Maternal Nursing–July 2015–SAU.UNI.RJKT

SECTIONI -I

I Long essay (Any one) 1×15-15

💜 (A) Define Preterm. (3+12)

1. A preterm baby, also known as a premature baby, is born before completing 37 weeks of gestation.

2. Gestational Age Categories:

• Extremely preterm: Born before 28 weeks.
• Very preterm: Born between 28 and 32 weeks.
• Moderate to late preterm: Born between 32 and 37 weeks.

💜 (B) Enumerate the characteristics and management of a preterm baby

Characteristics of preterm baby.

• Low birth weight: Preterm babies often have lower birth weights compared to full-term babies.
• Underdeveloped organs: Organs such as the lungs, brain, and immune system may not be fully developed, leading to potential health complications.
• Difficulty regulating body temperature: Premature babies may struggle to maintain their body temperature.
• Feeding challenges: They might have difficulties with breastfeeding or bottle-feeding due to underdeveloped sucking reflexes and digestive systems.
• Increased risk of health issues: Preterm birth increases the risk of various health complications, including respiratory distress syndrome, jaundice, infections, and developmental delays.

👉 Management of preterm baby..

◾Certainly, here’s a detailed outline of the management of a preterm baby:

Immediate Medical Care:

• Upon birth, assess the baby’s condition, including breathing, heart rate, and temperature.
• Provide respiratory support if needed, such as administering oxygen or initiating mechanical ventilation.
• Stabilize the baby’s temperature to prevent hypothermia, often through the use of an incubator or radiant warmer.

Admission to Neonatal Intensive Care Unit (NICU):

• Transfer the preterm baby to the NICU for specialized care and monitoring.
• NICU staff will assess the baby’s vital signs, monitor for complications, and provide interventions as necessary.

Respiratory Support:

• Provide respiratory support tailored to the baby’s needs, which may include:
  • Mechanical ventilation: For severe respiratory distress.
  • Continuous positive airway pressure (CPAP): To help keep the airways open and improve breathing.
  • Nasal cannula: Delivering oxygen to support breathing.

Nutritional Support:

• Initiate feeding strategies appropriate for the baby’s gestational age and condition, which may include:
  • Parenteral nutrition: Providing nutrients intravenously when the baby cannot tolerate oral feeding.
  • Tube feeding: Administering breast milk or formula through a nasogastric or orogastric tube until the baby can feed orally.
  • Breastfeeding support: Encouraging breastfeeding when the baby is ready, with assistance as needed.

Temperature Regulation:

• Ensure the baby remains warm to prevent hypothermia, utilizing incubators, radiant warmers, or skin-to-skin contact (kangaroo care).
• Monitor the baby’s temperature regularly and adjust environmental conditions as necessary.

Monitoring and Treatment of Complications:

• Monitor for common complications associated with preterm birth, such as:
  • Respiratory distress syndrome (RDS): Administer surfactant therapy and respiratory support as needed.
  • Jaundice: Monitor bilirubin levels and provide phototherapy if necessary.
  • Infections: Monitor for signs of infection and administer antibiotics if indicated.
• Address other potential complications promptly, such as apnea, intraventricular hemorrhage, and necrotizing enterocolitis.

Developmental Support:

• Provide developmental care to support the baby’s neurological and physical development, including:
  • Positioning: Proper positioning to support muscle tone and prevent contractures.
  • Sensory support: Minimizing exposure to excessive noise and light to reduce sensory overload.
  • Developmental interventions: Implementing activities to promote sensory stimulation and interaction.

Family-Centered Care:

• Involve parents in the care of their preterm baby, providing education, support, and opportunities for bonding.
• Encourage parental participation in caregiving activities and decision-making processes.

Long-Term Follow-Up:

• Schedule regular follow-up appointments to monitor the baby’s growth, development, and overall health.
• Provide support services and resources for families to address any ongoing medical, developmental, or psychosocial needs.

Overall, the management of a preterm baby requires a multidisciplinary approach, involving neonatologists, nurses, respiratory therapists, nutritionists, and other healthcare professionals, to provide comprehensive care tailored to the individual needs of the baby and family.

II

💜 (A) Define Obstetrical Emergency (2+3+10)

An obstetric emergency refers to a situation during pregnancy, labor, or postpartum period that poses a risk to the health or life of the mother, baby, or both. These emergencies require immediate medical attention to prevent serious complications or fatalities. Examples include placental abruption, eclampsia, or umbilical cord prolapse.

💜 (B) List down the Obstetrical emergencies

obstetric emergencies:

1. Placental abruption
2. Eclampsia
3. Umbilical cord prolapse
4. Shoulder dystocia
5. Postpartum hemorrhage
6. Pre-eclampsia
7. Amniotic fluid embolism
8. Cord compression
9. Uterine rupture
10. Fetal distress

Each of these situations requires urgent medical intervention to ensure the safety of the mother and baby.

👉 and medical teams is essential to ensure timely and effective management of these obstetric emergencies.

💜 (C) Discuss the Nursing and Medical management of any two obstetrical emergencies

Certainly, here are detailed descriptions of the nursing and medical management for two common obstetric emergencies:

👉 placental abruption and postpartum hemorrhage.

Placental Abruption:

Nursing Management:

Assessment:

• Assess the mother’s vital signs, including blood pressure, heart rate, and respiratory rate.
• Monitor fetal heart rate for signs of distress.
• Assess for abdominal pain, uterine tenderness, and vaginal bleeding.

Immediate Actions:

• Place the mother in a left lateral position to improve blood flow to the fetus.
• Administer oxygen to the mother to improve oxygenation to the fetus.
• Establish IV access for fluid resuscitation and medication administration.

Monitoring:

• Continuously monitor maternal and fetal vital signs.
• Monitor uterine contractions and document their frequency and intensity.

Collaboration:

• Collaborate with the healthcare team to expedite delivery if necessary.
• Communicate effectively with the physician to ensure timely interventions.

Medical Management:

Confirmation of Diagnosis:

• Conduct ultrasound to confirm the diagnosis and assess fetal well-being.
• Perform laboratory tests, including coagulation studies and complete blood count.

Delivery Management:

• If the fetus is viable and there are signs of fetal distress, expedite delivery via cesarean section.
• If the fetus is not viable, manage expectantly with close monitoring and supportive care.

