OBSTETRICS Past Papers-1

NURSING EXAMINATION BOARD PUNJAB, LAHORE
TIME: 1:30 HOURS. ROLL NO: ____________

PAPER: OBSTETRICS SESSION: SEP / OCT,2010
SUBJECTIVE PART
Q.No.5 ANSWER THE QUESTION ACCORDING TO THE STATEMENT:

(40 Marks)
A: write a short note on.
Eclampsia:
Eclampsia means to flush out with all signs of preeclampsia. It is
conditions characterized by convulsion or fits and coma .It may occur in antepartum,
intra partum and postpartum period.
Fibroid of uterus:
Fibroid are the most common benign tumors of the female genital
tract. Fibroid are benign tumor of muscle cells origin that contain varying amounts of
fibrous tissue.
Abortion:
It is an expulsion or extraction of all or any part of placenta and membrane
without identifiable or with a fetus alive or dead before 24 weeks of gestation.
B: Write a five contraindications of induction of labour :
The contraindications of Induction of labour are:
• Cephalo- pelvic disproportion.
• contracted pelvis.
• Malpresentation.
• Heart disease.
• pelvic tumor.
• cord presentation or cord prolapse.
C: Enlist the congenital abnormalities of new born:
• Microcephaly
• Spina bifida
• Anencephaly
• Hydrocephalic
• Neural tube defects
• Congenital heart disease
• Cleft plate and cleft lip
• Club foot
• Down syndrome
• Edward’s syndrome
• Patau’s syndrome
D: Enlist the five APGAR score of new born :
Apgar score is a method of assessment of status of oxygenation and well being of
newborn baby at birth. In which we see.
A : Appearance – Color of body
P: Pulse _ Heart rate
G: Grimes _ response to stimuli
A: Activity _ muscle tone
R: Respiration _Respiratory efforts.
SUBJECTIVE PART
ANSWER THE QUESTION ACCORDING TO THE STATEMENT: (40 Marks)
Q 1: what are the signs of impending eclampsia?
• severe headaches.
• vision problems, such as blurring or seeing flashing lights.
• pain just below the ribs.
• vomiting.
• sudden swelling of the feet, ankles, face and hands.
Q 2: what are the causes of obstructed labour?
Ans : The major cause of obstructed labour is
• cephalopelvic disproportion, which may be due to a
• small pelvis
• a large baby
• fetal Malpresentation
• a tight perineum
• abnormalities or tumors of the uterus, ovary, or vagina.
Q 3: write down the indication of forceps delivery?
• maternal exhaustion
• Fetal distress
• Maternal heart diseases
• Poor descent of fetus through birth canal
• Failure of internal rotation nerve root anaesthesia
Q 4: write down the sign and symptoms of PPH?
• Uncontrolled bleeding.
• Decreased blood pressure.
• Increased heart rate.
• Decrease in the red blood cell count (hematocrit)
• Swelling and pain in tissues in the vaginal and perineal area, if bleeding is due to
a hematoma
TIME: 1:30 HOURS. ROLL NO:____________
SUBJECTIVE PART
Q#1: Write down the complications of second stage of labor?

Ans: Second stage of labor:
Second stage of labor commences with complete cervical dilation to 10
cms and ends with the delivery of neonate.
Complications of second stage of labor:
A prolonged second stage of labor is known to be associated with
increased risk of certain maternal complications such as infection, urinary retention,
hematoma and ruptured sutures in the early post partum period.
Q#2: Write the signs and symptoms of PPH?
Ans: PPH:
PPH stands for post partum hemorrhage which occurs with in six weeks after
delivery.
Signs and Symptoms of PPH:
Following are the most common symptoms of PPH. However each woman may
experience symptoms differently. Symptoms may include:
• Uncontrolled bleeding
• Decreased blood pressure
• Increased heart rate
• Decrease in the red blood cell count
• Swelling and pain in the tissues of vaginal and perineal area, if bleeding is due to
hematoma.
Q#3: Write down the types of abortion?
Ans: Abortion:
It is an expulsion or extraction of all or any part of placenta and membranes
Types of abortion:
• Spontaneous abortion
• Threatened abortion
• Inevitable abortion
• Incomplete abortion
• Complete abortion
• Induced abortion
• Septic abortion
• Habitual abortion
• Missed abortion.
Q#4: Write down five points of nursing care during puerperium?
Ans:
To support the mother and her family in The transition to a New family.
Support of breastfeeding.
Counseling services on nutrition complementary feeding and immunization.
Counseling regarding contraceptive and resumption of sexual activity.

Principles or normal puerperium:.
To restore of normal status of mother.
To prevent infection.
To take care of breastfeeding and promote lactation.
To motivate mother for contraceptive acceptance.

Immediate attention:
Immediately following delivery the mother is closely observed for the care of Fourth
stage of labour.
If the mother is exhausted and tried a sedative inj.diazepam10 mg 1/M with
prescription to ensure good sleep..
Vital signs:
Pulse.
blood pressure.
temperature
Respiration
Bleeding per vagina:
Observed and Note the colour amount consistency of bleeding per vaginam.report if
any abnormal bleeding occur.
Rest:
after delivery the mother should have rest for at least 8-12 hour’s. After a good
resting period the patient become fresh and can breast feed baby or move a little out of
bed.
Early Ambulation:
constipation is reduced.
Help in uterine drainage.
Provide a sense of well being.

Iron supplements:
Help the mother to have complete rest both physically and mentally.
If the mother is hypertension then ensure her good sleep too after delivery. This
can be helpful by giving drugs like.
Tab.Diazepam 5 mg orally at bed time.
Tab .phenobarbitone 30 -60 mg at bed time.

Asepsis and antiseptics:
Drug the first week of puerperium asepsis must be maintained.
The room where the mother and baby is kept should to avoid infection
TIME: 1:30 HOURS. ROLL NO: _______
PAPER: OBSTETRICS SESSION: SEP OCT 2013
SUBJECTIVE PART
Q.No.5 ANSWER THE QUESTION ACCORDING TO THE STATEMENT: (40
Marks)
Q 2: Define placenta abruption?
Answer: Placental abruption:
It is one form of ante partum haemorrhage where the bleeding occurs due to premature
separation of normally situated placenta". The term "abruptio placenta" denotes "to tear
apart".
Q 3: Define postpartum haemorrhage?
Answer: Post partum haemorrhage
It is defined as excessive bleeding from the genital tract at any time following the baby's
birth upto 6 weeks after delivery.
Q 4: Define bishops score?
Answer: Bishop's score:
It is a method to access the favorability of cervix prior to induction of labour. In which we
assess the dilation, length. Consistency and position of cervix and station of head.
Q 5: Define cephalopelvic presentation?
Answer: Cephalo pelvic disproportion
The disparity in relation between the fetal head and the pelvis is called cephalo-pelvic
disproportion".
Q6: (a)Apgar score stands for :
APGAR Scoring:
The APGAR is an instant, quick and complete assessment of new-born or neonate well
being or it is a practical method of assessing a neonate or new-born.
The Apgar scorning is a number calculated by scorning the:
A:Appearance (skin colour)
P:Pulse (heart rate)
G:Grimse (Reflex irritability)
A:Activity ( muscle tone)
R:Respiration ( respiratory efforts)
Q6 B: Presumptive sign of pregnancy:
Presumptive signs of pregnancy:
• Amenorrhea (no period)

• Nausea — with or without vomiting
• Breast enlargement and tenderness
• Fatigue
• Poor sleep
• Back pain
• Constipation
• Food cravings and aversions
• Mood changes or "mood swings"
• Heartburn
• Nasal congestion
• Shortness of breath
• Lightheadedness
• Elevated basal body temperature (BBT)
• Spider veins
• Reddening of the palms
TIME: 1:30HOURS ROLL NO:_____
PAPER: OBSTETRICS SESSION: SEP Oct 2014
SUBJECTIVE PART
Q.NO.5: ANSWER THE QUESTION FOLLOWING TO THE STATEMENT.
Q.1 (a) Write down the major sign of PPH?
Signs of PPH:
1. Postpartum hemorrhage (PPH) is severe vaginal bleeding after childbirth.
2. It’s a serious condition that can lead to death.
3. Other signs of postpartum hemorrhage are dizziness, feeling faint and
blurred vision.
4. PPH can occur after delivery or up to 12 weeks postpartum.
5. Early detection and prompt treatment can lead to a full recovery. Get help right
away if you’re experiencing symptoms of PPH.
Q1(B) Enlist the sign of true labor?
TRUE LABOR PAINS
The features of true labor pains are:
1- Painful uterine contractions (Labor pains)
2- Show
3- Progressive effacement and dilation of cervix
4- Formation of “Bag of waters”
Q.2(A) Enlist the impending signs of eclampsia?
Signs of eclampsia:
• No improvement in pre-eclampsia
• Severe headache
• Visual disturbances like blurring of vision and spot of light before eyes.
• Rolling of eyes.
• Twitching of eye lids and face
• Epigastric pain
• Vomiting
• Oliguria
• Massive oedema of face ,hands, abdominal walls and legs
• Restlessness agitation
• Tachypnea with acidosis
• Hyperpyrexia is often present
• Protein urea, oligouria or even anuria in severe cases
• Fits: commonly occur at irregular interval but in severe cases may occur in rapid
succession
• Coma(unconscious):coma is assisted by GCS.
Q.2(B) Enlist the complications of placenta previa?
Complications
Maternal
1.During pregnancy:
• APH with varying degree of shock
• Malpresentation
• Premature labor
2.During labor:
• Early rupture of the membranes
• Cord prolapse
• Slow dilatation of cervix
• Intrapartum hemorrhage
• Increased incidence of operative interference
• PPH
• Retained placenta.
3.Puerperium:
• Sepsis
Fetal
1. Low birth weight
2. Asphyxia
3. Intrauterine death
4. Birth injuries
5. Congenital malformation
Q.3(A) Enlist the function of amniotic fluid?
Function of amniotic fluid:
• Maintains an even temperature
• Protects fetus and cord from injury
• Prevent sides of the fetal sac from sticking together.
• Help to dilate the cervix in labor
• Washes and clean cervix and birth canal.
• Prevent uterine infection
• Allow the fetus to move freely in the uterus.
Q.3(B) Write down five points of nursing care during puerperium?
Nursing care during puerperium
The objective of care of normal puerperium are:
1- To support the mother and her family in the transition to a new family.
2- Prevention, early diagnosis and treatment of complication of the mother and the
infant.
3- To provide referral services for (specialist care) in case the mother or the infant
requires.
• Support of breastfeeding.
• Counseling services on nutrition, complementary feeding and
immunization.
• Counseling regarding contraception and resumption of sexual activity.
Q.4(A) Write the advantages of breastfeeding for mother and baby?

