, she can assist the physician in this. It is the responsibility to care for such
client.
Nursing care of newborn:

Nurses have many responsibilities for newborn. She has to take the foot print of the
newborn, cord is clamped, wrist band has to be put for the identification,proper warminf
is maintained etc.
II. Short Notes (5marks )
1.History of midwifery and obstetrical nursing[DEC -2015]

 The history is as old as the history of mankind. The first midwives in literature
were,

 HIPPOCRATES : 460BC, Endorsed that the fetus has to fight its way out of the
uterus.

 ARISTOTLE :484-322BC, Discussed the roles and responsibilities of a midwife.
He also described female generative organs.

 LEONARDO DA VINCI :1452-1519 Contributed several drawings of the
pregnant uterus.

 AMBROISE PARE : Conducted the first delivery of a woman in bed instead of
a birthing stool. He is also known for perineal repair and skillful deliveries.

 JULIUS CAESAR: Authored the first book for midwives in Italy. CS was
advocated by him for mothers with contracted pelvis.
 FRENCH KING LOUIS XIV :1663 Coined the name ‘accoucheur’(person who
assisted with a woman in labour).

 CHAMBERLEN : Was associated with obstetric forceps as he was responsible
for designing it for the first time in 1675.

 WILLIAM SMELLIE: Designed lock for the obstetric forceps. He also made
detailed description about the process of labour with principles of pelvimetry and
cephalometry.

 CHARLES WHITE : In 1773, advocated lime as disinfectant along with clean
linen. He also attributed puerperal fever to infection.

 FIELDING OULD(1710-1789) was the first to perform episiotomy.

 GORDON : In 1795 attributed puerperal sepsis to wound contamination of the
placental site.

 LAENNEC : In 1816 invented stethoscope.

 FRANCOIS : Recognized fetal heart sounds from the gravid uterus.

 JAMES YOUNG SIMPSON: Responsible for effectively using chloroform as an
anesthetic for obstetric procedures.

 FLORENCE NIGHTINGALE: In 1862, known for her nursing contribution
during the Crimean war, started a training school for the midwives.

 SEMMELWEIS : In 1865, explained the causes for puerperal infections also
propagated measures for prevention that includes hand-washing with lime
chloride.

 FRANCOIS MAURICEAU : In 1668 He reported caesarean section .

 PORRO : In 1876 performed the first subtotal hysterectomy.

 MAX SANGER : Remembered for suturing the uterine walls.


 KRONIG : Introduced vertical section for the lower segment during caesarean
section.
2.Legal and ethical aspects of obstetrical nursing[DEC -2012]
Legal and ethical aspects:

Laws and ethics are often seen as complimentary to each other, but at same time they are
also seen as opposite sides of a coin. Midwives must follow standards and regulations
that range from the national level to the individual area of practice, such as hospital, labor
and delivery unit.
National standards of practice:

National standards provide an expectation of delivery care. The education programs of
midwifery assure that all new nurse midwives can safely deliver care within the scope of
usual midwifery practice.
State license:
Midwifery practice is regulated in the state of practice through license to practice. If a
midwife practices in two state, she must be licensed by both states. State license is meant
to protect the consumers by ensuring that the midwife has appropriate education for the
profession and can provide safe care.
Community standards:
it tells that a midwife’s duty must be evaluated according to the availability of medical
and practical knowledge that would be used in the treatment of similar patients under
similar circumstances, by competent midwives, given the facilities, resource and options
available.
Institutional policies:
The hospital laws govern midwives working in the hospital. The midwife working in the
should review the policies of the units which midwifery care is provided.
Professional negligence:
Medical malpractice is the legal error committed by medical personnel. In legal terms,
this error is tort- a civil wrong that injures a person. If tort is intentional, it becomes a
crime of assault or battery. Negligence, a form of malpractice, is an unintentional tort.

