Nurses Revision

Nurses Revision
Midwifery I, II, & III - Full Q&A Hub

Midwifery I, II, & III

Questions and Answers

Midwifery I

Question 1

RWENZORI SCHOOL OF NURSING AND MIDWIFERY - NO.103

  1. Describe the non-pregnant uterus.
  2. What changes take place in this organ during puerperium?
  3. List information obtained on vulva inspection during postnatal examination.
Examination Script
Answer: (Researched)a) Describe the Non-Pregnant Uterus:
The non-pregnant uterus is a hollow, pear-shaped, muscular organ located in the female pelvis, between the bladder (anteriorly) and the rectum (posteriorly). It is responsible for nurturing a fertilized ovum that develops into a fetus and holding it until the baby is mature enough for birth.
Size and Shape:Approximately 7.5 cm long, 5 cm wide (at its widest part), and 2.5 cm thick. It weighs about 30-60 grams. It resembles an inverted pear.
Parts:● Fundus: The dome-shaped upper part, above the entry points of the fallopian tubes.● Body (Corpus): The main, central part of the uterus. The uterine cavity is within the body.● Isthmus: A slight constriction between the body and the cervix. This area elongates and thins to become the lower uterine segment during pregnancy and labor.● Cervix: The narrow, lower part of the uterus that opens into the vagina. It has an internal os (opening into the uterine cavity) and an external os (opening into the vagina).
Layers of the Uterine Wall:● Perimetrium: The outer serous layer, part of the visceral peritoneum.● Myometrium: The thick middle layer composed of smooth muscle fibers. This layer is responsible for uterine contractions during labor and menstruation.● Endometrium: The inner mucous membrane lining the uterine cavity. It has two layers:› Stratum functionalis (functional layer): This layer thickens and develops glands and blood vessels during the menstrual cycle in preparation for pregnancy. If pregnancy does not occur, this layer is shed during menstruation.› Stratum basalis (basal layer): The permanent deeper layer that regenerates the functionalis after menstruation.
Position:Typically, the uterus is anteverted (tilted forward over the bladder) and anteflexed (bent forward on itself at the level of the internal os). However, positions can vary (e.g., retroverted).
Ligaments:Supported in the pelvis by several ligaments, including the broad ligaments, round ligaments, uterosacral ligaments, and cardinal (transverse cervical) ligaments.
Blood Supply:Mainly from the uterine arteries (branches of the internal iliac arteries) and ovarian arteries.
Function in Non-Pregnant State:The primary function is to undergo cyclical changes (menstrual cycle) in response to hormones, preparing for potential implantation of a fertilized ovum. If implantation occurs, it supports pregnancy. If not, the endometrial lining is shed.
b) Changes That Take Place in the Uterus During Puerperium:The puerperium is the period of about 6-8 weeks after childbirth during which the mother's reproductive organs, particularly the uterus, return to their non-pregnant state. This process of uterine return is called involution.
1. Reduction in Size and Weight (Involution):● Immediately after delivery: The uterus weighs about 1 kg, and the fundus is palpable at or near the umbilicus.● Within 1 week: Weight reduces to about 500g, fundus is halfway between umbilicus and symphysis pubis.● Within 2 weeks: Uterus descends into the pelvis and is no longer palpable abdominally.● By 6-8 weeks: Returns to near its non-pregnant size (approx. 60g) and position.
2. Myometrial Contractions (Afterpains):The myometrium (uterine muscle) contracts intermittently, especially in the first few days postpartum. These contractions help compress blood vessels at the placental site to control bleeding and aid in involution. They are often more noticeable in multiparous women and during breastfeeding (due to oxytocin release).
3. Changes in Uterine Muscle Cells:Involution involves a decrease in the size of individual muscle cells (atrophy), not a significant reduction in their number. Some protein breakdown (autolysis) also occurs.
4. Endometrial Regeneration:● Placental Site Healing: The area where the placenta was attached undergoes healing by a process of exfoliation (sloughing off of necrotic tissue) rather than scar formation, allowing for future normal implantation. This takes about 6 weeks.● Rest of Endometrium: The remaining endometrium regenerates from the basal layer, similar to after menstruation. By about 3 weeks, most of the endometrium (except placental site) is restored.
5. Lochia Discharge:This is the vaginal discharge during the puerperium, consisting of blood, decidual tissue, mucus, and leukocytes from the uterus. It changes color and consistency over time:› Lochia Rubra: Red, mostly blood, for the first 3-4 days.› Lochia Serosa: Pinkish or brownish, watery, contains serous exudate, leukocytes, and some blood, from about day 4 to day 10.› Lochia Alba: Whitish or yellowish-white, contains leukocytes, mucus, epithelial cells, and bacteria, from about day 10 up to 3-6 weeks.
6. Cervical Changes:The cervix, which dilated significantly during labor, gradually closes. Immediately after delivery, it is soft, flabby, and may admit two fingers. By the end of the first week, it is usually closed enough to admit only one fingertip. The external os often remains slightly wider and may have a slit-like appearance (parous os) compared to the round os of a nulliparous woman.
7. Changes in Uterine Ligaments:The ligaments that support the uterus, which were stretched during pregnancy, gradually shorten and regain tone, but may not return completely to their pre-pregnant state, especially after multiple pregnancies.
c) Information Obtained on Vulva Inspection During Postnatal Examination:Postnatal vulva inspection is important to assess healing, identify any abnormalities, and ensure comfort and hygiene.
1. State of Perineum (Episiotomy/Tear Repair):● Healing: Check for signs of good healing (apposition of edges, no gaping).● Signs of Infection: Look for redness, swelling, warmth, tenderness, pus discharge from the suture line.● Hematoma: Check for localized, painful swelling or bruising that might indicate a collection of blood.● Sutures: Note if sutures are intact or if any have dissolved or come loose.
2. Lochia:Observe the color, amount, consistency, and odor of the lochia on the sanitary pad.› Color: Should progress from rubra to serosa to alba appropriately for the postnatal day.› Amount: Assess if it's scanty, moderate, or heavy. Excessive bleeding or passage of large clots is abnormal.› Odor: Should have a fleshy, non-offensive odor. A foul smell suggests infection (endometritis).
3. Presence of Edema (Swelling):Note any swelling of the labia or perineum, which might be due to birth trauma or hematoma.
4. Presence of Varicosities (Vulval Varices):Check if any varicose veins present during pregnancy are resolving.
5. Condition of Labia and Clitoris:Look for any abrasions, lacerations, or bruising from delivery.
6. Hemorrhoids:Observe for the presence, size, and condition of hemorrhoids (piles) around the anus, which are common after pregnancy and delivery.
7. Cleanliness and Hygiene:Assess the general cleanliness of the perineal area. Provides an opportunity to reinforce perineal hygiene advice.
8. Any Abnormal Discharge (other than lochia):Look for signs of vaginal infection, such as curdy white discharge (thrush) or unusual colored/smelling discharge.
9. Patient's Comfort Level:Inquire about any pain, discomfort, itching, or burning in the vulval/perineal area.
10. Healing of any Grazes or Minor Lacerations:Check any small tears that did not require suturing for signs of healing or infection.