Advantages of breastfeeding:
FOR BABIES:
It is the best food for the mental and physical development of the baby.
It protects the baby from:
• Diarrhea
• Cough and colds
• Respiratory infection
• Ear infection
• Sudden infant death
It develops close bonding between mother and child.
Baby will not get:
• A sore bottom
• Stomach ache
• Constipation
• Too fat
It develops better:
• Jaws
• Speech
• Teeth
FOR MOTHER:
Breast feeding helps get:
• Weight back to normal after delivery.
• Womb back to normal after delivery.
Breast feeding gives:
• Pride and satisfaction to the mother.
Breast feeding does not put extra burden on once budget as it doesn’t cost money.
Breast feeding means a mother can feed her baby:
• Anytime
• Anywhere
• Without any preparation
Breast feeding mother develop a loving relationship with her baby.
Breast feeding delays pregnancy, if the baby is fed every 2-3 hours , morning and
evening.
Q.4(B) Write down the indication of cesarean section?
INDICATION OF CESARIAN SECTION:
• Cephalopelvic disproportion.
• Fetal distress
• Malpresentation
• Maternal diabetes
• Breech presentation in primi gravida
• Placenta previa/ placenta abruption
• Prolapsed cord
• Ineffective uterine contractions
• Multiple births
• Previous cesarean section
• Other obstetrics emergencies and conditions
PAPER: OBSTETRICS SESSION: March April 2014
SUBJECTIVE PART
Q.no.1 . Enlist the complications of polyhydramnios?
Ans. Polyhydramnios:
Polyhydramnios is where there is too much amniotic fluid around the baby
during pregnancy. Amniotic fluid is the fluid that surrounds your baby in the womb. Too
much amniotic fluid is normally spotted during a check-up in the later stages of
pregnancy.
Complications of polyhydramnios:
The risk of the following obstetric complications is increased when
polyhydramnios is present due to over-expansion of the uterus :
• maternal dyspnea.
• preterm labor.
• premature rupture of membranes.
• abnormal fetal presentation.
• umbilical cord prolapse.
• postpartum hemorrhage.
Q.no.2. write a note on ectopic pregnancy?
Ans.Definition:
An ectopic pregnancy is one in which the fertilized ovum is implanted and
develops outside the normal uterine cavity.
Incidence:
This is 1 in 300 pregnancies.
Causes:
• Factors preventing or delaying the migration of fertilized ovum to the uterine
cavity.
• Factors facilitating nidation of fertilized ovum in the tubal mucosa.
Risk factors for ectopic pregnancy:
• Previous ectopic pregnancy.
• Previous surgery on uterine tube.
• Intrauterine contraceptive device use.
• Infections like:
• PID
Chlamydial infection
• Gonorrhea
• Assisted reproductive technique.
Anatomical sites:
• Tubal pregnancy is more common on right tube than on left.
• Ampulla is the commonest site.
• It can be the isthmus and if ectopic pregnancy occur here then it is the most
dangerous site as it can lead to tubal rupture.
Clinical features:
The clinical features are divided according to the following types:
• Acute type
• Chronic type.
Management of ectopic pregnancy:
The management of ectopic pregnancy is also divided according to the type, I acute
ectopic and chronic ectopic.
Principles of management:
• To resuscitate the mother.
• To carry out urgent laparotomy.
Q no 3. Write down various indications of induction of labor?
Ans: Labor induction — also known as inducing labor — is prompting the uterus to
contract during pregnancy before labor begins on its own for a vaginal birth. A health
care provider might recommend inducing labor for various reasons, primarily when
there's concern for the mother's or baby's health.
Labor Induction
• Your pregnancy has lasted more than 41 to 42 weeks.
• You have health problems, such as problems with your heart, lungs, or kidneys.
• There are problems with the placenta.
• There are problems with the fetus, such as poor growth.
• There is a decrease in amniotic fluid.
• You have an infection of the uterus.
Q.no.4. Write a note on recurrent abortion?
Ans: Habitual (or recurrent) abortion refers to a history of repeated miscarriage,
defined as three or more successive pregnancy losses. Habitual miscarriage
suggests the need for medical evaluation of a couple and ongoing care for what may
be chronic problems (e.g., hormonal dysregulation, infection, etc.).
effects of recurrent abortion:
Women with a history of recurrent miscarriage experience an increase in depressive
symptoms and may be at increased risk of negative psychological effects such as
pregnancy-related anxiety, depression, irritability, excessive fatigue, fear, sleep
disorders and lack of concentration [4, 5] The increase in psychological
causes of repeated abortion of pregnancy:
The most commonly identified causes include uterine problems, hormonal disorders
and genetic abnormalities.
infections cause recurrent abortion?
Infections are estimated to be responsible for between 0.5 and 5% of cases with
recurrent miscarriage. The main suspected pathogens are mycoplasma, urea plasma,
Chlamydia trachomatis, Listeria monocytogenes, and herpes simplex virus
infections cause recurrent abortion:
Infections are estimated to be responsible for between 0.5 and 5% of cases with
recurrent miscarriage. The main suspected pathogens are mycoplasma, urea plasma,
Chlamydia trachomatis, Listeria monocytogenes, and herpes simplex virus
PAPER: OBSTETRICS SESSION: March/April 2015
SUBJECTIVE PART
Q.No.5: ANSWER THE QUESTION ACCORDING TO THE STATEMENT: (40
Marks)
Q.no.1:What is meant by hypertensive disorder of pregnancy?
Ans: Hypertension:
Hypertension in pregnancy is defined as a systolic blood pressure (SBP) greater than or
equal to 140 mm Hg or a diastolic blood pressure (DBP) greater than or equal to 90 mm
Hg or an increase of at least 30 mm Hg in the SBP and an increase of at least 15 mm
Hg in the DBP.
Hypertensive disorders:
Preeclampsia happens when a woman who previously had normal blood pressure
suddenly develops high blood pressure* and protein in her urine or other
problems after 20 weeks of pregnancy.
Hypertensive disorders of pregnancy (HDP) are the leading cause of maternal and
perinatal mortality and morbidity worldwide, causing complications in up to 10% of all
pregnancies. The common HDP are chronic hypertension, gestational hypertension
and preeclampsia.
Treatment for hypertension:
methyldopa, labetalol, beta blockers (other than atenolol), slow release nifedipine,
and a diuretic in pre-existing hypertension are considered as appropriate treatment.
Q .no.2.Describe the major categories of hypertension during pregnancy?