LEGAL ISSUES :
1. Problems of medication
2. Failure in monitoring of the patient
3. Failure to report changes in the patient
4. Failure in assessing the client
5. Abortions
6. Nursing care of newborn
ETHICAL PRINCIPLES :
7. Non maleficence
8. Respect for autonomy
9. Caring
10. Empowerment and advocacy
3.National policy and legislation in maternal health and welfare.

1. Maternal and child health program :
Objectives –:
To reduce the maternal infant and childhood mortality and morbidity
To promote reproductive health
To promote physical and psychological development of children and adolescent.
2. ICDS :
It provides services for pregnant and lactating mothers. These includes,
 Supplementary nutritional requirements
 Immunization
 Health check ups
 Referrals
 Health education for women.
3. RCH : Essential components are,
 Prevention and management of unwanted pregnancies

 Maternal care that includes antenatal, delivery and postpartum services.

 Child survival services for newborn and infants.

 Management of RTIs and STIs
4. JANANI SURAKSHA YOJNA :
Objectives
 Reduction in MMR and IMR
 Focus on institutional delivery
Features
 Encouraging small family norms
 Provision of CS
 Encourage women to undergo tubectomy / laproscopy
 Payment of incentives to dai/ASHA
4.Pre conceptional care and preparing for motherhood.
INTRODUCTION
 Concept of preconception care has evolved over the last several decades
 J.W. Ballantyne - originated concept of prenatal care
 Preconception and prenatal care are forms of primary care and prevention
 Opportunities exist in many settings
 Should target all women of reproductive age
 Education and preparation are key
 Worldwide maternal mortality approaches one million women annually
 Risk of maternal death in the is 1 in 10,000 live births
 Unintended pregnancy rate approaches 40% annually
COMPONENTS OF PRECONCEPTION CARE
 Risk assessment
 Education
 Intervention or modification
 Counseling
GOALS OF PRECONCEPTION CARE
 To identify pre-existing conditions that may affect an anticipated pregnancy

 This may allow for intervention(s) that could lead to more favorable outcome
 Goal should be realistic
 Identification process involves mother and fetus

BENEFITS OF PRE CONCEPTION CARE :
 Increased fertility . healthy conception and birth.

 Reduced risk for miscarriage , premature birth or abnormality
 Decreased occurrence of common complaints such as morning sickness.
 A successful alternative to assisted reproductive programs for many fertility problems.
 May improve the success rate of IVF
 Increased chance of a natural, intervention free birth.
 Reduced risk of post natal depression.
 Successful and long term breast feeding.
 Children those are healthy, intelligent,well balanced and happy.
SPECIAL PRE CONCEPTION ADVICES :
 Weight loss before pregnancy decreases the risk for neural tube defect, diabetes, CS, high
blood pressure
 Stop smoking, consuming alcohol before pregnancy.
 Manage blood sugars
 Diet with folic acid reduces neural tube defect.
 Some epilepsy medications causes fetal abnormality consult the doctor if taking epilepsy
medications.
 Control blood pressure to decrease the risk for pre eclampsia , kidney problems and fetal
growth retardation.
 Early diagnosis and treatment of sexually transmitted diseases.
 Incase of hypothyroidism get the doses adjusted
 Maintain oral hygiene. Dental caries , gingivitis can lead to preterm delivery and preterm
labor.
PREPARING FOR MOTHERHOOD :
SAFE MOTHERHOOD :
It is the global effort to reduce the maternal deaths.
It aims to improve women’s health through social , community and economic interventions.
Preparing for motherhood :
 Physical preparation :
 Psychological preparation
Functional preparation