Blood Transfusion:

• Administer blood transfusions if the mother is experiencing significant hemorrhage.
• Monitor coagulation parameters and correct any coagulopathy.

Medication Administration:

• Administer tocolytic agents to inhibit uterine contractions and decrease the risk of further abruption.
• Provide pain management for the mother, such as analgesics or epidural anesthesia.

Postpartum Hemorrhage:

Nursing Management:

Assessment:

• Monitor vital signs closely, especially blood pressure and pulse.
• Assess the amount and character of vaginal bleeding.
• Evaluate uterine tone and fundal height to detect uterine atony.

Immediate Actions:

• Massage the uterus to promote contraction and control bleeding.
• Administer uterotonics, such as oxytocin or misoprostol, to stimulate uterine contractions.
• Ensure IV access and initiate fluid resuscitation with crystalloids or colloids.

Monitoring:

• Monitor for signs of shock, such as pallor, cool clammy skin, and decreased urine output.
• Assess for signs of coagulopathy, such as prolonged bleeding or decreased platelet count.

Collaboration:

• Collaborate with the healthcare team to expedite interventions, such as surgical management if conservative measures fail.
• Communicate effectively with the physician to provide updates on the mother’s condition and response to treatment.

Medical Management:

Uterine Massage and Medications:

• Continue uterine massage and administration of uterotonic medications as needed.
• Consider additional medications, such as prostaglandins or ergot alkaloids, if uterine atony persists.

Surgical Intervention:

• Perform manual removal of retained placental fragments if indicated.
• Consider surgical interventions, such as uterine artery ligation or hysterectomy, for refractory hemorrhage.

Blood Transfusion:

• Administer blood products as necessary to correct hypovolemia and restore hemodynamic stability.
• Monitor hemoglobin and hematocrit levels to guide transfusion therapy.

Coagulopathy Management:

• Correct coagulopathy with blood products, such as fresh frozen plasma or platelet transfusions.
• Consider pharmacological agents, such as tranexamic acid, to promote hemostasis.

Both placental abruption and postpartum hemorrhage require prompt recognition, assessment, and intervention to prevent maternal and fetal morbidity and mortality. Close collaboration between nursing

II Short essays (any three) 3×5=15

💜 1.Cord Prolapse

Cord prolapse

👉Certainly, here’s a detailed breakdown of cord prolapse.

Definition:

• Cord prolapse is a serious obstetric emergency that occurs when the umbilical cord slips through the cervix or presents alongside the presenting part of the fetus, usually the head, before or during labor.

Causes:

• Premature rupture of membranes (PROM): When the amniotic sac ruptures before the onset of labor, there is a risk of cord prolapse as the umbilical cord may descend into the birth canal.
• Abnormal fetal presentation: Occurs when the fetus is in a breech or transverse position, increasing the likelihood of cord prolapse.
• Polyhydramnios: Excessive amniotic fluid can increase the risk of cord prolapse due to increased mobility of the fetus and umbilical cord within the uterus.
• Multiparity, preterm labor, and artificial rupture of membranes are other predisposing factors.

Signs and Symptoms:

• Sudden onset of fetal distress, characterized by abnormal fetal heart rate patterns, such as bradycardia or variable decelerations.
• Visible or palpable umbilical cord felt alongside or protruding through the cervix during vaginal examination.
• Maternal reports of a sudden gush of fluid or feeling something unusual in the vaginal canal.

Complications:

• Cord compression: External pressure on the umbilical cord can compromise blood flow to the fetus, leading to fetal hypoxia and acidosis.
• Fetal hypoxia and acidosis can result in intrauterine fetal demise or long-term neurological deficits if not promptly managed.
• Maternal complications may arise if emergency interventions, such as cesarean delivery, are not performed in a timely manner to relieve cord compression.

Diagnosis:

• Diagnosis is typically made based on clinical findings during vaginal examination or continuous electronic fetal monitoring.
• Visualization or palpation of the umbilical cord alongside or protruding through the cervix confirms the diagnosis of cord prolapse.

Management:

• Immediate action is required to relieve cord compression and minimize fetal hypoxia:
  • Manual elevation of the presenting part off the cord: A sterile gloved hand is inserted into the vagina to lift the presenting part off the cord until emergency measures, such as cesarean delivery, can be performed.
  • Positional changes: Changing the maternal position to a knee-chest or Trendelenburg position may alleviate cord compression temporarily.
• Emergency cesarean delivery is the definitive management to expedite delivery and prevent further compromise to fetal well-being.
• In cases of preterm gestation where delivery is not feasible, emergency obstetric interventions such as amnioinfusion or emergent cesarean delivery may be considered to relieve cord compression and buy time for fetal maturation.

Follow-Up:

• Close monitoring of maternal and fetal status post-delivery to assess for signs of fetal distress, uterine atony, or maternal hemorrhage.
• Evaluation of the neonate for signs of hypoxia, acidosis, or birth trauma requiring medical intervention.

Understanding the causes, signs, and management of cord prolapse is essential for healthcare providers to recognize and respond promptly to this obstetric emergency, minimizing the risk of adverse outcomes for both the mother and the baby.

💜 2.Forceps delivery

Forceps Delivery:

Definition:

• Forceps delivery is a method of assisted vaginal delivery in which obstetric forceps are used to grasp and guide the fetal head through the birth canal during labor.

Indications:

• Prolonged second stage of labor: When the mother is unable to push effectively or when fetal distress is present.
• Maternal exhaustion or inability to push due to medical conditions.
• Non-reassuring fetal heart rate patterns.
• Maternal medical conditions that necessitate expedited delivery, such as certain cardiac or respiratory conditions.

Preparation:

• Anesthesia: Ensure adequate pain relief, either through epidural anesthesia or local anesthesia if epidural is not in place.
• Positioning: Position the mother in lithotomy position with legs supported in stirrups.
• Informed Consent: Obtain informed consent from the mother after discussing the risks and benefits of forceps delivery.