Ans: The 4 categories of hypertensive disorders of pregnancy are chronic hypertension,
gestational hypertension, preeclampsia-eclampsia, and chronic hypertension with
superimposed preeclampsia. These disorders are among the leading causes of
maternal and fetal morbidity and mortality.
Chronic hypertension:
Chronic hypertension means having high blood pressure* before you get pregnant or
before 20 weeks of pregnancy. . Women who have chronic hypertension can also get
preeclampsia in the second or third trimester of pregnancy.
Gestational hypertension:
. Gestational hypertension is a form of high blood pressure in pregnancy. It occurs in
about 6 percent of all pregnancies. Gestational hypertension can develop into
preeclampsia.
Pre_eclampsia and eclampsia:
Preeclampsia and eclampsia are pregnancy-related high blood pressure disorders.
Preeclampsia is a sudden spike in blood pressure. Eclampsia is more severe and can
include seizures or coma
Superimposed Pre_eclampsia:
Superimposed preeclampsia refers to women with chronic arterial hypertension (primary
or secondary) who develop preeclampsia (PE). Because hypertension affects 5-15 % of
pregnancies, it is itself a matter of concern.
Q.no.3. Describe the physiological changes in the reproductive system during
pregnancy?
Ans: Physiological changes of pregnancy:
When a woman becomes pregnant, certain physiological changes occur in
her body due to the effects of hormones estrogen and progesterone.
Changes in reproductive system:
Uterus:
After conception, the uterus develops to provide nutritive and protective
environment in which the fetus will develop and grow.
Uterine layers:
Decidua:
The decidua is the name given to the endometrium during pregnancy. The decidua
provides a glycogen rich environment for blastocyst until the trophoblastic cells begin to
form placenta.
Myometrium:
• Inner circular
• Middle oblique
• Outer longitudinal
During pregnancy the muscle layers become more differentiated and organized for their
parts in expelling the fetus et term.
Perimetrium:
This does not totally cover the uterus being deflected over the bladder anteriorly
to form the uterovesical pouch and cover the rectum posteriorly to form pouch of
Douglas. This management allows for the unrestricted growth of uterus.
Weight:
It increases from 60gm to 1100gm.
The average weight gain is 12 to 14 kg.
Size: From 7.5×5×2.5cm to 30×23×20cm.
Uterine shape by week:
The uterus also changes from pear shape to globular in shape during the first
twelve weeks of pregnancy and at 20 weeks restore to it’s original pear shape.
12 weeks of pregnancy:
The uterus rise out of the uterus and becomes upright often inclines and rotates to
the right and the fundus of uterus may be palpated abdominally above the symphysis.
The uterus has a thicker more rounded fundus and become progressively more
vertical and fundus appears just below the umbilical level.
The lower uterine segment can be identified.
The uterus now reaches the level of xiphi sternum and lower uterine segment is
formed.
Cervix:
During pregnancy the cervix becomes more vascular and softer in response to
increased level of estrogen. The cervical glands secrete mucus in the cervical canal.
This thick mucus help in preventing ascending infection.
Vagina:
The epithelium of vagina undergoes hyperplasia, hypertrophy and increased
vascularization throughout pregnancy. By the end of pregnancy the vaginal wall and
perineal body have become relaxed to allow passage of fetus.
Vaginal discharge occurs through out pregnancy due to increased activity of epithelial
cells.
Q.no.4. Define eclampsia and write down signs of impending eclampsia?
Ans: Eclampsia:
Eclampsia is an extremely dangerous complication of severe pregnancy
induced hypertension (Pre_eclampsia). Convulsions and commas characterize it . It
may occur during pregnancy, during labour and after delivery.
It is more common in primigravida with a history of eclampsia, hypertension and
twins pregnancy.
Clinical features or sign symptoms:
• No improvement in pre-eclampsia.
• Severe headache.
• Visual disturbances.
• Rolling of eyes.
• Twitching of eye lids and face.
• Epigastric pain.
• Vomiting.
• Oligouria.
• Massive oedema of face,hands,abdominal walls and legs.
• Restlessness agitation.
• Tachypnea with acidosis.
• Hyperpyrexia is often present.
• Protein urea,oligourea or even anuria in severe cases.
• Fits commonly occur at irregular interval but in severe cases may occur in rapid
succession.
• Comma is assisted by GCS.
Q.no.5. Write down types of antepartum hemorrhage?
Ans: Antepartum hemorrhage (APH) is defined as bleeding from or in to the genital
tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby. The
most important causes of APH are placenta previa and placental abruption, although
these are not the most common.
Types of antepartum hemorrhage:
• Cervical
ectropion. The cells on the surface of the cervix often change in
pregnancy and make the tissue more likely to bleed, particularly after sex.
• Infection
• Placental edge bleed