5. Explain Maternal morbidity, mortality and fertility rates.

. Maternal mortality rate :
It measures the risk of women dying from puerperal causes and is defined as :
Total number of deaths due to complications of pregnancy , childbirth or
Within 42 days of delivery from puerperal causes in an area during a given year * 1000
Total number of live births in the same area and year
CAUSES OF MATERNAL DEATH :
Hemorrhage : 20- 25%. Mostly due to post partum hemorrhage ,
abortion and
ectopic pregnancy.
Sepsis : 20-25% . Deaths due to infections associated with labor and puerperium and unsafe
abortions.
Hypertensive disorders : 5-15%. Due to lack of antenatal care.
Anemia : 40% . if anemia is severe they may die from congestive cardiac failure during
pregnancy / labor.
Infective hepatitis : 20-25%. The risk of death is most in the last trimester with hepatic coma and
coagulation failure leading to hemorrhage.
Thrombo embolism : 2-5%. Deaths due to thrombophlebitis .
Lack of assistance of trained personnel : a large number of deliveries take place at home without
the services of trained midwifery personnel.
Preventive measures :
 Early registration of pregnancy.

 At least three antenatal checkups
 Improvement of nutritional status including correction of anemia

 Identification of high risk cases and their referrals appropriate referral hospitals.
 Prevention of complications such as eclampsia, malpresentations and ruptured uterus.
 Treatment of medical conditions such as HTN, DM , TB
 Antimalaria and tetanus prophylaxis.
 Institutional deliveries
 Promotion of family planning to control the number of children to not more than two and
spacing of birth.
 Identification of every maternal death and searching its causes.
 To provide safe delivery services to all mothers by traditional birth attendants.
 Upgrading the health centers, making government vehicles available in emergencies.
 Increasing the number of health care providers such as midwives, multi purpose health
workers, health workers, health assistants and other ancillary personnel.
 Periodic refresher courses for continuing education of all levels of health workers to
highlight the preventive measures.
MATERNAL MORBIDITY :
Classification :
Direct obstetric morbidity : Acute conditions are
 APH
 PPH
 Eclampsia
 Obstructed labor
 Rupture of uterus
 Sepsis
 Ectopic pregnancy
 Molar pregnancy
Chronic causes :
 VVF
 RVF
 Uterine prolapsed
 Secondary infertility
 Sheehan’s syndrome.
 Indirect morbidity :
 Malaria
 Hepatitis
 Tuberculosis
 Anemia

Reproductive morbidity : It includes
 Obstetric morbidity
 Gynecological morbidity
 Contraceptive morbidity
6.Explain perinatal morbidity and mortality rates.

PERINATAL MORTALITY
It is defined as deaths among fetuses weighing over 1,000 gm at birth,that die before and during
delivery or within the first 7 days of delivery. The perinatal mortality rate is expressed in terms
of deaths per 1,000 total births.
late fetal death (28 weeks gestation and more ) + early neonatal deaths
(first week ) in one year
ANTENATAL CAUSES :
 Maternal diseases : hypertension, cardiovascular diseases, diabetes, tuberculosis,anemia

 Pelvic diseases : uterine myomas, endometriosis, ovarian tumors
 Anatomical defects : uterine anomalies, incompetent cervix.
 Endocrine imbalance : inadequate uterine preparation
 Blood incompatibilities
 Malnutrition
 Toxemias of pregnancy
 Antepartum hemorrhage
 Congenital defects
 Advanced maternal age
 Preterm labor and preterm rupture of membranes.
INTRA NATAL CAUSES :
 Birth injuries
 Asphyxia
 Prolonged labor
 Obstetric complications: dystocia
 Abnormal uterine action
 Malpresentation
POSTNATAL CAUSES :
 Prematurity
 Respiratory distress syndrome
 Respiratory and alimentary infections
 Congenital anomalies
PREVENTIVE MEASURES:
 Prepregnancy health care and counseling

 Genetic counseling to detect genetic, chromosomal / structural abnormalities
 Regular antenatal care,with advice regarding health,diet and rest
 Improvement of maternal nutrition
 Screening of high risk mothers
 Careful monitoring during labor and avoidance of traumatic vaginal delivery
 Efficient neonatal service for preterm babies
 Health education to mothers about care of newborn
 Autopsy studies of prenatal death
 Continued study of perinatal mortality problems.