Procedure:

• Application of Forceps: The obstetrician gently inserts the forceps blades into the vagina and applies them to the sides of the fetal head.
• Traction: Controlled traction is applied during contractions to assist in guiding the fetal head through the birth canal.
• Episiotomy: In some cases, an episiotomy may be performed to enlarge the vaginal opening and facilitate delivery.
• Monitoring: Continuous monitoring of maternal and fetal vital signs, as well as fetal heart rate, throughout the procedure.
• Delivery: Once the fetal head is visible, the obstetrician guides it through the birth canal while applying traction with the forceps.
• Assessment: After delivery of the fetal head, the obstetrician assesses for shoulder dystocia and performs maneuvers if necessary to facilitate delivery of the shoulders.

Complications:

• Maternal: Risk of perineal trauma, including tears or lacerations, increased risk of postpartum hemorrhage, pelvic floor injury.
• Fetal: Risk of scalp trauma or bruising, facial nerve injury, cephalohematoma, intracranial hemorrhage, transient facial palsy.
• Failure: In some cases, forceps delivery may be unsuccessful, necessitating conversion to cesarean section.
• Long-term consequences: Potential long-term effects on pelvic floor function, although controversial, are a subject of ongoing research.

Post-procedure Care:

• Inspection and Repair: Inspect the perineum for any tears or lacerations and repair as needed.
• Maternal Monitoring: Monitor the mother closely for signs of postpartum hemorrhage, infection, or other complications.
• Neonatal Care: Assess the newborn for any signs of trauma or injury and provide appropriate neonatal care as needed.

Forceps delivery can be a valuable tool in obstetric practice when used judiciously and in appropriate clinical scenarios. Close monitoring and skilled obstetrical care are essential to minimize risks and optimize outcomes for both the mother and baby.

💜 3.Placental abnormalities

Placental Abnormalities:

Placental Abruption:

• Definition: Placental abruption occurs when the placenta partially or completely detaches from the uterine wall before delivery of the fetus.
• Risk Factors: Maternal hypertension, trauma, advanced maternal age, smoking, cocaine use, previous history of placental abruption.
• Clinical Presentation: Vaginal bleeding, abdominal pain, uterine tenderness, fetal distress, signs of maternal shock.
• Management: Immediate delivery if fetus is viable, supportive care including oxygen administration, IV fluids, blood transfusion, tocolytic agents to inhibit contractions, and pain management.

Placenta Previa:

• Definition: Placenta previa occurs when the placenta implants low in the uterus, partially or completely covering the cervix.
• Risk Factors: Previous cesarean section, multiparity, advanced maternal age, smoking, history of uterine surgery.
• Clinical Presentation: Painless vaginal bleeding in the second or third trimester, potentially associated with contractions.
• Management: Delivery via cesarean section if bleeding is significant or fetal compromise is present, close monitoring for signs of hemorrhage or preterm labor.

Placenta Accreta Spectrum Disorders:

• Definition: Placenta accreta spectrum disorders involve abnormal adherence of the placenta to the uterine wall, often due to defective decidualization.
• Types: Placenta accreta (placenta attaches too deeply), placenta increta (placenta invades the myometrium), placenta percreta (placenta penetrates through the myometrium).
• Risk Factors: Previous cesarean section, placenta previa, advanced maternal age, multiparity, history of uterine surgery.
• Clinical Presentation: Often diagnosed prenatally via ultrasound, may present with postpartum hemorrhage or difficulty with placental delivery during childbirth.
• Management: Antenatal diagnosis and planning for delivery in a tertiary care center with expertise in managing placenta accreta, often involves cesarean hysterectomy to remove the placenta and control bleeding.

Velamentous Cord Insertion:

• Definition: Velamentous cord insertion occurs when the umbilical cord inserts into the fetal membranes rather than directly into the placental tissue.
• Risk Factors: Multiparity, advanced maternal age, assisted reproductive technologies, multiple gestations.
• Clinical Presentation: Often asymptomatic, may be associated with fetal growth restriction, preterm birth, or vasa previa (fetal vessels traverse the membranes over the cervix).
• Management: Prenatal diagnosis via ultrasound, close monitoring for signs of fetal compromise, consideration of elective cesarean delivery to minimize the risk of cord compression or rupture.

Succenturiate Placenta:

• Definition: Succenturiate placenta occurs when accessory lobes of placental tissue are connected to the main placenta by fetal blood vessels.
• Risk Factors: Advanced maternal age, multiparity, smoking, history of previous placental abnormalities.
• Clinical Presentation: Often asymptomatic, may be associated with increased risk of postpartum hemorrhage due to retained placental tissue.
• Management: Prenatal diagnosis via ultrasound, careful examination of the placenta during delivery to ensure complete removal of all lobes, close monitoring for signs of postpartum hemorrhage.

Understanding these placental abnormalities is crucial for early recognition, appropriate management, and optimizing outcomes for both the mother and baby. Close collaboration between obstetricians, nurses, and other healthcare providers is essential for the comprehensive care of pregnant women with these conditions.

💜 4.Uterine inertia

Uterine Inertia:

Definition:

1. Uterine inertia refers to a condition characterized by ineffective uterine contractions during labor, resulting in prolonged or arrested labor progress.

Causes:

Primary Uterine Inertia:

• Occurs when the uterus fails to generate sufficient contractions from the onset of labor.
• Can be due to inadequate myometrial activity, hormonal imbalances, or maternal factors such as fatigue or dehydration.

Secondary Uterine Inertia:

• Occurs when contractions become weak or cease after an initial period of active labor.
• Can be triggered by factors such as maternal exhaustion, epidural anesthesia, or fetal malposition.

Signs and Symptoms:

Prolonged Labor:

• Labor lasting more than 20 hours for nulliparous women or more than 14 hours for multiparous women.

Slow Progress:

• Slow cervical dilation or descent of the fetal presenting part despite regular contractions.

Fetal Distress:

• Signs of fetal distress, such as abnormal fetal heart rate patterns or meconium-stained amniotic fluid, may occur due to compromised uteroplacental perfusion.

Diagnosis:

Clinical Evaluation:

• Assessment of maternal and fetal well-being, including vital signs, fetal heart rate monitoring, and uterine contractions.

Pelvic Examination:

• Examination of cervical dilation, effacement, and fetal station to assess labor progress.

Labor Monitoring:

• Continuous monitoring of uterine contractions and fetal heart rate patterns to detect signs of uterine inertia and fetal distress.