• Placenta previa
• Placental abruption
Q.no.6. Define abortion? Enlist it’s types and briefly describe the types of
spontaneous abortion?
Ans.Abortion:
It is an expulsion or extraction of all or any part of placenta and membranes
Types of abortion:
• Spontaneous abortion
• Induced abortion
• Septic abortion
• Habitual abortion
• Missed abortion
Types of spontaneous abortion:
It is defined as the loss of a pregnancy before fetal viability (22 to 24 weeks
gestation).
Spontaneous abortion includes:
Threatened abortion:
Pregnancy may continue.
Inevitable abortion:
Pregnancy will not continue and will proceed to complete or incomplete abortion.
Incomplete abortion:
Products of conception are partially expelled.
Complete abortion:
Products of conception are completely expelled.
Time:1:30 hr. ROLL No _________
PAPER: OBSTETRICS SESSION: SEP/OCT 2016
SUBJECTIVE PART
ANSWER THE QUESTION FOLLOWING TO THE STATEMENT. (40 MARKS)
Q1.Define the following.( Each carry 2 MARKS)
1. Menstrual Cycle:
Series of events through hormones, which takes place under the action of uterine walls
and ovaries, is said to be menstraul cycle. It begins from first day of menstruation until
the first day of next menstrual. The cycle has 28 days.
2. Menorrhagia:
Menorrhagia is an abnormally heavy and prolonged menstrual period at regular
intervals. It may be associated with high blood pressure, hormonal disturbance and
many other conditions including vitamin K Deficiences, aspirin usage and bleeding
disorder.
3. Fertilization:
The union of sperm and ovum is called fertilization.
4. Ectopic pregnancy:
The word Ectopic means ‘out of place’. An ectopic pregnancy is one in which fertilized
ovum implants outside the uterine cavity. Atleast 90% of extra uterine pregnancies
occur in uterine tubes but may occur in abdomen and ovaries.
5. Missed Abortion:
Fetus die in uterus, but is not expelled and retained for so some time.
Q2.A) Define Ovulation. Enlist the cause of Ovulation?
OVULATION:
Every month ovarian graafian follicles mature under the influence of follicle stimulating
hormone (FSH) release ovum this process called ovulation.
Causes of OVULATION: The following are the possible explanation that may operate
singly or in combination:
• Endocrinal
1. L.H. Surge
2. F.S.H. Rise
• Stretching factor
• Contractions of micromuscles
Q3: Explain the phases of Menstrual cycle?
Phases of Menstrual cycle:
The phases of menstrual cycle that denote changes in the uterine wall are
• Proliferative phase
• Secretary phase
• Menstrual phase
Proliferative phase:
At this stage an ovarian follicle, stimulates by FSH, is growing towards maturity and is
producing Estrogen. Estrogen stimulates endometrium . which becomes thicker by rapid
cell multiplication. Accompanied by an increase in mucus secreting glands and blood
capillaries. This phase ends when Ovulation occurs and Estrogen production stops.
Secretary phase:
Immediately after ovulation, the lining cells of ovarian follicle are stimulated by L.H to
develop corpus luteum, which produces progesterone. Under the influence of
progesterone the endometrium becomes oedematous and the secretary glands produce
increased amount of watery mucus. There is similar increase in the secretions of watery
mucus by the gland of the uterine tubes, vagina and cervix.
Menstrual phase :
If the ovum is not fertilized, the high level of progesterone in the blood inhibits the
activity of the pituitary gland and the production of luteinizing hormone is considerably
reduced. The withdrawal of this hormone causes degeneration of the corpus luteum and
this progesterone production is decreased. About 14 days , after ovulation the lining of
the uterus degenerate and breakdown and menstruation begins. The menstrual flow
consist of the extra secretions. Endometrial cell and blood from the broken down
capillaries and the unfertilized ovum.
If the ovum is fertilized there isn’t any breakdown of endometrium and thus no
menstrual flow. The fertilized ovum (zygote) travel through the uterine tube to the uterus
where it becomes embedded in the wall and produces the hormone chorion
gonadotropin . Which is similar to anterior pituitary luteinizing hormone. This hormone
keeps the corpus luteum intact continue to secret progesterone for the first 3 to 4
months of the pregnancy. Inhabiting maturation of ovarian follicles. During this period
placenta develops and produces , Oestrogen, progesterone and gonadotropin.
Q.3 A) Explain the mechanisms of normal labor?
Mechanisms of Labor:
Mechanisms of labor is defined as the series of movement that the fetus undergoes
during it’s passage through the birth canal during childbirth. This sequence of
movement is more or less similar and occur in most labors with size and shapes of the
fetus and pelvis are such that delivery would be impossible without the fetus undergoing
the specific movement.
Descent:
Descent means progesterone of the fetus toward the pelvic outlet. Descent is the
cardinal movement of labor . It is continuous and all other movement occur
simultaneously with descent.
Flexion:
There is flexion of the head at the neck and the spine. Flexion and descent make the
smaller suboccipitobregmatic diameter to engage in the right oblique diameter of the
pelvic inlet. The denominator is the occiput. Which lies against the ischiopubic.
Internal rotation:
Internal rotation with progressive descent and flexion , approaches the pelvic floor.
Because of the gutter-like forward inclination of the pelvic floor the undergoes an
internal rotation through 1/8th of a circle and lies under the symphysis pubis. This is
achieved with a twist at the neck.
Extension of head:
Extension of head with further descent the head is born by a process of extension.
Restitution after the birth of the head the twist at the neck is undone by a process of
restitution in which there is a correction of the rotation of the head by 1/18th of a circle.
External rotation:
With continued descent, the shoulder engage in the left of diameter of the inlet. There is
inward rotation the anterior shoulder so that it comes to lies under the symphysis pubic.
The head externally rotate through 1/18th of a circle along with the shoulder. This is
called “external rotation “OR Restitution.
Q.3(B) write down the nursing management of newborn just after birth?
Nursing management of newborn:
• Check the baby breathing for every 5 minutes.
If the baby become eye bluish or is heaving difficult breathing (less than 30 or more
than 60 breath per minute) or oxygen by nasal catheter or prongs.
• Check warmth by feeling the baby’s feet every 5 minutes:
1-If the baby’s feet feel cold. Check axillary temperature.
2-If the baby’s temperature is below 36.5 °C, rewarm the baby.
• Check the cord for bleeding every 15 minutes. If the cord is bleeding, rectic cord
more tightly.
• Apply antimicrobial drops ( 1% silver nitrate solution)or ointment (1% tetracycline
ointment) to the baby’s eyes.
• Note: povidone -iodine should have confused with tincture of iodine, which could
cause blindness if used.
• Wipe of any measurements blood from skin.
• Encourage breastfeeding when the baby appears ready (begins “rooting”) .Do
not the force baby to the breast.
Q.4A) Enlist the indication of cesarean section delivery and explain the
postoperative nursing management cesarean section?
Indication:
• Cephalopelvic disproportion
• Malpresentation
• Fetal distress
• Maternal diabetics
• Breech presentation in primigravida
• Placenta previa
• Placenta abruption
• Prolapsed cord
• Ineffective uterine contraction
• Multiple birth
• Previous cesarean births
Post operative nursing management:
• Assess for and maintain patient airway turn her face on side to facilitated
secretions.
• Check for presence / absence of gag reflex maintain artificial airway in place until
gag reflex has returned.
• Assess colour and temperature of skin , color of nailbeds and lips.
• Monitor IV infusions; condition of site ; types of solution and flow rate.
• Encourage client to cough and deep breath after airway is removed.
• If spinal anaesthesia is used keep client flat and check for sensation and
movement in lower extremities.
PAPER: OBSTETRICS SESSION: march/April 2016
SUBJECTIVE PART
Marks)
1 Define the following:
puberty:
Puberty is the period of time when children begin to mature biologically
psychologically socially and cognitively. Girls start to grow into women and boys into
men.
This is the period of increased general body growth and development of secondary
sexual characters.
Fertilization:
The union of sperms and ovum called fertilization.
Labour:
It is spontaneous expulsion at term of single alive fetus through vagina in
longitudinal lie cephalic presentation and occipito anterior position followed by after birth
of placenta cord and membrane in a reasonable time (12_18) hours period without any
complication.
Lochia:
The discharge from uterus through vagina after the delivery of placenta till 40
days of Puerperium Called lochia. It contains leucocytes, mucus and debris.
Abortion:
it is an expulsion of extraction of all or any part of placenta and membrane
Q:2 (A)Write down the function of uterus:
Menstruation:
Every month uterus prepares it self for receiving fertilized ovum but if it does not
happened it expel out all the uterine contents in the form of menstruation
Pregnancy :
The uterus receives fertilized ovum and helps to nourish that ovum. It provides he
environment for growing fetus during the 40 week gestation period.
Labour:
The muscles of uterus contract during the process of labour and help the fetus and
expulsion of fetus placenta and membrane.
Involution :
The uterus returns to its normal size following delivery.
Q2 (B) how does the blastocyst develop:
A fluid filled cavity or blastoccle appears in the morale which now become
known as the blastocyst.
On the outer side of blastocyst there is single layer of cells known as the trophoblast
which will form the placenta and chorion. While the remaining cell forming the inner cell.
Mass and will become the fetus and amnion.
After the six or seven days of fertilization the blastocyst embeds itself in the
endometrium embedding sometimes known as nidation nesting is normally completed
by the eleventh day after ovulation.
Q:3 (A) what are the causes of oedema in pregnancy :
* Physiological hypertension
* Long standing
* pre _ eclampsia
* cardiac failure
* Anemia
* Hyperproteinemia
* H. Form mole
Q3 (B) explain active management of third stage of labour:
Active management of third stage of labour includes:
*Immediate oxytocin
*Controlled cord traction
*Uterine massage
Oxytocin :
• Within 1 minute of delivery of the baby palpate the abdomen rule out the
presence of an additional baby and give oxytocin 10 units IM.
• Oxytocin is preferred because it is effective 2 to 3 minutes after injection has
minimal side effects and can be used in all women. It oxytocin is not available
give ergometrine 0.2 mg IM or prostaglandins. Make sure there is no additional
baby before giving these medications.
• Do not give ergometrine to women with pre eclampsia. Eclampsia or high blood
pressure because it increases the risk of convulsions.
• The procedure is recommended for mother area at risk of particularly high.
These include cases of prolonged labour uterine over distention due to hydra
minions or a big baby anemic mother history of postpartum haemorrhage in
previous labor and in grand multipara . Active management of the third stage
reduces the chances of postpartum haemorrhage in this high risk group and
helps to prevent maternal morbidity and mortality.
Controlled cord contraction:
• Clamp the cord close to the perineum using sponge forceps hold the clamped
cord and the end of forceps with one hand.
• Keep slight tension on the cord and await a strong uterine contraction(2_ 3
minutes).
• With the next contraction repeat controlled cord traction with counter traction.
• Slowly pull to complete the delivery.
• If the cord is pulled of the placental may be necessary.
• Place the other hand just above the woman pubic bone after nebulized the uterus
by applying counter traction during controlled cord traction. This helps prevent
inversion of the uterus.
• When the uterus becomes rounded or the cord lengthens very gently pull
downward on the cord to deliver the placenta. Do not wait for a gush of blood
before applying traction on the cord. Continue to apply counter traction to the
uterus with the other hand.
• If placenta does not descend during 30 _ 40 second controlled cord traction(i.e.
there are no signs of placental separation ) continue to pull on the cord.
• Gently hold the cord and wait until the uterus is well contracted again. If
necessary use a sponge forceps to clamp the cord close to the perineum as it
lengthens.
• Never Apply cord traction pull without applying traction (push) above the pubic
bone with the other hand.
• If the membranes tear gently examine the upper vagina and cervix wearing high
level disinfected gloves and use a sponge forceps to remove pieces of
membrane that are present.
• Look carefully at the placenta to be sure none of it is missing. If a portion of the
maternal surface is missing or there are torn membrane with vessels suspect
retained placental fragments.
• As the placenta delivers the thin membranous can tear off hold the placenta in
tow hands and gently turn it until the membranes are twisted
Uterine massage:
• Immediately massage the fundus of the uterus through the woman abdomen until
the uterus is contracted.
• Repeat uterine massage every 15 minutes for the first 2 hours.
• Examination for tears.
• Ensure that the uterus does not become relaxed soft after you stop uterine
massage.
• Examine the woman carefully repair any tears to the cervix or vagina or repair
episiotomy.
Q 4) Indication of caesarean delivery and describe the nursing management of
patient after caesarean delivery?
CAESARIAN SECTION :
A caesarean section ( C section) is surgery to deliver a baby. The baby is taken out
through the mothers abdomen.
INDICATION :
• Cephalopelvic disproportion.
• Fetal distress
• Mal presentation
• Maternal diabetics
• Breech presentation in primi gravida
• Placenta Previa placenta abruption
• Prolapsed cord
• Ineffective uterine contractions
• Multiple births
• Previous caesarean births
MANAGEMENT :
• Assess for and maintain patent airway turn her face on side to facilitated
secretions.
• Check for presence absence of gag reflex maintain artificial airway in place until
• Assess colour and temperature of skin colour of nailbeds and lips.
• Monitor Iv infusions condition of site type of solution and flow rate.
• Encourage client to cough and deep breath after airway is removed.
• If spinal anaesthesia is used keep client flat And check for sensations and
movement in lower extremities.
PAPER: OBSTETRICS SESSION: march April 2017
SUBJECTIVE PART
Q1 a Define infertility and write down causes of female infertility?
Ans: infertility is defined as a failure to conceive within one or more years of regular
unprotected coitus.
Causes:
1.ovarian factor
2.Tubal factor
3.Peritoneal factor
4.uterine factor
.Endometriosis
.Uterine fibroid
.Uterine hypoplasia
.Congenital malformation of uterus
.Uterine synchiae
5.cervical factor
6.vaginal factor
.Vaginal atresia
.Vaginal septum
.Narrow introits
Q1 b Enlist positive sign of pregnancy?
• missed period
• Urinary frequency tiredness
• Morning sickness
• Fatigue
• Vomiting
• Tender breast
Q2a Enlist causes of atonic uterine action?
1.Placenta previa or abruption placenta
2. Retained Placenta
3.incomplate separation of the placenta
4.A bladder which is full
5.High parity
6.multiple pregnancies
7. Polyhydramnios
8.large baby
9.prolong labour
10.Anemic mother
Q2b What is the contraindication of breastfeeding?
Ans: there are following maternal or neonatal conditions contraindicate breastfeeding
either temporary or permanently.
1.Temporary
a. Maternal
• acute puerperal illness
• cranked nipples, mastitis, breast cancer
b. Neonatal
• very low birth weight baby
• Asphyxia and intracranial stress
• Acute illness
2. Permanent
a. Maternal
• chronic medical illness i.e decompensated, tuberculosis
• Puerperal psychosis
• Patient having high dose of anti-epileptic and anti-thyroid drugs
b. Neonatal
• Severe degree of cleft palate
• Glucosemia
Q3A Define menstrual cycle?
Ans: the beginning of the menstrual cycle marks the onset of puberty (at the age of 12
to 13 years in females and it lasts upto 40-50 years. It is series of events through
hormones, which takes place under the uterine walls and ovaries, is said to be
menstrual cycle. It begins from first day of menstrual until the first day of next menstrual.
The cycle has 28 days .
B Briefly explain phases of menstrual or endometrial cycle?
The phases of menstrual cycle that denote changes in the uterine wall are
• Proliferative phase
• Secretary phase
• Menstrual phase
Proliferative phase:
At this stage an ovarian follicle, stimulates by FSH, is growing towards maturity and is
producing Estrogen. Estrogen stimulates endometrium . which becomes thicker by rapid
cell multiplication. Accompanied by an increase in mucus secreting glands and blood
capillaries. This phase ends when Ovulation occurs and Estrogen production stops.
Secretary phase:
Immediately after ovulation, the lining cells of ovarian follicle are stimulated by L.H to
develop corpus luteum, which produces progesterone. Under the influence of
progesterone the endometrium becomes oedematous and the secretary glands produce
increased amount of watery mucus. There is similar increase in the secretions of watery
mucus by the gland of the uterine tubes, vagina and cervix.
Menstrual phase :
If the ovum is not fertilized, the high level of progesterone in the blood inhibits the
activity of the pituitary gland and the production of luteinizing hormone is considerably
reduced. The withdrawal of this hormone causes degeneration of the corpus luteum and
this progesterone production is decreased. About 14 days , after ovulation the lining of
the uterus degenerate and breakdown and menstruation begins. The menstrual flow
consist of the extra secretions. Endometrial cell and blood from the broken down
capillaries and the unfertilized ovum.
If the ovum is fertilized there isn’t any breakdown of endometrium and thus no
menstrual flow. The fertilized ovum (zygote) travel through the uterine tube to the uterus
where it becomes embedded in the wall and produces the hormone chorion
gonadotropin . Which is similar to anterior pituitary luteinizing hormone. This hormone
keeps the corpus luteum intact continue to secret progesterone for the first 3 to 4
months of the pregnancy. Inhabiting maturation of ovarian follicles. During this period
placenta develops and produces , Oestrogen, progesterone and gonadotropin.