Obg Unit 1

Uploaded by

Copyright:

Available Formats

Obg Unit 1

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Obg Unit 1

Uploaded by

Copyright:

Available Formats

ACADEMIC YEAR : 2017 [Type text] REGULATION : 2008-2009

RAAK NURSING AND PARAMEDICAL COLLEGE

PREFACE OF THE COURSE FILE

BATCH : 2013 - 2017

COURSE : Bsc. Nursing

YEAR / SEMESTER : IV Year / VIII semester

REGULATION : 2008 – 2009 / on wards

SUBJECT CODE : T 81 (1)

NAME OF THE SUBJECT : OBSTETRICAL AND GYNECOLOGICAL NURSING

FACULTY INCHARGE : Miss. Nandhini. M

SIGNATURE HOD CO-

RNPC/B.SC.NSG/ OBSTETRICAL AND GYNECOLOGICAL NURSING/Ms. NANDHINI .M/NURSING

RAAK NURSING AND PARAMEDICAL COLLEGE, PUDUCHERRY

TYPE – 100 % THEORY

. INTRODUCTION TO MIDWIFERY AND OBSTETRICAL NURSING :

I. Essay Questions (15 marks )

An individual who has successfully completed a midwifery education program

 The midwife has a unique role in care of mothers and babies.

RNPC/B.SC.NSG/ OBSTETRICAL AND GYNECOLOGICAL NURSING/Ms. NANDHINI .M/NURSING

Health history, obstetric history ,physical examination is carried out by midwife.

Examination of pregnant women.

i. Supervision and Education of pregnant women

During labor midwife should,

POST NATAL PERIOD :

 Provide family planning instructions.

Changes in social structure, variations in family lifestyle

Expanded roles for nurses

Family Centered Care

RNPC/B.SC.NSG/ OBSTETRICAL AND GYNECOLOGICAL NURSING/Ms. NANDHINI .M/NURSING

Access to Health Care

Shortening Hospital Stays

Increased Use of Alternative Treatment Modalities

 There is a growing tendency to consult alternative forms of therapy, such as acupuncture

Increased Use of Technology

LEGAL AND ETHICAL ISSUES

National standards of practice:

Failure in monitoring of the client:

RNPC/B.SC.NSG/ OBSTETRICAL AND GYNECOLOGICAL NURSING/Ms. NANDHINI .M/NURSING

Failure in assessing the client:

Nursing care of newborn:

1.History of midwifery and obstetrical nursing[DEC -2015]

RNPC/B.SC.NSG/ OBSTETRICAL AND GYNECOLOGICAL NURSING/Ms. NANDHINI .M/NURSING

2.Legal and ethical aspects of obstetrical nursing[DEC -2012]

Legal and ethical aspects:

National standards of practice:

RNPC/B.SC.NSG/ OBSTETRICAL AND GYNECOLOGICAL NURSING/Ms. NANDHINI .M/NURSING

3.National policy and legislation in maternal health and welfare.

3. RCH : Essential components are,

 Prevention and management of unwanted pregnancies

RNPC/B.SC.NSG/ OBSTETRICAL AND GYNECOLOGICAL NURSING/Ms. NANDHINI .M/NURSING

 Child survival services for newborn and infants.

4. JANANI SURAKSHA YOJNA :

4.Pre conceptional care and preparing for motherhood.

COMPONENTS OF PRECONCEPTION CARE

GOALS OF PRECONCEPTION CARE

 To identify pre-existing conditions that may affect an anticipated pregnancy

RNPC/B.SC.NSG/ OBSTETRICAL AND GYNECOLOGICAL NURSING/Ms. NANDHINI .M/NURSING

BENEFITS OF PRE CONCEPTION CARE :

 Increased fertility . healthy conception and birth.