Management:

Augmentation of Labor:

• Administer synthetic oxytocin (Pitocin) intravenously to stimulate uterine contractions and promote labor progress.
• Start at a low dose and gradually titrate to achieve regular and effective contractions while monitoring uterine response and fetal well-being.

Positioning and Mobility:

• Encourage maternal position changes and mobility to optimize uterine activity and fetal descent.
• Upright positions such as walking, squatting, or using a birthing ball may facilitate labor progress.

Hydration and Nutrition:

• Ensure adequate hydration and nutrition to support maternal energy levels and uterine function during labor.
• Offer clear fluids and light snacks as tolerated to maintain maternal hydration and glucose levels.

Emotional Support:

• Provide emotional support and reassurance to the laboring woman and her birth partner to alleviate anxiety and promote relaxation.
• Encourage effective coping strategies such as deep breathing, relaxation techniques, and visualization exercises.

Continuous Monitoring:

• Continuously monitor maternal and fetal well-being, including uterine contractions, fetal heart rate patterns, and maternal vital signs.
• Promptly intervene in case of signs of fetal distress or maternal exhaustion.

Complications:

Maternal Complications:

• Prolonged labor increases the risk of maternal exhaustion, dehydration, and postpartum hemorrhage.

Fetal Complications:

• Prolonged labor may lead to fetal distress, meconium aspiration, or birth trauma due to prolonged pressure on the fetal head.

Collaborative Care:

Multidisciplinary Team:

• Collaboration with obstetricians, midwives, nurses, and anesthesia providers to ensure comprehensive care and timely interventions during labor.

Consultation:

• Consultation with obstetric specialists or perinatologists for complex cases of uterine inertia or suspected fetal compromise.

Emergency Preparedness:

• Preparedness for potential complications such as uterine rupture, shoulder dystocia, or emergency cesarean delivery in cases of labor dystocia.

Patient Education:

Antenatal Education:

• Educate women during prenatal care about the signs and stages of labor, coping techniques, and potential interventions for labor dystocia.

Intrapartum Guidance:

• Provide guidance and encouragement to laboring women and their birth partners regarding coping strategies, position changes, and communication with the healthcare team during labor.

Uterine inertia requires prompt recognition and management to prevent maternal and fetal complications and promote optimal outcomes for both mother and baby during childbirth.

💜 5.Breast engorgement

1. Definition: Breast engorgement is the swelling, firmness, and pain in the breasts due to an accumulation of milk.
2. Causes:

• Increased blood flow and milk production after childbirth.
• Delayed or missed feedings.
• Improper breastfeeding latch.
• Weaning from breastfeeding.

Symptoms:

• Swollen, hard, and tender breasts.
• Shiny, stretched skin over the breasts.
• Fever or flu-like symptoms in severe cases.

Treatment:

• Frequent breastfeeding or expressing milk to relieve pressure.
• Warm compresses or showers before feeding to encourage milk flow.
• Cold compresses or cabbage leaves between feedings to reduce swelling.
• Pain relievers like ibuprofen or acetaminophen, if recommended by a healthcare provider.
• Proper breastfeeding techniques to prevent further engorgement.

Prevention:

• Nurse frequently and ensure proper latch.
• Avoid skipping feedings and empty breasts fully during each feeding.
• Use breastfeeding pillows or positions that aid in proper latch and milk removal.
• Avoid tight bras or clothing that can restrict milk flow.
• Gradually wean from breastfeeding to allow the body to adjust milk production.

When to Seek Medical Help:

• If symptoms worsen or do not improve with home remedies.
• If you develop a fever higher than 101°F (38.3°C).
• If there are signs of infection such as redness, warmth, or pus discharge from the breasts.

Breast engorgement is common, especially in the early postpartum period, but proper management can help alleviate discomfort and prevent complications.

III Short answer. (any four) 1×2=8

💜 1.Asphyxia Neonatorum

Asphyxia neonatorum is a condition where a newborn experiences oxygen deprivation, typically during the birthing process. Consequences can include neurological damage, developmental delays, and even death if not promptly treated.

👉 Treatment

Treatment of asphyxia neonatorum typically involves resuscitation measures such as providing supplemental oxygen and clearing the airways to ensure adequate breathing.

💜 2.Molar pregnancy

Molar pregnancy

Definition: A molar pregnancy, also known as gestational trophoblastic disease, is an abnormality of pregnancy where a non-viable fertilized egg implants in the uterus and develops into an abnormal mass of tissue. There are two main types: complete and partial molar pregnancies.

Causes:

• Chromosomal abnormalities during fertilization, leading to abnormal growth of placental tissue.
• Typically occurs due to an error during the fertilization process where an egg is fertilized by two sperm or by a single sperm that duplicates its genetic material.

Symptoms:

• Vaginal bleeding, often resembling prune juice, especially in the first trimester.
• Enlarged uterus disproportionate to the stage of pregnancy.
• Severe nausea and vomiting.
• Hyperthyroidism due to increased levels of human chorionic gonadotropin (hCG).

💜 3.Four purposes of family welfare program

1. Promoting Reproductive Health: Educating individuals and families about reproductive health, contraception methods, and family planning to enable them to make informed decisions regarding their reproductive choices.
2. Ensuring Maternal and Child Health: Providing essential healthcare services such as antenatal care, immunizations, and nutritional support to pregnant women and children to reduce maternal and infant mortality rates and improve overall health outcomes.
3. Population Control: Implementing measures to control population growth through voluntary family planning methods, which can help alleviate social, economic, and environmental pressures associated with overpopulation.
4. Empowering Families: Offering support and resources to empower families to improve their socio-economic status, including access to education, employment opportunities, and social services, thereby enhancing their overall well-being and quality of life.

💜 4.Abortion

Abortion, from a gynecological perspective, encompasses a variety of procedures and considerations that involve the termination of a pregnancy. This overview includes the types of abortion, indications, methods, potential complications, and ethical considerations.

Types of Abortion

Spontaneous Abortion (Miscarriage):

• Occurs naturally without any medical intervention.
• Often due to chromosomal abnormalities, uterine anomalies, hormonal imbalances, infections, or other maternal health issues.

