Unit I

Introduction to midwifery and obstetrical Nursing

Introduction to concepts of midwifery and obstetrical nursing
Trends in midwifery and obstetrical nursing

Historical perspectives and current trends
Legal and ethical aspects
Pre-conception care and preparing for parenthood
Role of nurse in midwifery and obstetrical care.
National policy and legislation in relation to maternal health and welfare.
Maternal, morbidity, mortality and fertility rates.
Perinatal, morbidity and mortality rates

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Unit II

Review of anatomy and physiology of female reproductive system and foetal
development

Female pelvis-general description of the bones joints, ligaments, planes of the
pelvis diameters of the true pelvis, important landmarks, variations in pelvis shape.
Female organs of reproduction-external genitalia, internal genital organs and their
anatomical relations, musculature-blood-supply, nerves, lymphatics, pelvic cellular
tissue, pelvic peritoneum.
Physiology of menstrual cycle
Human sexuality
Foetal development

Conception
Review of fertilization, implantation (embedding of the ovum), development
of the embryo and placenta at term-functions, abnormalities, the foetal sac,
amniotic fluid, the umbilical cord,
Foetal circulation, foetal skull, bones, sutures and measurements.

Review of Genetics

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Unit III

Assessment and management of pregnancy (ante-natal)

Normal pregnancy
Physiological changes during pregnancy

Reproductive system
Cardio vascular system
Respiratory system
Urinary system
Gastero intestinal system
Metabolic changes
Skeletal changes
Skin changes
Endocrine system
Psychological changes
Discomforts of pregnancy

Diagnosis of pregnancy

Signs
Differential diagnosis
Confirmatory test

Ante-natal care

Objective
Assessment

History and physical examination
Antenatal Examination
Signs of previous child-birth

Relationship of foetus to uterus and pelvis: Lie, Attitude, Presentation,
position
Per-vaginal examination.

Screening and assessment for high risk;
Risk approach
History and Physical Examination
Modalities of diagnosis; Invasive & Non-Invasive, ultrasonic, cardiotomography,
NST,CST
Antenatal preparation

Antenatal counseling
Antenatal exercises
Diet
Substance use
Education for child-birth
Husband and families
Preparation for safe-confinement
Prevention from radiation

Psycho-social and cultural aspects of pregnancy

Adjustment to pregnancy
Unwed mother
Single parent
Teenage pregnancy
Sexual violence

Adoption

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Unit IV

Assessment and management of intra-natal period

Physiology of labour, mechanism of labour
Management of labour

First stage

Signs and symptoms of onset of labour; normal and abnormal
Duration
Preparation of;

Labour room
Woman

Assessment and observation of women in labour; partogram-maternal and
foetal monitoring
Active management of labour, Induction of labour
Pain relief and comfort in labour

Second stage

Signs and symptoms; normal and abnormal
Duration
Conduct of delivery ; Principles and techniques
Episiotomy (only if required)
Receiving the new born

Neonatal resuscitation; initial steps and subsequent resuscitation
Care of umbilical cord
Immediate assessment including screening for congenital anomalies
Identification
Bonding
Initiate feeding
Screening and transportation of the neonate

Third stage

Signs and symptoms; normal and abnormal
Duration
Method of placental expulsion
Management; Principles and technique
Examination of the placenta
Examination of perineum

Maintaining records and reports
Fourth Stage

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Unit V

Assessment and management of women during post natal period

Normal puerperium ; Physiology, Duration
Postnatal assessment and management

Promoting physical and emotional well-being
Lactation management
Immunization

Family dynamics after child-birth.
Family welfare services; methods, counseling
Follow-up
Records and reports

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Unit VI

Assessment and management of normal neonates

Normal neonate;

Physiological adaptation;
Initial & Daily assessment
Essential newborn care; Thermal control,
Breast feeding, presentation of infections

Immunization
Minor disorders of newborn and its management
Levels of neonatal care (level I, II, & III)
At primary, secondary and tertiary levels
Maintenance of Reports and Records

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Unit VII

High risk pregnancy assessment & management

Screening and assessment

Ultrasonic, cardiotomography, NST, CST, non-invasive & invasive,
Newer modalities of diagnosis

High-risk approach
Levels of care; primary, secondary and tertiary levels
Disorders of pregnancy

Hyper-emesis gravidarum, bleeding in early pregnancy, abortion, ectopic
Pregnancy, vesicular mole,
Ante-partum haemorrage.

Uterine abnormality and displacement.
Diseases complicating pregnancy

Medical and surgical conditions
Infections, RTI (STD), UTI, HIV, TORCH
Gynecological diseases complicating pregnancy
Pregnancy induced hypertension & diabetes,
Rh incompatibility
Mental disorders

Adolescent pregnancy, elderly primi and grand multipara
Multiple pregnancy
Abnormalities of placenta & cord
Intra-uterine growth-retardation
Nursing management of mothers with high-risk pregnancy
Maintenance of records and report

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Unit VIII

Abnormal Labour-assessment and management

Disorders in labour

CPD and contracted pelvis
Malpositions and malpresentations
Premature labour, disorders of uterine actions-precipitate labour, prolonged
labour
Complications of third stage: injuries to birth canal

Obstetrical emergencies and their management;

Presentation and prolapsed of cord, Vasa praevia, amniotic fluid embolism,
rupture of uterus, shoulder dystocia, obstetrical shock

Obstetrical procedures and operations;

Induction of labour, forceps, vacuum, version, manual removal of placenta,
caesarean section, destructive operations

Nursing management of women undergoing Obstetrical operations and procedures

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Unit IX

Abnormalities during Postnatal Periods

Assessment and management of woman with postnatal complications

Puerperal infections, breast engorgement & infections,UTI, thrombo-Embolic
disorders, post partum hemorrhage, Eclampsia and subinvolution.
Psychological complications:

Post partum Blues
Post partum Depression
Post partum Psychosis

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Unit X

Assessment and management of High risk newborn

Admission of neonates in the neonatal intensive care unit – protocols
Nursing management of :

Low birth weight babies
Infections
Respiratory problems
Hemolytic disorders
Birth injuries
Malformations

Monitoring of high risk neonates
Feeding of high risk neonates
Organisation and management of neonatal intensive care units
Infection control in neonatal intensive care units
Maintenance of reports and records

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Unit XI

Pharmaco-therapeutics in obstetrics

Indication, dosage, action, contra-indication and side effects of drugs
Effect of drugs on pregnancy, labour & puerperium,
Nursing responsibilities in the administration of drug in obstetrics – Oxytocins
antihypertensives, diuretics, tocolytic agents, anticonvulsatnts,
Analgesics and anesthetics in obstetrics.
Effects of maternal medication on foetus and neonate

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Unit XII

Family Welfare programme

Population trends and problems in India
Concepts, aims, importance and history of family welfare programme
National Population : dynamics, policy and education
National family welfare programme; RCH, ICDS, MCH. Safe motherhood
Organization and administration; at national, state, district, block and village
levels
Methods of contraception; spacing, temporary and permanent, Emergency
contraception
Infertility and its management
Counseling for family welfare
Latest research in contraception
Maintenance of vital statistics
Role of national, international and voluntary organizations
Role of a nurse in family welfare programme
Training/supervision/Collaboration with other functionaries in community like
ANMs. LHVs. Anganwadi workers, TBAs (Traditional birth attendant Dai)

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