PAPER: OBSTETRICS SESSION: sept/Oct 2017
SUBJECTIVE PART
Marks)
Q#01 :Define ectopic pregnancy and write down clinical features of ectopic
pregnancy.
Ans. Ectopic pregnancy:
“An ectopic pregnancy is one in which the fertilized ovum is implanted and develops
outside the normal uterine cavity.”
Clinical features:
The clinical features are divided according to the following types:
1. Acute type
2. Chronic type
Clinical features of acute type
Mainly in acute type of ectopic pregnancy, there is a triad of symptoms.
1. Amenorrhea: A short period of amenorrhea of 6-8 weeks or a delayed period or slight
spotting on the expected date of periods is usually present.
2. Colicky abdominal pain: The pain is acute, agonizing or colicky in nature.
3. Vaginal bleeding: The bleeding is slight ,bloody or dark coloured and usually
continuous.
4. There is nausea and vomiting.
5. There are fainting attacks.
6. On examination, the patient’s general look itself is diagnostic of acute ectopic.
7. The patient lies quiet and conscious, perspires and looks pale.
8. Pallor is usually severe and depends on the amount of haemorrhage.
9. On abdominal examination, the abdomen is tense, timid and tender.
10. There is diffuse tenderness and muscle guard on lower abdomen.
11. Bowel is distended with positive shifting dullness.
12. Cullen’s sign is positive.
13. Vagina looks pale on pelvic examination.
14. Pain is felt on moving the cervix.
15. The uterus floats as if in water.
Chronic type of old ectopic:
1. It is commonest clinical type met and associated with pelvic effusion of blood in
pouch of Douglas.
2. The symptoms are amenorrhea of short period of 6-8 weeks.
3. Abdominal pain is present.
4. Vaginal bleeding appears sooner or later following the pain. It is dark coloured.
5. There is bladder irritation.
6. If the haematocele gets infected then rectal tenesmus may appear.
7. There may be rise of temperature due to infection.
8. On examination the patient looks ill.
9. There is varying degree of pallor.
10. There is persistent high pulse rate even during rest.
11. Temperature is slightly elevated to 38°C.
12. Bimanual examination is painful.
13. There is extreme tenderness on movement of cervix.
14. An ill defined, boggy and extremely tender mass is felt through the posterior-lateral
fornix extending to the pouch of Douglas.
Q#02:Define 3rd stage of labour. Write down the specific care of fourth stage of
labour.
Ans. Third stage of labour:
It begins after expulsion of fetus and ends with expulsion of placenta and membranes.
Duration in primigravida and multi para is 15 minutes.
Fourth stage of labour:
It is the stage of observation for at least one hour after expulsion of the “after births”.
During this period the general condition of the patient and behaviour of the uterus are to
be carefully watched.
Care during fourth stage:
1. Mother should be monitor closely for first six weeks.
2. Check vital signs and firmness of cervix.
3. Frequency every 15 minutes (first 2 hours) every 30 minutes (for one hour) and every
hour ( for 3 hours).
4. If episiotomy is done repair it and check it for any hematoma, bleeding or pain.
5. Clean perineal area and apply sanitary pad.
6. Make mother comfortable.
7. Clean her properly and send her bathroom to have warm shower that will relax her.
8. Offer her hot tea to drink.
9. Initiate Brest feeding as early as possible.
Q#03:Define the following
1. Lochia serosa
2. Low birth weight baby
3. False labour pain
4. HELLP syndrome
5. Oxytocin
Ans.
Lochia serosa:
pinkish brown colour, days 4-10 Mostly serum, some blood and tissue debris.
Low birth weight baby:
According to W.H.O. “low birth weight is less than 2500g irrespective of the gestational
age.”
False labour pain:
false pains are found more in primigravida than In parous women. It usually appears
prior to onset of true labour pain by one or two weeks in primigravida and by a few days
in multipara.
The main cause of such pains is stretching of the cervix and lower uterine segment with
consequent irritation of the neighboring ganglia.
Oxytocin:
Oxytocin is a potent stimulant of uterine contractions. There is a progressive increase in
the number of oxytocin receptors in the myometrium near term. Oxytocin acts on the
decidua to promote the release of prostaglandin.
Q#04 A:What is jaundice and write its types?
Ans. Jaundice in neonate:
Jaundice is the yellow discoloration of the skin and mucosa caused by accumulation of
excess of bilirubin in the tissue and plasma conjugated (140-170 m mol /liter for infants
weighing 2000-2500g)
Types:
• Physiological jaundice
• Pathological jaundice
Physiological jaundice:
1-This is the common from of unconjugated non hemolytic jaundice in the newborn,
found more in premature.
1- The jaundice usually appears on 2nd or 3rd day and disappears by the 7th to 10th
days ,a little later in premature neonates.
3- It is usually mild and never lasts beyond the 11th week
*Bilirubin level*:
the bilirubin level may be arise to 10mg% in mature and even more in premature
babies (normal level is under 34 micromole/L or 2mg%)
Causes:
1- Increase red fells destruction due to shorter life spam (1/8 th per day instead of
1/20th in adults) of excess RBC.
2- Immature liver functions .
3- Inadequate production of enzymes from liver which normally converts unconjugated
bilirubin to soluble conjugated bilirubin.
*Pathological jaundice:*
Definition: It appears within 24 hours of birth and persist for more then 1 week and 2
weeks in premature neonates.
*Bilirubin level*
1- there is increase in bilirubin level at the rate of 5mg/100 ml per 24 hours.
3- Absolute bilirubin more than 15 mg/100 ml.
Cause of pathological jaundice:
• 1-Excessive red cell hemolysis.
• Defective conjugation of bilirubin.
• Failure to excrete the conjugated bilirubin.
• Iatrogenic
• Miscellaneous
Q#04 (B)Write down the midwifery management of hyperemesis gravidaum.
Ans. Management of hyper emesis gravidaum:
o Reassurance and explanation.
o Diet control in early cases should be tried first.
o Small carbohydrates meals should be taken at short intervals.
o Constipation should be treated.
o Fatty food is avoided.
o For morning sickness something in the form of toast or biscuits should be
taken while getting up from the bed.
SUBJECTIVE PART
Q1. Define the following terms:
a. Hegar Sign
Hegar’s sign is demonstrated between 6-10 weeks. It is based on the fact that:
a. Upper part of the body of uterus is enlarged by the growing fetus.
b. Lower part is empty and extremely soft.
c. Cervix is comparatively firm.
b. Fontanelles
“A wide gap in the suture line is called Fontanelle”
Fontanelle is a “non-ossified, membranous space of the skull formed from the union of
two or more sutures”
Types of many fontanelles (six in number), only two are of obstetric significance. These
are:
1 Anterior fontanelle (Bregma)
2 Posterior fontanelle (Lambda)
c. Funis
It is also called as umbilical cord. It forms the connecting link between the fetus and
placenta through
Which the fetal blood flows to and from the placenta. It extends from fetal umbilicus to
fetal surface Of placenta.
d. Restitution
It is the visible passive movement of the head due to untwisting of the neck sustained
during internal rotation. It occurs with the rotation of the head through 1/8 of a circle in
the direction opposite to that of internal rotation.
e. Oestrogen
Estrogen ( also called oestrogen) is secreted by the ovary at the beginning of
pregnancy and later on by the placental cells. It acts singly or in combination with
other hormones and brings about normal changes in the pregnant women.
Q2. A) Define syphilis, its clinical features and write down its management.
SYPHILIS
Syphilis is caused by spirochete Treponema pallidum. Syphilitic lesion of the genital
tract is acquired by direct contact with another person who has open primary or
secondary syphilitic lesion. Transmission occur through the abraded skin or mucosal
surface.
Incubation Period
9-90 days
Clinical Features
1. Primary lesion (chancre):