Induced Abortion:

• Therapeutic Abortion: Performed for medical reasons, such as risk to the mother’s life, severe fetal abnormalities, or health conditions exacerbated by pregnancy.
• Elective Abortion: Chosen for non-medical reasons, such as personal or socioeconomic factors.

Indications for Therapeutic Abortion

• Maternal Health: Conditions like severe preeclampsia, cancer requiring treatment incompatible with pregnancy, or severe cardiac disease.
• Fetal Health: Diagnoses of severe congenital or genetic anomalies (e.g., anencephaly, trisomy 18).

Methods of Induced Abortion

Medical Abortion:

• Involves the use of medications to terminate a pregnancy, typically within the first 10 weeks of gestation.
• Common regimen: Mifepristone followed by Misoprostol.
  • Mifepristone: Blocks progesterone, causing the lining of the uterus to break down.
  • Misoprostol: Induces contractions to expel the pregnancy.

Surgical Abortion:

• Aspiration (Suction) Abortion: Used up to 16 weeks of gestation. Involves suction to remove the pregnancy tissue.
• Dilation and Curettage (D&C): Similar to aspiration but may include the use of a curette to scrape the uterine lining.
• Dilation and Evacuation (D&E): Used after 16 weeks of gestation. Involves dilation of the cervix and surgical instruments to remove the fetus and placenta.
• Induction Abortion: Used in the second trimester. Induces labor with medications to deliver the fetus.

Complications and Management

• Immediate Complications:
• Hemorrhage
• Infection
• Injury to the uterus or other organs
• Incomplete abortion requiring further intervention
• Long-term Complications:
• Rare but may include Asherman’s syndrome (intrauterine adhesions), infertility, or psychological effects.

Ethical and Legal Considerations

• Abortion laws vary significantly worldwide, impacting access and practice.
• Ethical considerations involve balancing maternal autonomy with fetal rights and considering the impact of societal, cultural, and personal beliefs.
• Counseling and informed consent are critical components, ensuring that women understand the risks, benefits, and alternatives.

Pre- and Post-Abortion Care

Pre-abortion Care:

• Comprehensive assessment including medical history, gestational age determination, and counseling.
• Screening for sexually transmitted infections (STIs) and other health conditions.

Post-abortion Care:

• Monitoring for complications such as excessive bleeding or signs of infection.
• Providing contraception and family planning advice.
• Offering psychological support if needed.

Counseling and Support

• Essential to address emotional and psychological aspects.
• Supportive counseling can help mitigate negative emotional outcomes and provide necessary information for future reproductive choices.

Abortion, as a component of gynecological care, requires a nuanced understanding of medical procedures, patient-centered care, and ethical considerations. It is imperative that healthcare providers offer compassionate, non-judgmental, and evidence-based care to women seeking abortion services.

💜 5.Indications for caesarean section

Indications for a cesarean section (LSCS):

1. Failure to Progress in Labor: Prolonged labor where the cervix fails to dilate sufficiently or fetal descent is inadequate despite appropriate interventions.
2. Fetal Distress: Signs of fetal distress during labor, such as abnormal fetal heart rate patterns indicating compromised oxygen supply to the fetus.
3. Malpresentation: When the baby is in a non-vertex presentation, such as breech (feet or buttocks first) or transverse lie (sideways), and attempts to manually reposition the baby (external cephalic version) are unsuccessful or contraindicated.
4. Placental Abnormalities: Placenta previa (where the placenta partially or completely covers the cervix) or placental abruption (premature separation of the placenta from the uterine wall) can necessitate a cesarean section to avoid maternal and fetal hemorrhage.

Other indication are….

5. Previous Cesarean Section:
6. Maternal Health Conditions:
7. Multiple Gestation:
8. Failed Induction:
9. Maternal Request:

💜 6.Palmar Sign

Definition: The palmar sign involves examining the palmar creases or lines on the hands of the fetus during prenatal ultrasound examinations. These creases are formed due to fetal hand movements and development in utero.

Purpose: The palmar sign is used as one of the indicators to estimate gestational age during pregnancy. It is particularly useful when other methods, such as crown-rump length measurement, are not feasible or inconclusive.

Method: During ultrasound examination, the sonographer or obstetrician carefully examines the palmar creases on the fetus’s hands. The presence and extent of creases are compared to established norms for different gestational ages.

Interpretation:

• In early gestation, the palmar creases may be less distinct or absent.
• As gestational age progresses, the palmar creases become more defined and develop characteristic patterns.
• The presence and maturity of palmar creases can provide valuable information about the fetal development and estimated gestational age.

SECTION II

IV Long essay (any one)1×10=10

1.💜 (A) Define PIH (2+8)

Pregnancy-induced hypertension (PIH), also known as gestational hypertension, is high blood pressure that develops during pregnancy. It typically occurs after the 20th week of pregnancy and usually resolves after delivery.

💜 (B) Discuss the management of a second gravida mother at 34 weeks of pregnancy suffering from severe pre- eclamptic toxaemia

Management of a second gravida mother at 34 weeks of pregnancy suffering from severe preeclampsia (toxemia) involves several steps:

1. Hospital Admission: Admit the mother to the hospital for close monitoring and management.
2. Bed Rest: Advise strict bed rest to reduce blood pressure and prevent complications.
3. Blood Pressure Monitoring: Monitor blood pressure regularly to assess the severity and control of preeclampsia.
4. Fetal Monitoring: Monitor the fetal heart rate and movement to ensure the baby’s wellbeing.
5. Antihypertensive Medications: Administer antihypertensive medications to control high blood pressure and reduce the risk of complications.
6. Antenatal Corticosteroids: Administer corticosteroids to accelerate fetal lung maturity if delivery is anticipated before 37 weeks.
7. Magnesium Sulfate: Initiate magnesium sulfate therapy to prevent seizures in the mother (eclampsia) and protect the baby’s brain.
8. Labor Induction or Cesarean Section: Depending on the severity of preeclampsia, consider inducing labor or performing a cesarean section to deliver the baby and placenta, which is the only cure for preeclampsia.
9. Blood Transfusion: Prepare for potential blood transfusion if significant bleeding occurs during delivery.
10. Postpartum Care: Monitor the mother closely post-delivery for any signs of complications such as hemorrhage, eclampsia, or HELLP syndrome (a severe form of preeclampsia).
11. Neonatal Care: Provide appropriate neonatal care for the premature baby, including monitoring for respiratory distress syndrome and other complications of prematurity.
12. Follow-up: Schedule regular follow-up visits for both mother and baby to monitor recovery and address any ongoing health issues.