Question 2

NGORA SCHOOL OF NURSING AND MIDWIFERY - NO.104

  1. Describe the vagina.
  2. Outline signs of pregnancy identified on vaginal examination.
  3. With aid of diagrams, explain possible findings on vaginal examination related to the presentation.
Examination Script
Answer: (Researched)a) Describe the Vagina:
The vagina is a fibromuscular, elastic tubular organ that is part of the female reproductive system. It connects the cervix (the lower part of the uterus) to the vulva (the external female genitalia).
Location:Situated in the pelvis, posterior (behind) to the urinary bladder and urethra, and anterior (in front) to the rectum.
Structure and Size:● It is a distensible tube, typically about 7-10 cm (3-4 inches) in length in an adult woman, but can stretch significantly during sexual intercourse and childbirth.● The walls of the vagina are normally collapsed and touch each other. They have folds or ridges called rugae, which allow the vagina to expand.● The upper end of the vagina surrounds the cervix, creating recesses called fornices (anterior, posterior, and lateral). The posterior fornix is the deepest.
Layers of the Vaginal Wall:● Mucosa (Inner Layer): Lined by stratified squamous epithelium (non-keratinized), which provides protection. It is rich in glycogen, which is metabolized by normal vaginal flora (like Lactobacillus) to lactic acid, creating an acidic environment (pH around 3.8-4.5) that helps protect against infections. This layer has no glands; lubrication comes from cervical mucus and transudation from the vaginal walls.● Muscularis (Middle Layer): Composed of smooth muscle fibers (outer longitudinal and inner circular layers) that allow for distension and contraction.● Adventitia (Outer Layer): A fibrous connective tissue layer that anchors the vagina to surrounding structures.
Functions:● Receives the penis during sexual intercourse and holds semen after ejaculation.● Serves as the birth canal for the delivery of a baby during childbirth.● Provides an outlet for menstrual flow from the uterus.● Connects the uterus to the outside of the body.
Vaginal Environment:Maintained by normal bacterial flora (Döderlein's bacilli/Lactobacilli) which produce lactic acid, creating an acidic pH that inhibits the growth of many pathogenic organisms. Estrogen influences the glycogen content of the vaginal epithelium.
b) Signs of Pregnancy Identified on Vaginal Examination:Vaginal examination (VE) by a healthcare provider can reveal several presumptive or probable signs of pregnancy, especially in early gestation.
1. Chadwick's Sign:A bluish or purplish discoloration of the vaginal mucosa and cervix due to increased blood flow (vascular congestion). Usually visible from about 6-8 weeks of gestation.
2. Goodell's Sign:Softening of the cervix. In a non-pregnant state, the cervix feels firm like the tip of the nose; during pregnancy, it softens and feels more like the lips. Apparent around 6 weeks.
3. Hegar's Sign:Softening and compressibility of the lower uterine segment (the isthmus) found on bimanual examination. The cervix may feel separate from the uterine body. Usually detectable around 6-8 weeks.
4. Osiander's Sign:Increased pulsation felt in the lateral fornices of the vagina due to increased blood flow through the uterine arteries. Detectable around 8 weeks.
5. Increased Vaginal Discharge (Leukorrhea):An increase in whitish, non-irritating vaginal discharge due to hormonal changes (increased estrogen) causing increased cervical mucus production and vaginal transudation.
6. Softening and Thickening of Vaginal Mucosa:The vaginal walls may feel softer and thicker due to increased vascularity and hypertrophy of tissues.
7. Uterine Enlargement (on bimanual examination):The uterus will be palpably larger than its non-pregnant size, corresponding to the gestational age. (e.g., size of a hen's egg at 6 weeks, orange at 8 weeks, grapefruit at 12 weeks).
8. Changes in Uterine Shape and Consistency:The uterus becomes more globular and softer.
c) Possible Findings on Vaginal Examination Related to the Presentation (During Labor):Vaginal examination during labor provides crucial information about labor progress and fetal presentation. Presentation refers to the part of the fetus that enters the pelvic inlet first.A complete answer would ideally include diagrams for each presentation felt on VE. Since I cannot generate images, I will describe the findings and include placeholders.
1. Cephalic Presentation (Head First - Most Common):The fetal head is the presenting part. Findings depend on the flexion or extension of the head (attitude).● Vertex Presentation (Well-flexed head): This is the most common and ideal presentation.› Palpable: Smooth, hard, round fetal head. Sutures (sagittal, coronal, lambdoid) and fontanelles (anterior and posterior) can be identified. The posterior fontanelle (smaller, triangular) is usually felt if the head is well-flexed and the occiput is the denominator. The sagittal suture indicates the direction the head is facing.
[Diagram: Pelvic view showing palpation of fetal head in vertex presentation, highlighting sutures and fontanelles]
● Brow Presentation (Partially extended head):› Palpable: Forehead (brow) is the presenting part. The anterior fontanelle (larger, diamond-shaped) and orbital ridges may be felt. The chin is not palpable. This presentation often requires Cesarean section.
[Diagram: Pelvic view showing palpation of brow presentation]
● Face Presentation (Hyperextended head):› Palpable: Facial features – mouth, nose, chin (mentum), orbital ridges. The chin is the denominator. Vaginal delivery is possible if chin is anterior (mento-anterior).
[Diagram: Pelvic view showing palpation of face presentation, highlighting facial features]
2. Breech Presentation (Buttocks or Feet First):The fetal buttocks or feet are the presenting part.● Complete Breech: Buttocks present, with hips and knees flexed (fetus is "sitting" cross-legged).› Palpable: Soft, irregular mass (buttocks), ischial tuberosities, anus, and possibly feet alongside the buttocks.● Frank Breech: Buttocks present, with hips flexed and legs extended upwards towards the head (feet near the face).› Palpable: Soft, irregular mass (buttocks), ischial tuberosities, anus. Legs are not felt alongside.● Footling Breech (Single or Double): One or both feet present.› Palpable: One or both small, irregular feet. Heels and toes can be distinguished.
[Diagram: Pelvic view illustrating palpation of different types of breech presentations – complete, frank, footling]
3. Shoulder Presentation (Transverse Lie):The fetus is lying sideways (transverse) across the uterus. The shoulder is usually the presenting part if labor progresses. Vaginal delivery is not possible in this presentation unless the baby is very small or can be turned.● Palpable: May feel the acromion process (tip of the shoulder), ribs (a "grid-like" feel), axilla, or sometimes an arm/hand if prolapsed. The presenting part is high and ill-fitting in the pelvis.
[Diagram: Pelvic view showing palpation of shoulder presentation in a transverse lie]
4. Compound Presentation:An extremity (e.g., a hand or foot) prolapses alongside the main presenting part (usually the head).› Palpable: The main presenting part (e.g., head) along with a small, irregular part (hand or foot).
[Diagram: Pelvic view showing palpation of head with a prolapsed hand (compound presentation)]
Other findings on VE related to presentation include: position (relationship of the denominator to the maternal pelvis), station (descent of presenting part), presence of caput succedaneum or molding (on fetal head), and assessment of fetal well-being if membranes are ruptured (e.g., color of liquor, feeling for cord prolapse).