a. Small papule and lesions.
b. Painless ulcers without any surrounding inflammatory reaction.
c. Inguinal glands are enlarged, discrete and painless.
2 Secondary syphilis: Within 6 weeks-6 months from the onset of primary chancre.
The secondary syphilis may be evidenced in the vulva.
a. Coarse, flat topped, moist and necrotic lesions.
b. Patient may present with systemic. Symptoms like fever, headache and sore
throat.
c. Maculopapular skin rashes on palms and sores.
d. Lymphadenopathy, alopecia and mucosal ulcers.
3 Latent syphilis: It is the quiescence phase after the secondary syphilis.
4 Tertiary syphilis: After late latent stage, tertiary syphilis is evidenced. Painless
lesions with a leather base.
Treatment of syphilitic lesion divided into three phases:
1. Early syphilis: (Primary, secondary and early latent syphilis)
a. Benzathine penicillin G 2.4 mega units I/M single dose half to each buttock.
b. Procaine penicillin 600, 000 units I/M daily for 10-14 days.
c. In penicillin hypersensitive cases, tetracycline or erythromycin 500 mg 4 times a day
orally for 14 days.
2 Late syphilis: Benzathine penicillin G 2.4 mega units is given I/M weekly for 3 weeks.
3 Follow up:
Test is to be performed 1,3,6 and 12 months after treatment of early syphilis.
In late symptomatic cases, surveillance is for life, the serological test is to be done
annually.
B) Define amniotic fluid, what are the functions of amniotic fluid?
It is a faint, alkaline, watery content of the amniotic sac in which embryo-fetus grows. It
is primarily of fetal origin
Function:
During Pregnancy
1. Its main function is to provide protection to the fetus.
2. In pregnancy, it acts as a shock absorber, protecting the fetus from possible
extraneous injury.
3. In pregnancy, it maintains an even temperature.
4. In pregnancy, the fluid distends the amniotic sac and thereby allows for growth
and free movement of the fetus and prevents adhesion between the fetal parts
and amniotic sac.
5. It keeps fetus well by supplying mainly drinking water and helps in its growth.
6. Serves as an immunologic, (antibacterial) bio-chemical and hormonal functions.
7. Prevents adhesions of the sticky skin and umbilical cord compression.
During Labor
1. Helps in dilatation of soft tissue of birth passage by fluid wedge of bag of
membranes
2. Protects fetus and placenta from pressure by contracting uterus.
3. Washes the vagina before birth of baby, thus preventing infection to baby and
uterine cavity.
Q3. A) What do you mean by family planning?
• Family planning is the first line of defense against unwanted pregnancy and
illegal abortion .
• It will prevent pregnancies that are too early, too closely spaced to many or too
late.
• The intervals of pregnancies should be at least two years
B) Write down the merits and demerits of oral contraceptive pills
Merits
• Very effective
• Regulates menstrual cycle
• Reduces menstrual flow
• Reduces cramping
• Reduces acne & hirsutism
• Decreases risk of ovarian &
endometrial cancer
• Reduces risk of PID
• Completely reversible
• No interruption of sex
Demerits
• No protection against STIs
• Possible side effects (nausea,
• Bloating, breast tenderness,
• Headaches, break-through
• Bleeding)
• Need a prescription
• Must remember to take pills
• Around the same time every day
• Increases risk of blood clots
• Cannot use if over age 35 and a
• Smoker
Q4. A) What are the specific features of true labour pains?
The feature of true labour pains are
1. Painful uterine contraction( labor pain)
2. Show
3. Progressive effacement and dilation of cervix
4. Formation of bag of water
B Write down the difference between of Cephalohematomas and Caput
Succedaneum
Caput Succedaneum
• It is the formation of swelling due to stagnation of fluid in the layers of the scalp
beneath the girdle of contact.
• Girdle of contact is either bony or the dilating cervix or vulval ring’”.
Cephalohematoma
• Collection of blood beneath the scalp. These (caput succedaneum and
cephalohematoma) may further
• Distort the shape and appearance of the baby’s head. Fluid and blood collection
in and around the scalp is Common during delivery. It usually disappears after a
few days.
PAPER: OBSTETRICS SESSION: March/April 2018
SUBJECTIVE PART
Marks)
Q1.A.Define menstrual cycle?
Ans. MENSTRUAL CYCLE
The beginning of the menstrual cycle marks the onset of puberty (at the age of 12-13
Years in human females and it lasts up to 40-50 years). Menopause is the phase when
the Reproductive capacity of the female is arrested. The menstrual cycle begins with the
casting. Of endometrial lining of the uterus and bleeding. Changes take place in ovaries
and uterine wall, due to change in concentration of hormones in blood.
Definition:
The series of changes which take place regularly in females. It takes place in even 26-
30 days throughout the child bearing period of about 36 years.
Q1. B. What are the phases of menstrual cycle?
Ans. MENSTRUAL PHASES
1. Menstrual Phase:
• (bleeding phase): This phase is also called the stage Of Menstrual flow
and lasts about 4 days. During this phase, uterus endometrial lining is
sloughed off and bleeding also takes place due to rupture of blood
vessels. This happens only when fertilization is not accompanied. When
pregnancy does not retain, the Corpus luteum is replaced by scar tissue,
Corpus Albicans.
2. Proliferative Phase:
• This phase is also called follicular phase or stage of repair And