💜 (C) Write in detail about the iron deficiency anemia

Anemia:

Definition and Causes:

1. Definition: Anemia is a condition characterized by a decrease in the number of red blood cells (RBCs) or hemoglobin levels in the blood, resulting in reduced oxygen-carrying capacity.
2. Causes: Anemia can be caused by various factors, including nutritional deficiencies (such as iron, vitamin B12, or folate deficiency), chronic diseases (such as chronic kidney disease or inflammatory conditions), genetic disorders (such as sickle cell disease or thalassemia), and blood loss (such as from menstruation or gastrointestinal bleeding).

Signs and Symptoms:

1. Fatigue: Due to decreased oxygen delivery to tissues.
2. Weakness: Reduced energy levels and stamina.
3. Pale skin: Decreased red blood cell count.
4. Shortness of breath: Difficulty in breathing due to decreased oxygenation.
5. Dizziness or lightheadedness: Resulting from decreased oxygen supply to the brain.

👉Management of Mother with Severe Anemia:

Assessment and Diagnosis:

1. Clinical Evaluation: Assess symptoms such as fatigue, weakness, pallor, and shortness of breath.
2. Laboratory Tests: Conduct blood tests to measure hemoglobin levels, hematocrit, and red blood cell indices to confirm the diagnosis and determine the severity of anemia.
3. Underlying Causes: Investigate potential underlying causes of anemia, such as nutritional deficiencies or chronic diseases, through additional tests as needed.

Treatment and Nursing Interventions:

Iron Supplementation:

• Prescribe oral or intravenous iron supplementation based on the severity and cause of anemia.
• Educate the mother about the importance of taking iron supplements as prescribed and potential side effects such as constipation or nausea.

Blood Transfusion:

• Administer packed red blood cell transfusions for severe cases of anemia with hemodynamic instability or symptoms of hypoxia.
• Monitor vital signs and signs of transfusion reactions during and after the transfusion.

Nutritional Support:

• Encourage a diet rich in iron, vitamin B12, and folate to support red blood cell production.
• Provide dietary counseling and education on sources of iron-rich foods such as lean meats, leafy green vegetables, beans, and fortified cereals.

Monitoring and Follow-Up:

• Monitor hemoglobin levels and hematocrit regularly to assess response to treatment.
• Assess symptoms and overall well-being to evaluate the effectiveness of interventions.
• Schedule follow-up appointments to monitor progress and adjust treatment as needed.

Complication Prevention:

• Educate the mother about the signs and symptoms of complications such as iron overload (in cases of excessive iron supplementation) or transfusion reactions.
• Monitor for potential complications such as thromboembolism or infections associated with blood transfusions.

Psychosocial Support:

• Provide emotional support and counseling to address the impact of severe anemia on the mother’s physical and emotional well-being.
• Offer resources and referrals to support groups or mental health professionals if needed.

Patient Education:

• Educate the mother about the importance of compliance with treatment, including medication adherence and dietary modifications.
• Provide information on lifestyle changes to optimize recovery and prevent recurrence of anemia, such as stress management and adequate rest.

Management of severe anemia in mothers requires a multidisciplinary approach involving medical interventions, nursing care, nutritional support, and patient education to improve hemoglobin levels, alleviate symptoms, and promote overall well-being.

V Short essay (any three) 3×5=15

💜 Problems of unwanted pregnancy

Unwanted pregnancies can have various complexities and consequences. Here are some detailed aspects to consider:

1. Emotional Impact: Unplanned pregnancies can bring about a range of emotions such as shock, fear, anxiety, guilt, and sadness. Individuals may experience stress and uncertainty about their future and the decisions they need to make.
2. Relationship Strain: Unplanned pregnancies can strain relationships, whether it’s with a partner, family members, or friends. Communication breakdowns, disagreements about how to proceed, and feelings of resentment or blame can arise.
3. Financial Burden: Raising a child requires significant financial resources for healthcare, childcare, education, and other expenses. For individuals or couples who are not financially prepared, an unplanned pregnancy can lead to financial strain and hardship.
4. Educational and Career Implications: For individuals pursuing education or career goals, an unplanned pregnancy can disrupt plans and aspirations. Balancing parenthood with academic or professional responsibilities can be challenging and may require difficult decisions about priorities and goals.
5. Access to Healthcare: Access to comprehensive healthcare services, including prenatal care, childbirth, and postnatal care, may be limited for some individuals due to factors such as location, financial constraints, or lack of healthcare coverage.
6. Social Stigma: In some communities or cultures, there may be social stigma associated with unplanned pregnancies, particularly for unmarried individuals or those in non-traditional family structures. This stigma can lead to feelings of shame, isolation, and judgment.
7. Reproductive Choices: Unplanned pregnancies can raise questions about reproductive choices, including whether to continue the pregnancy, pursue adoption, or consider abortion. These decisions can be deeply personal and may involve ethical, religious, and moral considerations.
8. Health Risks: Unplanned pregnancies may pose health risks for both the pregnant individual and the fetus, especially if prenatal care is delayed or inadequate. Complications such as high blood pressure, gestational diabetes, and preterm birth may be more common in unplanned pregnancies.
9. Legal and Policy Issues: Laws and policies related to reproductive rights and access to abortion services vary by country and region. Legal restrictions or barriers to accessing abortion services can impact individuals’ ability to make informed choices about their reproductive health.

Addressing the problem of unwanted pregnancies requires a comprehensive approach that includes access to sexual education, contraception options, reproductive healthcare services, and support for individuals facing unplanned pregnancies. It’s essential to respect individuals’ autonomy and provide non-judgmental support and resources to help them make informed decisions about their reproductive health.