Question 3

KYETUME SCHOOL OF NURSING AND MIDWIFERY - NO.105

  1. What is normal labour.
  2. Define the 3 major stages of labour.
  3. Outline management of second stage of labour.
  4. List 5 points to emphasize to a Para 1 mother on discharge after delivery.
Examination Script
Answer: (Researched)a) What is Normal Labour?
Normal labour (also known as eutocia) is a physiological process characterized by a series of events that take place in the female genital organs in an effort to expel the viable products of conception (fetus, placenta, and membranes) out of the womb through the vagina into the external world.
Key characteristics of normal labour typically include: ● Spontaneous onset (starts on its own) at term (between 37 and 42 completed weeks of gestation).● The fetus presents by the vertex (head first, well-flexed).● Labour progresses without undue prolongation.● Natural termination with no complications to mother or baby.● Accomplished without artificial aid or intervention (though this aspect is sometimes debated in modern practice where some interventions are routine).
b) Define the 3 Major Stages of Labour:
1. First Stage of Labour:This stage begins with the onset of regular, painful uterine contractions that cause progressive cervical effacement (thinning) and dilatation (opening), and ends when the cervix is fully dilated (typically 10 centimeters).● It is the longest stage and is divided into two phases:› Latent Phase: From the onset of regular contractions until the cervix is about 3-4 cm dilated. Contractions are usually milder and less frequent. Effacement is significant.› Active Phase: From 3-4 cm cervical dilatation until full dilatation (10 cm). Contractions become stronger, more frequent, and longer. Cervical dilatation accelerates.
2. Second Stage of Labour:This stage begins when the cervix is fully dilated (10 cm) and ends with the complete birth (expulsion) of the baby.● It is often called the "pushing stage." The mother experiences an involuntary urge to bear down with each contraction as the fetal head descends into the pelvis and presses on the pelvic floor.● Duration varies, generally shorter in multiparous women than in primiparous women.
3. Third Stage of Labour:This stage begins immediately after the birth of the baby and ends with the complete expulsion of the placenta and membranes.● It involves separation of the placenta from the uterine wall and its delivery.● Control of bleeding from the placental site is critical during this stage. This stage is typically managed actively (e.g., with uterotonic drugs) to reduce risk of postpartum hemorrhage.● Duration is usually 5-15 minutes, but can extend up to 30 minutes (or longer with expectant management).
c) Outline Management of Second Stage of Labour:Management aims to ensure a safe delivery for both mother and baby, provide support and comfort to the mother, and monitor progress closely.
1. Confirmation of Full Cervical Dilatation:Perform a vaginal examination to confirm the cervix is fully dilated (10 cm) and effaced, and to assess fetal position, station, and presence of molding/caput.
2. Maternal Support and Comfort:● Provide continuous emotional support and encouragement.● Help the mother find a comfortable position for pushing (e.g., squatting, semi-sitting, side-lying, hands and knees). Upright positions are often encouraged.● Offer sips of water, keep her cool.● Provide pain relief options if available and desired (though many rely on non-pharmacological methods in this stage).
3. Guidance on Pushing Efforts:● Encourage spontaneous, physiological pushing in response to the natural urge to bear down, rather than prolonged, directed breath-holding (Valsalva maneuver), unless specifically indicated.● Advise her to take deep breaths between contractions and to push effectively during contractions.● Provide positive feedback and reassurance.
4. Monitoring Maternal Well-being:● Monitor vital signs (pulse, blood pressure) regularly (e.g., every 15-30 minutes).● Assess hydration and bladder status (encourage voiding if able, catheterize if bladder is full and obstructing descent).● Observe for signs of exhaustion or distress.
5. Monitoring Fetal Well-being:● Auscultate fetal heart rate (FHR) frequently, ideally after every contraction or every 5 minutes if using a Pinard stethoscope or Doppler, or continuously with electronic fetal monitoring if available and indicated.● Observe for signs of fetal distress (e.g., significant decelerations in FHR, passage of meconium in cephalic presentation).
6. Monitoring Progress of Descent:Assess the descent of the presenting part through the pelvis. Observe for perineal bulging and crowning (when the widest diameter of the fetal head is visible at the vaginal opening).
7. Preparation for Delivery:● Ensure delivery area is clean, warm, and well-lit.● Prepare delivery pack/equipment (gloves, cord clamps, scissors, drapes, resuscitation equipment for baby).● Perform hand hygiene and wear appropriate PPE.
8. Perineal Management and Delivery of the Head:● Support the perineum as the head crowns to prevent or minimize tears. Warm compresses or perineal massage may be used.● Control the delivery of the head – encourage gentle pushing or panting as the head emerges to allow for gradual stretching of the perineum.● Check for nuchal cord (cord around the neck) once the head is delivered and manage accordingly (slip over head or clamp and cut if tight).● Wipe baby's face, suction mouth and nose if necessary (routine suctioning not always recommended).
9. Delivery of Shoulders and Body:Wait for restitution and external rotation of the head. Then, apply gentle downward traction to deliver the anterior shoulder, followed by upward traction to deliver the posterior shoulder and the rest of the body.
10. Immediate Care of the Newborn:Note time of birth. Place baby skin-to-skin on mother's abdomen/chest if stable. Dry the baby, assess Apgar scores, clamp and cut the umbilical cord (delayed cord clamping often recommended). Initiate breastfeeding within the first hour if possible.
11. Episiotomy (if indicated):Perform an episiotomy (surgical cut to enlarge vaginal opening) only if strictly necessary (e.g., fetal distress requiring expedited delivery, instrumental delivery, severe perineal rigidity).
12. Documentation:Record all events, timings, observations, and interventions accurately.
d) 5 Points to Emphasize to a Para 1 (Primiparous) Mother on Discharge After Delivery:
1. Perineal Care and Hygiene:Teach proper perineal care, especially if she had an episiotomy or tear: keep the area clean and dry, change sanitary pads frequently, use perineal washes or sitz baths if advised, wipe from front to back. Emphasize signs of infection to watch for (increased pain, redness, swelling, pus, foul odor).
2. Breastfeeding Support and Techniques:Reinforce correct positioning and attachment for breastfeeding. Advise on feeding frequency (on demand, 8-12 times/day), signs of adequate milk intake in the baby, and where to get help if she experiences breastfeeding difficulties (e.g., sore nipples, engorgement). Highlight benefits of exclusive breastfeeding for 6 months.
3. Postnatal Danger Signs for Mother and Baby:● Mother: Excessive vaginal bleeding, high fever, severe abdominal pain, foul-smelling lochia, signs of DVT (calf pain/swelling), severe headache, blurred vision, signs of infection in C-section wound (if applicable) or perineum.● Baby: Poor feeding, fever or low temperature, lethargy, convulsions, fast/difficult breathing, jaundice, signs of umbilical cord infection.Emphasize seeking immediate medical attention if any of these occur.
4. Importance of Postnatal Check-ups and Family Planning:Stress the need to attend scheduled postnatal check-ups for herself (usually around 6 weeks) and for the baby (for immunizations and growth monitoring). Discuss family planning options and when she can resume contraception.
5. Self-Care, Rest, and Nutrition for the Mother:Encourage her to get adequate rest, eat a balanced nutritious diet (especially if breastfeeding), drink plenty of fluids, and accept help from family. Discuss emotional well-being and signs of postnatal depression, advising her to seek support if needed.
6. Newborn Care Basics:Reinforce umbilical cord care (keep clean and dry), bathing, keeping baby warm, recognizing normal newborn behaviors, and safe sleep practices (e.g., baby on back to sleep).
7. Importance of Pelvic Floor Exercises:Advise on starting gentle pelvic floor exercises (Kegel exercises) to help strengthen muscles and prevent future incontinence.

