Syllabus

MIDWIFERY AND OBSTETRIC NURSING SYLLABUS

Course Description- This course is designed for students to appreciate the concept and principles of

midwifery and obstetrical nursing. It help them to acquire knowledge and skill in rendering nursing care to normal and high risk pregnant women during antenatal, natal and post natal period in hospital and community settings. It also develops in skills in managing normal and high risk neonates and participates in family welfare programme.

Course Contents

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 & obstetrical care.

·         National policy and legislation in relation to maternal health and welfare

·         Maternal morbidity, mortality and fertility rates

·         Perinatal, morbidity and mortality rates

Unit II

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

·         Female pelvis-general description of the bones, joints, ligament, planes of the pelvis diameters of the

·         true pelvis, important landmarks, variations in pelvis shape,

·         Female organs of reproductions-external genetalia, internal genital organs and their anatomical

·         Relations, musculature – blood supply, nerves, lymphatic, 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

Unit III

Assessment and management of pregnancy (ante-natal)

·         Normal pregnancy

·         Physiological changes during pregnancy.

•          Reproductive system

•          Urinary system

•          Cardio vascular system

•          Respiratory system

•          Gastro intestinal system

•          Metabolic changes

•          Skeletal changes

•          Skin changes

•          Endocrine system

•          Psychological changes

•          Discomforts of pregnancy

·         Diagnosis of pregnancy

•          Signs

•          Different diagnosis

•          Confirmatory tests

•          Confirmatory tests

·         Ante-natal care

•          Objectives

•          Assessment

•          History and physical examination

•          Antenatal Examination

•          Signs of previous child-birth

•          Relationship of fetus 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, ultrasonics, cardio tomography, 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

Unit IV

Assessment and management of intra-natal period.

·         Physiology of labour ,

·         Management of labour.

•          First stage

•          Signs and symptoms of onset of labour, normal and abnormal –

•          Duration

•          Preparation of Labour room and Women

•          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

•          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 techniques

•          Examination of the placenta

•          Examination of perineum

•          Maintaining records and reports

·         Fourth Stage

Unit V

Assessment and management of women during postnatal 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; method counseling

·         Follow-up

·         Records and reports

Unit VI

Assessment and management of normal neonates

·         Normal Neonate;

·         Physiological adaptation,

•          Initial & Daily assessment

•          Essential newborn care; Thermal control,

•          Breast feeding , prevention of infections

·         Immunization

·         Minor disorder of newborn and its management

·         Level of Neonatal care (level, II, & III)

·         At primary, secondary and tertiary levels

·         Maintenance of Reports and Records

Unit VII

High-risk pregnancy –assessment & management

·         Screening and assessment

•          Ultrasonics, cardio tomography, NST, CST, non-invasive

•          Newer modalities of diagnosis

·         High-risk approach

·         Levels of care; primary, secondary and tertiary levels

·         Disorders of pregnancy,

•          Hyper-emesis gravid arum, bleeding in early pregnancy, abortion, ectopic

•          Pregnancy, vesicular mole,

•          Ante-partum hemorrhage

·         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, Toxemia of pregnancy , hydraminors,

•          Rh incompatibility

•          Mental disorders

·         Adolescent Pregnancy, Elderly Primi and Grant Multipara

·         Multiple pregnancy

·         Abnormalities of placenta & cord

·         Intra-uterine growth-retardation

·         Nursing management of mothers with high-risk pregnancy

·         Maintenance of Records and Report

Unit VIII

Abnormal Labour –assessment and management

·         Disorders in labour

•          CPD and contracted pelvis

•          Malposititions 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;

•          Presentations and prolapses 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

Unit IX

Abnormalities during Postnatal periods

·         Assessment and management of woman of with postnatal complications

•          Puerperal infections, breast engorgement & infections, UTI, thrombo-Embolic disorders,

·         Postpartum hemorrhage, Eclampsia and sub involution,

•          Psychological complications:

•          Post partum Blues

•          Post partum Depression

•          Post partum psychosis

Unit X

Assessment and management of High risk new born

·         Admission of neonates in the neonatal intensive care Units-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

·         Organization and management of neonatal intensive care Units

·         Infection control in neonatal intensive care Units

·         Maintenance of Records and Reports

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, antihypertensive,

·         Diuretics, tocolytic agents, anti –consultants;

·         Analgesics and anesthetics in obstetrics

·         Effects of maternal medication on foetus and neonate

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 a nurse in family welfare programme

·         Training/Supervision/Collaboration with other functionaries in community like ANMs. LHVs,

·         Anganwadi workers, TBAs(Traditional birth attendant-Dais)

Reference Books

1.       Buckley Kathleen and Kulb Nancy W, High Risk Maternity Nursing Manual, Williams & Wilkin, 1993,Philadelphia.

2.       Bennet V Ruth & Brown K Linda, Myles Text Book for Midwives, ELBS, Churchill Livingstone.

3.       Calander, R & Miller A, Obstetrics Illustrated, Churchill & Livingstone, 1993, New York.

4.       Dawn C.S, Text Book of Obstetrics and Neonatology, Dawn Books, Calcutta.

5.       Dawn C.S, Text Book of Gynecology and Contraception, Dawn Books, Calcutta.

6.       Dutta D.C, Text Book of Obstetrics, New Central Agency, Calcutta.

7.       Dutta D.C, Text Book of Gynaecology, New Central Agency, Calcutta.

8.       Daftary Shrish, Holland and Brews Manual of Obstetrics, B Churchill Livingstone Ltd, New Delhi.