proliferation. During this phase, repairing of endometrial lining of the
uterus (which was sloughed off during menstruation takes place and a
functional lining is repaired in the uterus to receive the fertilized ovum.
This phase ends when ovulation starts and oestrogen production stops.
This phase generally involves 10 days.
Ovulatory Phase:
• During this phase, no conspicuous changes occur in the uterus
• Endometrium. During this period, ovulation takes place and body temperature
rises which remains high until the onset of next menstrual period.
Secretory phase:
• This phase is under the control of progesterone and oestrogen.
• Secreted by the corpus luteum. Therefore, it is known as presentational or luteal
phase. It is also known as Pregravid phase as this phase prepares the
endometrium for pregnancy and implantation. If pregnancy does not retain, it is
followed by menstruation so, it is called premenstrual period. This phase lasts
Tor about 13-14 days and is accompanied by marked hypertrophy of uterine
endometrium. Progesterone helps the endometrium to become oedematous and
secretory gland produces increased amount of mucus. This helps the sperm to
move through the uterus to uterine tubes where ovum usually fertilizes. Similarly,
there is increased secretion of mucus in uterine tubes and by cervical gland, this
lubricates the vagina.
Q2.A.What do you mean by normal Puerperium?
Ans. PUERPERIUM
Definition: Puerperium is the period following childbirth during which the body tissues
Specially the pelvic organs revert back approximately. To the pre-pregnant state both
Anatomically and physiologically and in the same way. Involution is the process
whereby. The genital organs revert back approximately to the state as they were before
pregnancy The woman in Puerperium is termed as puerpera.
Duration of Puerperium
Puerperium begins as soon as the placenta is expelled and lasts for approximately 6
Weeks when uterus -becomes regressed almost to the non-pregnant size. The period is
Divided into:
• Immediate Within 24 hours
• Early Upto 7 days
• Remote Up to 6 weeks
INVOLUTTON OF THE UTERUS
The involution of uterus is explained as follows.
Physiological Changes:
Involution of Uterus
Involution is a process in which bulky uterus following delivery progressively returns to
normal pregravid state. Its size comes to 20 weeks pregnancy after child birth at term.
Anatomical Consideration
Immediately following delivery, the uterus becomes firm and retracted with alternate
Hardening and softening.
1 Measurements: The uterus measures about 20 x 12x7.5cm (i.e. Length, Breadth And
Thickness).
3. Weight: Weight of uterus after delivery is reduced from 1000-900 g to 60 g at the
end of 6 weeks.
3 Rate of Involution:
• Fundus lies 5” (12.5 cm) above symphysis pubis. Total length 8’ (20 cm).
• First 24 hrs.-There is no change.
• From 2nd to 11th day – Fundus descends at the rate of (1.25 cm) per 24
hrs.
• By 11th day, uterus skins behind symphysis pubis and becomes pelvic
organ returns to normal Pregravid size by 6n week.
Involution of lower uterine segment
• Immediately following delivery, the lower uterine segment becomes a thin, flabby,
• Collapsed structure. Lower uterine segment involutes faster, not recognized by
30 day
Involution of Cervix
The cervix contracts slowly. The external orifice admits 2 fingers for a few days but by
The end of first week, narrows down to admit the tip of a finger only (by the end of first
Week). T he contour of cervix takes longer time to regain (six weeks) but external os
never Reverts to nulliparous state.
Involution of other pelvic structures
The other pelvic structures that involute are:
• 1.Vagina
• 2.Broad ligaments and round ligaments
• 3.Pelvic floor and pelvic fascia.
Vagina
1.The distensible vagina takes about 4-8 weeks to involute.
2. It regains its tone but never to the virginal state.
Q2. B. Write down the steps of immediate care of new-born?
Ans. IMMEDIATE CARE OR NEWBORN:
New-born Infant:
A new-born infant is a healthy infant born at between 38-42 weeks, should have an
Average birth weight (usually exceeding 2500 g), cries immediately following birth
Establishes independent rhythmic respiration and quickly adapts to the changed
environment.
Immediate Care of the Newborn:
Goals:
The goals for immediate care of new-born are as follows:
1. To establish, maintain and support respiration.
2. To provide warmth and prevent hypothermia.
3 To prevent infection.
4 To provide safety and prevent injury.
To identify actual or potential problems that may require immediate attention
Management
1. Establishment of Respiration:
o The nurse receiving the newborn should clear the newborns airw
• Immediately after birth to help the newborn breath effectively.
o Newborns are obligatory nose breathers. The reflex response to nasal
obstacle
• Opening the mouth to maintain airway is not present in most newborns upto 3
Weeks after the birth of the baby. Hence, nares of newborn should be checked
Frequently and always kept patent. Remove mucus and other particles that may
cause obstacle of the nose.
• c) After the head of the newborn is delivered, immediately wipe the mouth and
nose.
• d) Suction secretion from mouth and nose. The mouth of the newborn is to be
• suctioned just followed by nose.
2. Initiation of Cry:
(a) Normally 99% of the newborn cry immediately after the delivery. This is
considered a
Good sign as a crying infant is a breathing infant. In case the baby does not cry follow
The below steps.
If the baby does not cry spontaneously or if the cry is weak then slightly stimulate
The baby to cry
Never slap the buttocks instead rub the soles of the feet to stimulate cry. Always
Stimulate the new-born to cry after the secretion are removed.
The infant cry is loud and husky. Observe the new-born for the following abnormal Cry
High Pitched cry can be due to hypoglycemia or increased intracranial Pressure
Week cry-prematurity
Hoarse cry-laryngeal stridor
b. maintain P0sition of the New-born:
• 1.The new-born is likely to choke, cough or gag during the first 12-18 hrs. Of life
because Of oral mucus so care should be taken and the new-born infant should
be placed in a Position that would promote drainage of secretions.
• Trendelenburg position head lower than the body.
• 3.Side lying position should be given. If Trendelenburg position is contraindicated
place The infant in side lying position to allow drainage of mucus from the mouth
support the New-born with a small pillow or rolled towel at the back.
4. APGAR Score: This is the most important part of immediate care of new-born.
APGAR
Scoring is done immediate after birth at 1 min. And 5 minutes. APGAR Scoring rate
Includes heart rate, respiration, reflexes, skin colour and muscle tone.
• The one minute score indicates the necessity for resuscitation deficit.
• b) The five main score helps to note the mortality and neurologic.
• c). The normal APGAR Score is between 7 10 which signifies good adjustment of
the infant to the extra uterine environment.
5.Care of Cord:
This is another important part in the immediate care of the new-born The cord of the
new-born is clamped and cut within 30 second after the birth. The below Written point
are followed in care of cord.
• The cord is clamped at different two points in the delivery room once the infant Is
delivered and put on the abdomen of the mother.
• The first clamp from the abdomen and cut in between after clamping it from the
Opposite side near to the placenta.
• The nose and mouth is wiped and the infant is immediately brought to nursery (in
the labour room) and another clamp is applied half to 1 inch from the Abdomen
and the cord is cut at second time.
• Nothing should be applied on the cord. It should left to dry and fall naturally.
• The cord stump usually dries and fall off within 7- 10 days. Leaving a granulating
area that heals in another 7- 10 days.
• Make sure that the cord does not get wet by water or urine. Advice the mother to
fold the diaper below to prevent it from getting wet.
• Note daily for any kind of discharge, bleeding, if bleeding is seen immediate
check the cord clamp for being loose, if the clamp is found to be loose fasten it.
h) Report immediately if the below mentioned sign and symptoms occur due to an
infection:
• Foul odor in cord
• Any discharge
• Redness around the cord
• Wet cord
• Cord not falling off within
• 7-10 days
• Inflammation
• Fever
Q3. Define abortion. Write down the causes. Clinical features and management of
septic abortion in detail?
Ans. SEPTIC ABORTION

Definition
Any abortion associated with clinical evidence of infection of the uterus and its Contents
is called septic abortion.
Incidence:
It is 10% of all abortions
Causes
• 1 It is caused by micro-organisms involved in the sepsis that are usually present
• In the vagina (Endogenous)
• 2 The micro-organisms are
a)Anaerobic:
Bactericides group (fragilis)
Anaerobic streptococci
Clostridium welchi
Tetanus bacilli
b)Aerobic:
E.coli
Klebsiela
Staphylococcus
Pseudomonas
Hemolytic Streptococcus
The increased association of sepsis in illegal induced abortion is due to the fact That:
• Proper antiseptic and asepsis are not taken.
• Incomplete evacuation.
• Inadvertent injury to the genital organs and adjacent structures, particularly the
Gut.
Clinical Features:
The clinical features of septic abortion are as follows
• Pyrexia associated with chills and rigors suggestive of blood stream spread of
Infection.
• 2 The patient has pain in abdomen of varying degree.
• 3 There is rise or increase in pulse rate 100-120/min. Or more. It indicates
Spread of infection beyond the uterus.
• 4 There is vaginal bleeding followed by foul vaginal discharge.
• 5 Products of conception may or may not be expelled.
• 6 There may be septic shock.
• There may be jaundice, oliguria, anuria.
• On pelvic examination, the gravid uterus is felt same or small sized, firm, tender
On movement.
• 9 There is foul purulent discharge from the uterus.
Investigations:
The investigations for septic abortion are of two types
1 Routine investigations
2 special investigation
• Routine Investigations: These include:
• Cervical or high vaginal swabs taken prior to internal examination (to find.
Dominant microorganisms).
• Blood for Hb estimation is taken.
• WBC – total and differential count.
• Urinalysis including culture.
• ABO and Rh grouping.
2. Special Investigations: These include
a) Ultrasonography pelvis and abdomen: To detect pyometra, foreign body
intrauterine products of conception, in peritoneal cavity or in pouch of Douglas
b)X-ray abdomen and pelvis.
c)Blood study: Culture, serum electrolytes and coagulation profile
Nursing Management of Septic Abortion:
• The management of patient with septic abortion depends upon the severity of
Infection or sepsis.
• Even a mild case of septic abortion is to be hospitalized.
• Get the mother high vaginal or cervical swab culture, drug sensitivity test and
Gram Stains.
• Perform vaginal examination to note the state of abortion. If the products are
found Loosely Iying in the cervix, they should be removed by sponge holding
forceps
• Do overall assessment of the case and grading is done for further treatment.
• Get all the investigations done.
• Formulate the line of treatment to control sepsis, remove source of infection.
• Give the mother supportive therapy to bring back the normal homeostatic and
Cellular metabolism.
• . In Grade I or mild septic abortion the drug of choice or antibiotic used are
capsule.
a) Ampicillin / Amoxicillin (Mox, Coymox)
b) 500 mg TDS x 7 days.
c) Cap. Cephadroxil (Cephodar) 500 mg BDx7 days.
d) Cap. Chloromycetin 500 mg 6 hrly. X 7 days.
• While giving Cap. Chloromycetin blood tests are done for Hb, TLC, DLC and
platelets
• In Grade I prophylactically anti-gas gangrene serum of 8000 units and 3000 units
Of antitetanus serum are given I/M.
• Analgesics and sedatives are given as per the prescription of the doctor.
• To minimize oliguria, anemia or shock, blood transfusions are done.
In Grade I abortion, an incomplete evacuation should be done within 24 hrs
Following antibiotic therapy.
• While doing curettage, practice gentleness to avoid and minimize injury if any
and Spread of infection in deeper tissues.
• In Grade Il the drugs given are according to the type of organisms, 1.e., Gram
Positive and Gram negative.
Q4.A.Causes of anemia during pregnancy?