Question 4

VILLA MARIA SCHOOL OF NURSING AND MIDWIFERY - NO.106

  1. Explain observations carried out on a mother in first stage of labour.
  2. Formulate 3 actual and 2 potential nursing diagnoses for a mother in first stage of labour.
  3. Outline at least 10 nursing interventions for this woman giving rationale for each.
Examination Script
Answer:The first stage of labor begins with the onset of regular uterine contractions causing progressive cervical effacement and dilatation, and ends when the cervix is fully dilated (10 cm). Careful observation is crucial to monitor maternal and fetal well-being and labor progress.a) Observations Carried Out on a Mother in First Stage of Labour:
1. General Condition and Appearance:● On Admission: Observe stature, gait, shape of abdomen, level of distress, anxiety, fatigue. Note physical appearance (e.g., messy, edematous face can indicate problems like obstructed labor).● Behavior: Mood, coping mechanisms, level of anxiety or fear.
2. Vital Signs (Maternal):● Temperature: Usually every 4 hours (more often if elevated or membranes ruptured). High temperature can indicate infection.● Pulse: Every 30 minutes to 1 hour in active phase. Tachycardia can indicate dehydration, pain, anxiety, hemorrhage, or infection.● Blood Pressure: Every 1-4 hours (more often if abnormal). Monitor for hypertension (pre-eclampsia) or hypotension.● Respirations: Rate and character, observe for signs of distress.
3. Labor Progress - Uterine Contractions:Assessed by abdominal palpation or tocodynamometer (if EFM used).● Frequency: How often they occur (e.g., number of contractions in 10 minutes).● Duration: How long each contraction lasts (from beginning to end).● Strength/Intensity: Assessed by palpating uterine tone during contraction (mild, moderate, strong) or by patient report.● Resting Tone: Uterus should relax completely between contractions.
4. Labor Progress - Cervical Dilatation and Effacement:Assessed by sterile vaginal examination (VE).● Dilatation: Opening of the cervix, measured in centimeters (cm), from 0 to 10 cm.● Effacement: Thinning and shortening of the cervix, measured as a percentage (0-100%) or length.
5. Labor Progress - Descent of Presenting Part:Assessed abdominally (fifths palpable above pelvic brim) and/or by VE (station, relationship of presenting part to ischial spines).
6. Labor Progress - Status of Membranes and Liquor:● If membranes are intact or ruptured (spontaneously or artificially). Note time of rupture.● If ruptured, observe color, amount, and odor of amniotic fluid (liquor). Clear is normal. Meconium-stained (greenish/brownish) indicates possible fetal distress. Foul odor suggests infection.
7. Fetal Well-being:● Fetal Heart Rate (FHR): Auscultate with Pinard stethoscope or Doppler. Normal range: 110-160 beats per minute. Note baseline, variability, accelerations, decelerations.● Fetal Movements: Ask mother about movements (less emphasized once in active labor).● Molding: Overlapping of fetal skull bones, assessed on VE if head is presenting.● Caput Succedaneum: Swelling of the fetal scalp, assessed on VE.
8. Maternal Hydration and Nutrition:● Assess for signs of dehydration (dry mouth, concentrated urine, ketonuria).● Encourage oral fluids (water, juice). Light, easily digestible food may be allowed in early labor if no contraindications. IV fluids if dehydrated or NPO.
9. Maternal Bladder Care:Encourage frequent voiding (e.g., every 2 hours) as a full bladder can impede labor progress and fetal descent. Palpate for bladder distension.
10. Pain and Coping:Assess mother's level of pain (using a scale or her description) and her coping mechanisms. Offer pain relief options.
11. Psychological and Emotional State:Observe for anxiety, fear, support from partner/family. Provide reassurance and support.
12. Use of Partograph:Once in active labor (usually from 4cm dilatation), all key observations are plotted on a partograph to visually monitor progress and detect deviations from normal early.
b) Formulate 3 Actual and 2 Potential Nursing Diagnoses:
Actual Nursing Diagnoses:1. Acute Pain related to uterine contractions and cervical dilatation as evidenced by patient verbalization, facial grimacing, and restlessness.2. Excessive Anxiety related to the labor process, unknown outcome, and pain, as evidenced by patient's statements of fear, increased pulse rate, and tense posture.3. Fatigue related to prolonged labor, energy expenditure during contractions, and inadequate rest, as evidenced by patient reporting tiredness and decreased ability to cope.
Potential Nursing Diagnoses (Risk for):1. Risk for Ineffective Coping related to intensity of labor pain and duration of labor.2. Risk for Fetal Injury related to prolonged labor, abnormal fetal heart rate patterns, or maternal complications.3. Risk for Impaired Urinary Elimination related to pressure from presenting part and effects of labor.4. Risk for Infection related to rupture of membranes and multiple vaginal examinations.
c) Outline at Least 10 Nursing Interventions with Rationale:
1. Provide Continuous Emotional Support and Reassurance:Rationale: To reduce anxiety, promote coping, and help the mother feel safe and supported, which can positively influence labor progress.
2. Monitor Maternal Vital Signs Regularly:Rationale: To detect any deviations from normal (e.g., hypertension, tachycardia, fever) that could indicate complications like pre-eclampsia, infection, or dehydration.
3. Assess and Monitor Fetal Heart Rate (FHR) Regularly:Rationale: To assess fetal well-being and detect signs of fetal distress (e.g., bradycardia) that may require intervention.
4. Assess and Monitor Uterine Contractions:Rationale: To evaluate the effectiveness of labor and progress. Abnormal patterns can indicate problems and guide interventions.
5. Monitor Progress of Labor (Dilatation, Descent):Rationale: To assess if labor is progressing normally. Early detection of slow progress allows for timely interventions.
6. Encourage Comfortable Positions and Mobilization:Rationale: Upright positions and walking can utilize gravity to aid fetal descent, may improve contraction efficiency, and can enhance maternal comfort.
7. Offer and Administer Pain Relief Measures:Rationale: To help the mother cope with labor pain, reduce stress, and conserve energy. Options include massage, breathing techniques, and analgesics.Example: Give IM morphine 15mg (if BP stable and in active phase) to reduce pain.
8. Maintain Adequate Hydration and Nutrition:Rationale: Labor is energy-demanding. Adequate fluids prevent dehydration and ketosis. Light foods or IV fluids as appropriate.Example: Encourage fluids or start IV Normal Saline to rehydrate.
9. Promote Bladder Emptying:Rationale: Encourage voiding every 2 hours. A full bladder can impede fetal descent and contractions. Catheterize if necessary.
10. Provide Information and Explanations:Rationale: Keep the mother informed to reduce anxiety and enhance participation.
11. Maintain Aseptic Techniques:Rationale: To prevent introduction of infection, particularly if membranes are ruptured.
12. Prepare for Delivery:Rationale: Ensure necessary equipment and personnel are ready for a safe delivery as full dilatation approaches.
13. Tepid Sponging (if febrile):Rationale: To reduce high body temperature.
14. Administer Antibiotics if Indicated:Rationale: To prevent neonatal or maternal infection (e.g., prolonged ROM).