💜 Urinary tract infection in puerperium

1. Definition: UTIs are bacterial infections affecting any part of the urinary system, including the kidneys, bladder, ureters, and urethra. In the puerperium period, changes in the urinary tract, such as increased bladder capacity and decreased bladder tone, can increase susceptibility to UTIs.
2. Risk Factors: During the puerperium period, various factors can increase the risk of UTIs, including urinary stasis (due to pressure from the gravid uterus during pregnancy), urinary catheterization during labor or delivery, trauma during childbirth, hormonal changes, and general postpartum stress.
3. Symptoms: Common symptoms of UTIs in the puerperium period include frequent urination, burning or pain during urination (dysuria), urgency to urinate, lower abdominal pain or discomfort, cloudy or foul-smelling urine, and in severe cases, fever and chills.
4. Diagnosis: UTIs can be diagnosed through a combination of patient history, physical examination, and laboratory tests. Urinalysis is typically performed to detect the presence of bacteria, white blood cells, and other indicators of infection. A urine culture may be done to identify the specific bacteria causing the infection and determine the most effective treatment.
5. Treatment: Treatment for UTIs during the puerperium period usually involves antibiotics to eradicate the bacterial infection. The choice of antibiotics depends on the severity of the infection, the identified bacteria, and any underlying health conditions or allergies. It’s essential to complete the full course of antibiotics as prescribed by a healthcare provider to ensure complete eradication of the infection and prevent recurrence.
6. Prevention: Strategies to prevent UTIs during the puerperium period include maintaining good hygiene practices, such as wiping from front to back after urination or bowel movements, staying hydrated, emptying the bladder regularly, avoiding holding urine for extended periods, and promptly treating any signs or symptoms of UTIs.
7. Complications: Untreated or recurrent UTIs during the puerperium period can lead to more severe complications, such as kidney infections (pyelonephritis), which can cause kidney damage if not promptly treated. Additionally, UTIs can increase the risk of postpartum depression and negatively impact maternal well-being and breastfeeding success.
8. Follow-Up: Women who develop UTIs during the puerperium period should follow up with their healthcare provider for monitoring and evaluation, especially if symptoms persist or worsen despite treatment. Follow-up care may include repeat urine testing to ensure the infection has resolved and addressing any lingering symptoms or complications.

💜 HIV in pregnancy

HIV in pregnancy:

Transmission Risk: HIV can be transmitted from an HIV-positive mother to her baby during pregnancy, childbirth, or breastfeeding. Without intervention, the risk of transmission is around 15-45%.

Prevention Strategies:

• Antiretroviral Therapy (ART): Treatment with ART during pregnancy dramatically reduces the risk of HIV transmission to the baby.
• Prevention of Mother-to-Child Transmission (PMTCT): This involves a combination of ART for the mother, elective cesarean section delivery in some cases, and avoidance of breastfeeding if safe alternatives are available.

Antenatal Care:

• HIV screening is a routine part of antenatal care.
• Early detection allows for timely initiation of ART, which significantly reduces the risk of mother-to-child transmission.

Treatment during Pregnancy:

• HIV-positive pregnant women are typically prescribed ART to suppress the virus, protect their health, and reduce the risk of transmission to their babies.
• The choice of ART regimen depends on factors such as the woman’s viral load, drug resistance testing, and potential side effects.

Mode of Delivery:

• In cases where the viral load is high or viral suppression has not been achieved, a cesarean section delivery may be recommended to further reduce the risk of transmission during childbirth.
• However, if the viral load is undetectable and other factors are favorable, vaginal delivery may be considered.

Breastfeeding:

• The risk of HIV transmission through breastfeeding is significant, especially in regions with limited access to clean water and formula feeding.
• In settings where formula feeding is safe and accessible, HIV-positive mothers are generally advised to avoid breastfeeding and opt for formula feeding to prevent transmission.
• However, in resource-limited settings where formula feeding may pose risks of malnutrition and infectious diseases, the benefits and risks of breastfeeding need to be carefully weighed, and strategies such as exclusive breastfeeding combined with ART may be recommended.

Postnatal Care:

• HIV-exposed infants require close monitoring and early HIV testing.
• If the infant tests positive for HIV, prompt initiation of ART is crucial to improve health outcomes.

Supportive Services:

• HIV-positive pregnant women and their families may benefit from psychosocial support, counseling, and access to resources such as support groups, education, and assistance with adherence to ART.

Long-Term Follow-Up:

• Both the mother and the child require long-term follow-up care to monitor their health, manage HIV infection, and address any complications or side effects associated with ART.

💜 Vacuum extraction

vacuum extraction:

Preparation:

• Ensure the mother’s bladder is empty to allow space for the vacuum cup.
• Assess fetal position, cervix dilation, and station to determine suitability for vacuum extraction.

Equipment Setup:

• Choose an appropriate vacuum extractor (e.g., Malmstrom or Kiwi) and ensure it’s assembled correctly.
• Attach the vacuum pump to the extractor device and ensure it’s functioning properly.
• Select an appropriate-sized cup based on the fetal head size and position.

Positioning:

• Position the mother in lithotomy position (lying on her back with legs raised and knees bent).
• Insert a speculum to visualize the cervix if necessary.
• Sterilize the perineum and apply lubricant to the vacuum cup to facilitate placement.

Cup Placement:

• Place the cup on the fetal head, typically on the occiput (back of the head) if possible.
• Ensure proper placement by confirming that the cup is well-sealed to the scalp without any folds.

Vacuum Application:

• Gradually apply suction using the vacuum pump until the gauge reaches the recommended pressure (usually around 0.6 to 0.8 kg/cm²).
• Assess the cup for proper attachment and suction by gently pulling to ensure it doesn’t detach.

Traction:

• Coordinate traction with uterine contractions to minimize maternal and fetal distress.
• Apply gentle, steady traction in alignment with the birth canal axis, avoiding excessive force.

Monitoring:

• Continuously monitor maternal vital signs, fetal heart rate, and uterine contractions throughout the procedure.
• Adjust traction as necessary based on fetal response, maternal tolerance, and progress of delivery.

Delivery:

• Once the fetal head reaches the perineum, stop traction and allow time for controlled delivery of the head.
• Provide support to the perineum to minimize trauma and facilitate the birth of the shoulders and body.

Post-Delivery Care:

• Assess the newborn for signs of trauma or injury, especially to the scalp where the vacuum cup was attached.
• Monitor maternal and neonatal well-being closely in the immediate postpartum period for any complications.