Question 5

NYENGA SCHOOL OF NURSING AND MIDWIFERY - NO.107

  1. What is the importance of accurate calculation of EDD and WOA?
  2. Define the following midwifery terms and demonstrate both the normal and abnormal (lie, presentation, denominator, position, attitude)
  3. Explain the important points to report after vaginal examination on a woman in labour.
Examination Script
Answer: (Researched)a) Importance of Accurate Calculation of EDD (Estimated Date of Delivery) and WOA (Weeks of Amenorrhea):
1. Monitoring Fetal Growth and Well-being:Allows assessment if the fetus is growing appropriately by comparing fetal size with expected norms. Deviations can indicate intrauterine growth restriction (IUGR) or macrosomia.
2. Timing of Antenatal Screening Tests:Many screening tests (e.g., nuchal translucency scan) are highly dependent on accurate gestational age.
3. Scheduling Antenatal Visits:Care schedules, tests, and immunizations (like Tdap) are timed according to gestational age.
4. Assessing Fetal Maturity for Delivery:Crucial for decisions regarding elective delivery or induction of labor to avoid iatrogenic prematurity.
5. Management of Preterm Labor:Vital for decisions on tocolysis or corticosteroids for fetal lung maturity.
6. Management of Post-term Pregnancy:Helps identify pregnancies extending beyond 41-42 weeks which carry increased risks.
7. Interpretation of Maternal Conditions:Management of conditions like pre-eclampsia varies with gestational age.
8. Planning for Delivery:Allows preparation for birth logistics.
9. Legal and Administrative Purposes:Important for maternity leave and birth registration.
10. Reducing Maternal Anxiety:Helps the mother prepare emotionally and physically.
b) Midwifery Terms - Normal and Abnormal:
1. Lie:The relationship between the long axis of the fetus and the long axis of the mother's uterus.● Normal: Longitudinal Lie (fetal spine parallel to maternal spine).● Abnormal: Transverse Lie (perpendicular) or Oblique Lie (diagonal).
[Diagram: Illustrating Longitudinal, Transverse, and Oblique fetal lies]
2. Presentation:The part of the fetus that lies lowest in the maternal pelvis and enters the pelvic inlet first.● Normal: Cephalic (Vertex) Presentation.● Abnormal (Malpresentations): Breech (Complete, Frank, Footling), Shoulder, Face, Brow, Compound.
[Diagram: Illustrating different fetal presentations]
3. Denominator:An arbitrary bony landmark on the fetal presenting part used to describe its position.● Normal (Vertex): Occiput (O).● Abnormal: Mentum (M - Face), Sacrum (S - Breech), Acromion (A - Shoulder), Frontum (Brow).
4. Position:The relationship of the denominator to the quadrants of the maternal pelvis.● Normal: Left Occipito-Anterior (LOA), Right Occipito-Anterior (ROA).● Abnormal (Malpositions): Occipito-Posterior (OP), Occipito-Transverse (OT).
[Diagram: Illustrating common fetal positions like LOA, ROP]
5. Attitude:The relationship of fetal parts to each other (flexion/extension of head).● Normal: Full Flexion (chin on chest).● Abnormal: Military (neutral), Partial Extension (Brow), Complete Extension (Face).
[Diagram: Illustrating different fetal attitudes]
c) Important Points to Report After Vaginal Examination in Labour:
1. Cervical Dilatation:In centimeters (0-10 cm).
2. Cervical Effacement:Percentage or length.
3. Station of Presenting Part:Relationship to ischial spines (-3 to +3).
4. Presenting Part:Identity (vertex, breech, etc.).
5. Position of Presenting Part:Denominator relationship (e.g., LOA).
6. Status of Membranes:Intact or ruptured.
7. Characteristics of Amniotic Fluid:Color (clear, meconium, blood), amount, odor.
8. Caput/Molding:Presence and degree.
9. Abnormalities:Cord prolapse, placenta previa, masses.
10. Maternal Response:Pain or concerns.
11. Time and Examiner Name.

Question 6

SALEM SCHOOL OF NURSING AND MIDWIFERY – KOLONYI - NO.108

  1. What is the importance of knowledge of the urinary system to a midwife?
  2. Outline effects of full bladder on labour and puerperium.
  3. Outline nursing measures of managing urine retention during puerperium.
Examination Script
Answer: (Researched)a) Importance of Knowledge of the Urinary System:
1. Understanding Physiological Changes:Differentiating normal pregnancy changes (e.g., dilated ureters) from pathology.
2. UTI Detection/Management:Recognizing and managing common infections like cystitis or pyelonephritis.
3. Monitoring Renal Function:Crucial in pre-eclampsia (proteinuria, oliguria).
4. Bladder Care During Labour:Preventing obstruction of labor progress.
5. Postpartum Problems:Managing retention, incontinence, or infection.
6. Newborn Assessment:Identifying congenital anomalies.
7. Health Education:Hygiene and fluid intake advice.
8. Medication Effects:Understanding drugs affecting the renal system.
9. Fluid Balance:Monitoring urine output in critical conditions.
10. Preventing Complications:Avoiding long-term renal damage.
b) Effects of Full Bladder on Labour and Puerperium:
During Labour:● Obstructed/Prolonged Labour: Occupies pelvic space, preventing descent.● Ineffective Contractions: Interferes with uterine action.● Maternal Discomfort and Pain.● Risk of Bladder Trauma.● Difficulty assessing fetal station.● Risk of PPH.
During Puerperium:● Postpartum Hemorrhage (PPH): Displaces uterus, causing atony.● Urinary Retention: Overstretching leads to atony.● Risk of UTI: Stasis promotes bacterial growth.● Subinvolution of Uterus.● Overflow Incontinence.
c) Nursing Measures for Managing Urine Retention During Puerperium:
1. Early Recognition:Monitor for first void within 4-6 hours. Assess for bladder distension.
2. Promote Spontaneous Voiding:● Ensure privacy and comfort.● Upright positioning.● Running water sound.● Warm water over perineum/sitz bath.● Pain relief (analgesia).● Ambulation.
3. Intermittent Catheterization:If non-invasive measures fail, preferred over indwelling initially.
4. Indwelling Catheter:For significant overdistension/atony, to rest the bladder (24-48 hrs).
5. Bladder Training:Timed voiding schedule after catheter removal.
6. Fluid Intake:Maintain adequate hydration.
7. Monitor for UTI:Check for symptoms and test urine if needed.
8. Education:Explain causes and importance of regular voiding.
9. Documentation.
10. Referral:If retention persists.

Question 7

INDIAN INSTITUTE OF HEALTH SCIENCE - NO.109

  1. Define the term focused antenatal.
  2. Outline 5 objectives of focused antenatal care.
  3. Outline 10 information a midwife should obtain from a mother who has come for the first antenatal visit.
Examination Script
Answer: (Researched)a) Definition: Focused Antenatal Care (FANC)
Focused Antenatal Care (FANC) is an evidence-based model of antenatal care recommended by the WHO. It emphasizes quality over quantity of visits, focusing on providing essential, goal-oriented interventions proven to improve outcomes. It typically involves a minimum of four comprehensive visits for uncomplicated pregnancies, prioritizing early detection of complications, health promotion, and birth preparedness.
b) 5 Objectives of Focused Antenatal Care (FANC):
1. To Promote and Maintain Well-being:Physical, mental, and social well-being of mother and baby via education and screening.
2. To Detect and Manage Complications Early:Identifying anemia, hypertension, diabetes, infections (HIV, malaria) for timely intervention.
3. Birth Preparedness and Complication Readiness (BPCR):Preparing for childbirth, transport, funds, and emergencies.
4. Health Promotion and Prevention:Nutrition, supplements (iron/folic), immunization (TT), malaria prevention (IPTp), PMTCT.
5. Develop Positive Provider Relationship:Fostering trust to encourage skilled delivery.
6. Reduce Morbidity and Mortality:Ultimate goal is safer pregnancy outcomes.
c) 10 Information a Midwife Should Obtain on First Antenatal Visit:
1. Sociodemographic Information:Name, age, address, marital status, education, occupation.
2. Menstrual and Obstetric History:● LMP for EDD calculation.● Gravidity/Parity, details of previous pregnancies/labors/complications.
3. Current Pregnancy Details:Symptoms, bleeding/pain, planned pregnancy status.
4. Medical History:Chronic illnesses (HTN, diabetes, HIV), allergies, surgeries.
5. Family Medical History:Genetic conditions, twins, diabetes, hypertension.
6. Lifestyle/Social History:Nutrition, substance use, domestic violence screening.
7. Immunization History:Tetanus status.
8. Current Medications:Prescribed or herbal.
9. Knowledge/Expectations:Understanding of pregnancy/birth.
10. Mental Health:Depression/anxiety history.
11. Review of Systems:General symptom check.
12. Contraceptive History.
Midwifery II

Question 8

KAMPALA INTERNATIONAL UNIVERSITY - NO.110

  1. Define still birth.
  2. Outline (8) causes of intra uterine fetal death.
  3. How would you diagnose intra uterine fetal death?
  4. Give 3 specific complications of intra uterine fetal death explaining why each occurs.
Examination Script
Answer: (Researched)a) Definition: Stillbirth
A stillbirth is the death of a baby in the uterus at or after a specific gestational age (commonly 20-28 weeks or weight >500g), before or during delivery. Intrauterine Fetal Death (IUFD) is often used synonymously.
b) Causes of IUFD:
1. Placental Problems:Abruption, Previa, Insufficiency, Infarcts.
2. Maternal Medical Conditions:Hypertension, Diabetes, Thyroid disorders, Autoimmune diseases.
3. Infections:Malaria, Syphilis, CMV, Listeriosis.
4. Fetal Genetic/Chromosomal Abnormalities.
5. Umbilical Cord Accidents:Prolapse, knots, stricture.
6. Intrauterine Growth Restriction (IUGR).
7. Labor Complications:Obstructed labor, Uterine rupture.
8. Multiple Pregnancy Complications:TTTS, cord entanglement.
c) Diagnosis of IUFD:
1. Absent Fetal Movements:Maternal report.
2. Absence of Fetal Heart Tones:On auscultation/Doppler.
3. Ultrasound:Definitive; shows no cardiac activity or movement.
4. Cessation of Uterine Growth.
5. Absence of Palpable Fetal Parts/Movement.
6. Regression of Pregnancy Symptoms.
d) 3 Specific Complications of IUFD:
1. DIC (Disseminated Intravascular Coagulation):Why: Thromboplastin release from decomposing fetus triggers clotting cascade, consuming factors and causing bleeding.
2. Maternal Sepsis:Why: Dead tissue is a medium for bacteria, leading to chorioamnionitis or endometritis, especially if membranes rupture.
3. Psychological Trauma:Why: Profound grief, loss, and trauma of delivering a stillborn baby.