Documentation and Follow-Up:

• Document the procedure, including indication, technique, maternal and fetal responses, and outcome.
• Follow up with appropriate postpartum care for both mother and baby, addressing any concerns or complications.

💜 Mechanism of labour

mechanism of labor:

1. Initiation of Labor: Labor typically begins with the onset of regular uterine contractions, which may be accompanied by other signs such as the rupture of membranes (breaking of the amniotic sac) or the passage of the mucus plug (bloody show).
2. Cervical Changes: As labor progresses, the cervix begins to efface (thin out) and dilate (open). Effacement is the process of the cervix becoming thinner, while dilation refers to the widening of the cervical opening. These changes allow the baby to pass through the birth canal.
3. Engagement and Descent: The baby’s head (or presenting part) moves deeper into the pelvis and becomes engaged. This is often referred to as “lightening.” As labor continues, the baby’s head descends further into the pelvis, pressing against the cervix and aiding in dilation.
4. Rupture of Membranes: In some cases, the amniotic sac may rupture spontaneously, releasing amniotic fluid. This is commonly referred to as the “water breaking.” However, in other cases, the healthcare provider may manually rupture the membranes to augment labor.
5. First Stage of Labor: The first stage of labor is characterized by regular contractions and cervical dilation. This stage is further divided into the latent phase, where cervical dilation progresses slowly, and the active phase, where dilation occurs more rapidly.
6. Transition: Transition marks the end of the first stage of labor and the beginning of the second stage. During transition, contractions become more intense and frequent, and the cervix reaches full dilation (typically around 10 centimeters).
7. Second Stage of Labor: The second stage of labor begins with full dilation of the cervix and ends with the birth of the baby. During this stage, the mother experiences strong urges to push as the baby moves through the birth canal. The healthcare provider may assist the delivery by guiding the baby’s head and shoulders.
8. Birth of the Baby: Once the baby’s head crowns (becomes visible at the vaginal opening), the healthcare provider helps deliver the head and then the shoulders, followed by the rest of the baby’s body. After birth, the baby is placed on the mother’s abdomen or chest for skin-to-skin contact.
9. Third Stage of Labor: The third stage of labor involves the delivery of the placenta (afterbirth). Contractions continue to help expel the placenta from the uterus. The healthcare provider may gently tug on the umbilical cord or apply controlled cord traction to assist in placental delivery.
10. Fourth Stage of Labor: The fourth stage, also known as the recovery stage, is the period immediately following childbirth. During this time, the mother and baby are monitored closely for any signs of complications, and the healthcare provider may administer medications to prevent excessive bleeding.

This comprehensive process of labor and childbirth involves a series of physiological and mechanical events that culminate in the safe delivery of the baby and placenta.

VI Short answer (Compulsory)6×2=12

💜 APH

APH

👉Antipartum hemorrhage refers to bleeding from the birth canal that occurs after the 20th week of pregnancy and before the birth of the baby. It can be a serious complication during pregnancy and can pose risks to both the mother and the baby.

Causes of antepartum hemorrhage include:

1. Placenta previa: The placenta partially or completely covers the cervix.
2. Placental abruption: The placenta detaches from the uterine wall before delivery.
3. Vasa previa: Fetal blood vessels cross or run near the internal opening of the cervix.
4. Uterine rupture: A tear in the wall of the uterus.
5. Cervical or vaginal lesions: Infections, tumors, or other abnormalities.

💜 Monozygotic Twins

👉- Monozygotic twins are identical twins that develop from a single fertilized egg, also known as a zygote.

• They share 100% of their genetic material.
• Monozygotic twins have the same DNA, which makes them genetically identical.
• They can have different physical appearances due to environmental factors and random genetic mutations.
• They are always of the same sex.
• Monozygotic twins can develop with separate or shared placentas and amniotic sacs, depending on when the fertilized egg splits during development.

💜 Ectopic pregnancy

Definition

• An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tube, though it can also occur in other locations such as the ovary, abdominal cavity, or cervix.

👉 The symptoms of an ectopic pregnancy.

• Symptoms of an ectopic pregnancy may include abdominal pain, vaginal bleeding, shoulder pain, dizziness, and fainting. In some cases, there may be no symptoms initially, and the condition is only detected through routine prenatal testing or when complications arise.

💜 Partograph

Background: The partograph is a tool used to monitor labor progress and detect deviations from normal patterns. It helps prevent prolonged labor, which can lead to complications for both the mother and baby.

Components: The partograph typically consists of a graph/chart where various parameters related to labor are recorded. These include:

• Cervical dilation: The opening of the cervix, measured in centimeters.
• Fetal heartbeat: Monitored periodically to ensure the baby’s well-being.
• Contractions: Frequency and duration of contractions are recorded.
• Membrane status: Whether the membranes have ruptured or not.
• Maternal vital signs: Including temperature, blood pressure, and pulse.

Labor Progress: The cervical dilation is plotted against time on the graph. Ideally, labor should progress at a steady rate, with the cervix dilating around 1 cm per hour in active labor.

Alert Lines: The partograph often includes alert lines that indicate when intervention may be necessary. These are based on established guidelines and help healthcare providers identify abnormal progress.

Decision Making: Based on the information recorded on the partograph, healthcare providers can make decisions regarding the management of labor. This may include interventions such as augmentation of labor, pain relief measures, or, in some cases, emergency interventions like cesarean section.

Documentation: The partograph serves as a legal document of the labor process, providing a comprehensive record of events and interventions.

💜 Fertilization

👉Fertilization is the process by which a sperm cell combines with an egg cell to form a new organism.

This union typically occurs in the reproductive system of animals, leading to the formation of a zygote.

The zygote then undergoes cell division and development to eventually become an embryo.

In plants, fertilization involves the fusion of male and female gametes to produce a seed.

💜 Presumptive symptoms of pregnancy

Presumptive symptom of pregnancy

👉Some common presumptive symptoms of pregnancy include:

1. Missed period
2. Breast tenderness
3. Nausea or vomiting (morning sickness)
4. Increased urination
5. Fatigue
6. Food cravings or aversions
7. Mood swings
8. Light spotting or implantation bleeding

It’s important to remember that these symptoms can also be caused by other conditions, so a pregnancy test or consultation with a healthcare provider is the best way to confirm pregnancy.