Question 9

INTERNATIONAL INSTITUTE OF HEALTH SCIENCE JINJA - NO.111

  1. What is Eclampsia?
  2. Outline stages of an eclampsia fit.
  3. How would you manage a mother with eclampsia from the time she reports to health Centre until you hand her over to the midwife in hospital?
Examination Script
Answer: (Researched)a) What is Eclampsia?
Eclampsia is a life-threatening complication of pregnancy characterized by the new onset of generalized tonic-clonic seizures in a woman with pre-eclampsia (hypertension and proteinuria), typically occurring after 20 weeks gestation. It is a medical emergency.
b) Stages of an Eclamptic Fit:
1. Premonitory Stage:Aura (headache, visual changes, epigastric pain), restlessness. Seconds to minutes.
2. Tonic Stage:Rigidity, apnea, cyanosis, eyes roll up. 15-30 seconds.
3. Clonic Stage:Violent jerking, frothing, tongue biting. 1-2 minutes.
4. Post-ictal (Coma) Stage:Unconsciousness, stertorous breathing, confusion upon waking. Minutes to hours.
c) Management from Health Centre to Hospital:
1. Call for Help / Prepare for Resuscitation.
2. Ensure Safety:Protect from injury, do not restrain, recovery position after seizure.
3. Maintain Airway:Suction if needed, oral airway if unconscious.
4. Breathing:Give Oxygen.
5. Circulation:IV access, check vitals.
6. Magnesium Sulfate (MgSO4):Loading Dose: 4g IV slowly + 10g IM (5g each buttock). Antidote: Calcium Gluconate.
7. Control Hypertension:Antihypertensives (e.g., Hydralazine/Labetalol) if BP severe.
8. Prepare Transfer:Notify hospital, arrange transport, referral note.
9. Monitor:Vitals, FHR, urine output during transport.
10. Handover:Detailed report to hospital team.

Question 10

HOIMA SCHOOL OF NURSING AND MIDWIFERY - NO.112

  1. List 6 causes of fundal height bigger than weeks of amenorrhea.
  2. Explain how multiple pregnancy can be diagnosed.
  3. Outline 6 specific complications of multiple pregnancy.
  4. Malpresentations are very common in multiple pregnancy. Explain 4 ways you can differentiate footling breech presentation from arm prolapse.
Examination Script
Answer: (Researched)a) 6 Causes of Fundal Height > Weeks of Amenorrhea:
1. Incorrect Dates.
2. Multiple Pregnancy.
3. Polyhydramnios.
4. Macrosomia.
5. Uterine Fibroids.
6. Molar Pregnancy.
(Others: Full bladder, Obesity).
b) Diagnosis of Multiple Pregnancy:
1. Clinical:Family history, large fundal height, palpation of multiple poles, auscultation of >1 heart beat.
2. Ultrasound:Definitive diagnosis.
3. Elevated Serum Markers:High hCG/AFP.
c) 6 Complications of Multiple Pregnancy:
1. Preterm Labor.
2. IUGR / Discordant Growth.
3. Pre-eclampsia.
4. Anemia.
5. Polyhydramnios / TTTS.
6. PPH / Malpresentations.
d) Differentiating Footling Breech from Arm Prolapse:
1. Landmarks:Foot has heel (hard/pointed); Hand has fingers/thumb.
2. Axis:Foot is at right angle to leg; Hand is in line with arm.
3. Mobility:Toes are short/straight; Fingers are long/mobile. Thumb opposes fingers (can grasp), big toe cannot.
4. Adjacent Structures:Breech has anus/buttocks palpable higher up; Arm prolapse usually has shoulder/ribs (transverse lie).

Question 11

SOROTI SCHOOL OF COMPRREHENSIVE NURSING AND MIDWIFERTY - NO.113

  1. List 8 medical diseases that can complicate or be complicated by pregnancy, labour and puerperium.
  2. Outline 5 physiological changes of pregnancy that can worsen cardiac disease.
  3. List 12 complications caused by medical diseases during pregnancy, labour and puerperium.
Examination Script
Answer: (Researched)a) 8 Medical Diseases Complicating Pregnancy:
1. Hypertensive Disorders.
2. Diabetes Mellitus.
3. Cardiac Disease.
4. Anemia.
5. Thyroid Disorders.
6. Infections (HIV, Malaria, UTIs).
7. Epilepsy.
8. Autoimmune Diseases (SLE).
b) 5 Changes Worsening Cardiac Disease:
1. Increased Blood Volume (Preload).
2. Increased Cardiac Output.
3. Decreased Vascular Resistance (Afterload changes).
4. Increased Heart Rate.
5. Autotransfusion during labor contractions and postpartum.
c) 12 Complications caused by Medical Diseases:
1. Worsening of disease (e.g., Heart Failure).
2. Pre-eclampsia.
3. Infections.
4. Hemorrhage.
5. Thromboembolism.
6. Cesarean Delivery.
7. Preterm Birth.
8. IUGR.
9. Congenital Malformations.
10. Stillbirth.
11. Birth Asphyxia.
12. Neonatal Hypoglycemia/Complications.

Question 12

PUBLIC HEALTH COLLEGE OF NURSING AND MIDWIFERY - NO.114

  1. List 8 indications for induction of labour.
  2. Outline 5 methods of induction of labour.
  3. Explain 6 responsibilities of a midwife during oxytocin induction.
Examination Script
Answer: (Researched)a) 8 Indications for IOL:
1. Post-term pregnancy (>41-42 weeks).
2. PROM at term.
3. Hypertensive disorders (Pre-eclampsia).
4. Maternal medical conditions (Diabetes, Renal).
5. Fetal Compromise (IUGR, Oligohydramnios).
6. Chorioamnionitis.
7. IUFD.
8. Logistics/History of precipitous labor (selective).
b) 5 Methods of IOL:
1. Prostaglandins (Misoprostol/Dinoprostone).
2. Oxytocin Infusion.
3. Membrane Sweeping.
4. Balloon Catheter (Foley).
5. Amniotomy (ARM).
c) 6 Responsibilities of Midwife during Oxytocin Induction:
1. Monitor Uterine Activity:Frequency/strength to prevent hyperstimulation.
2. Monitor FHR:Continuous or frequent auscultation for distress.
3. Accurate Titration:Use pump, adjust dose per protocol.
4. Monitor Maternal Vitals:BP, Pulse, fluid balance.
5. Assess Progress:VEs for dilatation.
6. Manage Complications:Stop infusion if distress/hyperstimulation occurs.

Question 13

MAYANJA INSTITUTE OF NURSING AND MIDWIFERY - NO.115

  1. List 5 causes of polyhydramnios.
  2. Mention 5 clinical manifestation of polyhydramnios.
  3. Outline the specific intervention for the above condition in maternity ward.
  4. Mention the possible complications that may arise from the above condition.
Examination Script
Answer: (Researched)a) 5 Causes:
1. Maternal Diabetes.
2. Fetal Anomalies (GI obstruction, CNS defects).
3. Multiple Pregnancy (TTTS).
4. Fetal Anemia/Hydrops.
5. Idiopathic.
b) 5 Clinical Manifestations:
1. Uterus larger than dates.
2. Dyspnea/Respiratory distress.
3. Abdominal pain/discomfort/tight skin.
4. Difficulty palpating fetal parts/hearing heart.
5. Edema (vulva/legs).
c) Interventions:
1. Treat cause (e.g., glucose control).
2. Monitoring (Ultrasounds, rest).
3. Amnioreduction (if severe symptoms).
4. Indomethacin (selected cases).
5. Controlled delivery (slow ARM).
d) Complications:
1. Preterm Labor/PROM.
2. Placental Abruption.
3. PPH (Atony).
4. Malpresentations/Cord Prolapse.
5. Perinatal Morbidity.
Midwifery III

Question 14

KAMULI SCHOOL OF NURSING AND MIDWIFERY - NO.86

  1. Define puerperium.
  2. What are the causes of puerperal psychosis?
  3. How can you prevent puerperal psychosis in a young prime gravida admitted in labour ward?
Examination Script
Answer:a) Define Puerperium:
The puerperium is the period following childbirth, typically lasting about 6 to 8 weeks, during which the mother's body returns to its non-pregnant state.
b) Causes of Puerperal Psychosis:
Maternal Factors:Family/Personal history of mental illness (Bipolar), hormonal changes, sleep deprivation, stress, infection.
Fetal Factors:Congenital abnormalities, stillbirth, terminal illness (psychological stress).
Social Factors:Poverty, lack of support, trauma, substance abuse.
c) Prevention in Prime Gravida in Labour Ward:
1. Screening:Identify risk factors/history.
2. Intrapartum Care:Emotional support, pain management, prevent traumatic birth.
3. Relationship:Build therapeutic trust.
4. Support:Involve partner/family.
5. Postnatal Plan:Ensure rest/sleep, early observation for signs.

Question 15

RAKAI COMMUNITY SCHOOL OF NURSING AND MIDWIFERY - NO.85

  1. List 6 causes of puerperal pyrexia.
  2. Outline signs and symptoms of puerperal sepsis.
  3. How would you prevent occurrence of puerperal sepsis in your health facility?
Examination Script
Answer: (Researched)a) 6 Causes of Puerperal Pyrexia:
1. Puerperal Sepsis (Genital tract infection).
2. UTIs.
3. Wound Infection (CS/Perineal).
4. Mastitis/Breast Abscess.
5. Respiratory Infections.
6. DVT/Thrombophlebitis.
7. Malaria.
b) Signs of Puerperal Sepsis:
1. Fever/Chills.
2. Foul-smelling lochia.
3. Uterine tenderness/Subinvolution.
4. Pelvic pain.
5. Tachycardia.
6. Malaise.
c) Prevention of Sepsis:
1. Hand Hygiene.
2. Aseptic Technique during labor/delivery.
3. Minimize VEs.
4. Sterile instruments.
5. Prophylactic antibiotics (if indicated).
6. Proper perineal care/wound care.
7. Complete placental removal.
8. Infection control protocols.

Question 16

MAYAYANJA MEMORIAL SCHOOL OF NURSING AND MIDWIFERY - NO.87

  1. What are the causes of obstructed labour?
  2. Outline complications of obstructed labour.
  3. Explain 7 strategies you would use as a midwife to prevent obstructed labour.
Examination Script
Answer: (Researched)a) Causes:
1. Maternal (Passage):Cephalopelvic Disproportion (CPD), Pelvic tumors, Soft tissue obstruction.
2. Fetal (Passenger):Malpresentation (Brow, Face, Shoulder), Malposition, Macrosomia, Hydrocephalus.
b) Complications:
Maternal:Uterine Rupture, PPH, Sepsis, Fistula (VVF), Trauma, Death.
Fetal:Asphyxia, Stillbirth, Sepsis, Trauma, Brain damage.
c) Prevention Strategies:
1. Quality Antenatal Care (Risk assessment).
2. Skilled Birth Attendance.
3. Use of Partograph (Monitor progress).
4. Diagnose Malpresentations early.
5. Hydration/Nutrition during labor.
6. Mobility during labor.
7. Timely Referral.

Question 17

NTUNGAMO SCHOOL OF HEALTH SCIENCE - NO.88

  1. Define third degree tear.
  2. Explain the 3 outstanding signs of third degree tear.
  3. Outline 4 ways you can prevent third degree tear during second stage of labour.
  4. List 6 complications of third degree tear.
Examination Script
Answer: (Researched)a) Define Third-Degree Tear:
A third-degree perineal tear is an injury during childbirth involving damage to the perineal skin, vaginal mucosa, perineal muscles, and partial or complete disruption of the anal sphincter complex, but with an intact rectal mucosa.
b) 3 Outstanding Signs:
1. Disruption of Anal Sphincter:Visible tear in the circular muscle.
2. Involvement of Perineal Muscles/Skin.
3. Intact Rectal Mucosa:Distinguishes it from 4th degree.
c) 4 Prevention Ways:
1. Perineal Support:Hands-on protection/controlled crowning.
2. Controlled Delivery:Encourage gentle pushing/panting.
3. Positioning:Warm compresses, alternative positions.
4. Avoid Routine Episiotomy.
d) 6 Complications:
1. Fecal Incontinence.
2. Pain.
3. Infection/Dehiscence.
4. Dyspareunia.
5. Fistula risk.
6. Psychological distress.

Question 18

MUTOLERE SCHOOL OF NURSING AND MIDWIFERY - NO.89

  1. Define puerperal pyrexia.
  2. Outline the specific nursing care a midwife can give to a mother with puerperal pyrexia.
  3. What are the complications of the above conditions (puerperal pyrexia)?
Examination Script
Answer: (Researched)a) Define Puerperal Pyrexia:
Puerperal pyrexia is a temperature of 38°C (100.4°F) or higher on any two of the first 10 days postpartum, exclusive of the first 24 hours.
b) Nursing Care:
1. Assessment:Monitor vitals, identify source (lochia, breasts, wound).
2. Reduce Fever:Tepid sponge, antipyretics, fan.
3. Hydration/Nutrition:Increase fluids and diet.
4. Medications:Antibiotics as prescribed.
5. Comfort/Hygiene:Rest, perineal care.
6. Infection Control:Isolation if needed, hygiene.
7. Specimens:Collect blood/urine/swabs.
c) Complications:
1. Septic Shock.
2. Peritonitis/Abscess.
3. DVT/Embolism.
4. Infertility.
5. Chronic Pain.
6. Death.

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