Ans. Anemia
Definition
“Anemia is a reduction in red blood cells (erythrocytes) which in turn decrease the
Oxygen carrying capacity of the blood. It reflects an abnormality red blood cell number
Structure or function.”
Causes of Anemia During Pregnancy
• Inadequate iron reserve: If the mother does not take a balanced diet and
who Has got an insufficient iron reserve is likely to develop anemia.
• Increased demands of iron: During pregnancy, the demand of iron is
increased. This amount cannot or can be hardly fulfilled by a normal
balanced diet. It is fulfilled By supplementary therapy
• Disturbed metabolism: It depresses the erythropoietic function of the
bone Marrow.
• 4 Pre-pregnant health status: Majority of women in tropics actually start
their Pregnancy in a pre-existing anemic state or at. Least with inadequate
or with a nil Iron reserve.
• Conditions requiring excess demand: These include.
a) Multiple pregnancy: It increases the iron demand by two fold.
b) Women with rapidly recovering pregnancy within 2 years following the last
Delivery, need more iron to replenish deficient iron reserve
• Faulty dietetic habit: A diet rich in carbohydrate reduces the absorption of
iron Even if there is no deficiency of iron.
• Iron loss: Iron loss too contributes in causing anemia like:
a) Loss of iron through sweat, i.e., 15 mg per month.
b) Repeated pregnancies at short intervals puts a serious strain on the
iron
reserve.
c) Excessive loss of blood during menstruation.
d) Hook worm infestation causes loss of blood to an extent of 0. 5 to 2 mg
of iron
daily.
e)Chronic blood loss caused by dysentery, bleeding piles cause iron
deficiency Anemia.
Q4. B.Write down the specific midwifery management of Hyperemesis
Gravidarum?
Ans. Hyperemesis Gravidarum
• Nausea and vomiting in pregnancy are extremely common.
• 70-80% of women Experience these symptoms early in their pregnancy and
approximately 35% of all Pregnant patients are absent from work on at least one
occasion through nausea and Vomiting .
• Although the symptoms are often most pronounced in the first trimester, they Dre
by no means confined to it.
• Similarly, despite common usage of the term morning Sickness, in only a minority
of cases are the symptoms solely confined to the morning Nausea and vomiting
in pregnancy tends to be mild and self-limited and is not associated With adverse
pregnancy outcome.
• Hyperemesis gravidaum, however, is a severe, intractable form of nausea and
Vomiting that affects 0.3- 2.0% of pregnancies.
• It causes imbalances of fluid and Electrolytes, disturbs nutritional intake and
metabolism, causes physical and psychological Debilitation and is associated
with adverse pregnancy outcome, including an increased Risk of preterm birth
and low birth weight babies.
• The etiology is unknown and various Putative mechanisms have been proposed
including an association with high levels of Serum human chorionic gonadotropin
(HCG), estrogen and thyroxine.
• The likely cause Is multifactorial Severe cases of hyperemesis gravidarum cause
malnutrition and vitamin Deficiencies including Wernicke’s encephalopathy and
intractable retching predisposes of Esophageal trauma and Mallory-Weiss tears.
• Treatment includes fluid replacement and Thiamine supplementation.
• Antiemetic such as phenothiazine are safe and are Commonly prescribed Other
proposed treatments including the administration of Corticosteroids have not yet
been adequately proven and remain empirical.

SUBJECTIVE PART
Marks)
Q1: (a) Define Post partum hemorrhage and write down predisposing causes of
post partum hemorrhage?
Definition:
Loss of blood more than 500ml at the time of delivery.
OR
It is define as excessive bleeding from genital tract at any time following baby’s birth up
to 6 weeks after delivery. It is the major cause of maternal mortality.
Type of post partum hemorrhage:
• Primary: If it occur within first 24 hours of delivery.
• Secondary: If it occur 24 hours of birth up till 6 weeks postpartum.
Causes:
Major causes includes: 4TS
• T1=TONE
• T2=TEAR
• T3=TISSUE
• T4=THROMBIN
(a)T1= Uterine atony:
• Lose of muscle tone in uterus may be the result of over distention.
• Polyhydramnios, large baby, Multiple pregnancies
• Mismanagement of 3rd stage of labor over massage
• Maternal exhaustion inhalation anesthesia
(b)T2= Laceration of the birth canal (tears or laceration of cervix,vagina,labia,
perineum)
(c)T3= Retained placental fragments:
OR incomplete expulsion of placenta(usually the cause of late PPH) may be due to:
• Placenta Accereta:
Occurs when the placenta attaches too deep in the uterine wall but it does not penetrate
the uterine muscle. This is the most common accounting for approximately 75% of all
cases.
• Placenta Increta:
Occurs when the placenta attaches even deeper into the uterine wall and does
penetrate into the uterine wall. This accounts for approximately 15% of all cases.
• Placenta percreta:
Occurs when the placenta penetrate through the entire uterine wall and attaches to
another organ such as blaader.This is the least common of the three conditions
accounting for approximately 5% of all cases.
Placenta Accretes:
• Requires manual removal of the placenta.
(d)T4= THROMBIN = DIC Coagulation failure:
• Intrauterine death with retained fetus
• severe pre-eclampsia
• premature separation of the placenta
• Retained placenta
• Amniotic fluid embolism (usually not able to be determined until autopsy)
• Hemorrhagic shock
• Transfusion reaction
• Following sever Antepartum hemorrhage
Q1: (B) Differentiate between Caput succedaneum and cephalohematoma?
Caput Succedaneum Cephalohematoma
Caput is a severe swelling of the soft tissues Cephalohematoma is an area of bleeding

of the baby’s scalp that develops as the underneath one of the cranial bones. It often
baby travels through the birth canal. Some appears several hours after birth as a raised
babies have some bruising of the area. The Lump on the baby’s head. The body
swelling usually disappear in a few days reabsorbs the blood . Depending on the
without problems. Babies delivered by size, most cephalohematomas take two
vacuum extraction are more likely to have weeks to three months to disappear
this condition. completely. If the area of bleeding is large,
some babies may develop jaundice as the
red blood cells break down.
Q2: Define the Following terms: (Each carry 2 marks)

1. HELLP Syndrome:
• HELLP syndrome is ab acronym of hemolysis, elevation of liver enzymes
and low platelets.
• Women with HELLP syndrome typically present with epigastric pain ,
nausea and vomiting.
• Hypertension may be mild or even absent
• HELLP syndrome is associated with a range of serious complications
including actual renal failure, placental abruption and stillbirth.
• The management of HELLP Syndrome involves stabilizing the mother,
correcting any coagulation defects and assessing the fetus for delivery.
2. Restitution:
It is the visible passive movement of the head due to untwisting of the
neck sustained during internal rotation. Movement of restitution occur
rotating the head through 1/8th o a circle In a direction opposite to that of
internal rotation.
3. Retraction:
Retraction is the phenomenon of uterus in labor in which the muscles
fibers are permanently shortened. Retraction also effects the reduction of
the surface area of the uterus which keep pace with gradual descent of
the presenting part. thus, retraction is specially a property of upper uterine
segment.
4. Forewater:
The amniotic fluid that escapes from the uterus through the vagina when
that part of the amnion lying in front of the presenting part of the fetus
ruptures, either spontaneously or by amniotomy. Spontaneous rupture is
usual in labour but rupture may occur before labour starts (premature
rupture of membranes).
5. Lochia Serosa:
Lochia Serosa is pinkish brown color, days 4-10, mostly serum , some
blood and tissue debris.
Q3: (a) What is birth asphyxia and how you will differentiate the mild and severe
birth asphyxia?
BIRTH ASPHYXIA
“commonly asphyxia neonatrum Means non- establishment Of Satisfactory pulmonary
Respiration at birth.”
It’s literal meaning is absence of pulse. it is defined as Failure to initiate and maintain
spontaneous respiration within one minute of birth.
ETIOLOGY:
The Etiology of asphyxia can be classified broadly into the following groups:
continuation of intrauterine hypoxia:
The causes may be:
1-functional failure of placenta as A respiratory organ due to anatomical changes In the
placenta or due to inadequacy of utero placental circulation.
2-premature placental separation.
3-Extensive infants with/without postdatism.
4-retro placental hemorrhage.
5-thin small placenta.
6-circumvallate placenta.
7-hypertensive disorder.
8-supine hypotensive syndrome.
9-cord compression.
10-true knot in cord.
11-vascular anomalies in cord.
Q3: (b) Write down the modes of heat loss in neonate?
The four mechanisms of heat loss which place newborns at risk
include: conduction, evaporation, radiation and convection.
Convection. This is the loss of heat from the newborn's skin to the surrounding air.
Newborns lose a lot of heat by convection when exposed to cold air or draughts.
Conduction. This is the loss of heat when the newborn lies on a cold surface.
Newborns lose heat by conduction when placed naked on a cold table, weighing scale
or are wrapped in a cold blanket or towel.
Evaporation. This is the loss of heat from a newborn's wet skin to the surrounding air.
Newborns lose heat by evaporation after delivery or after a bath. Even a newborn in a
wet nappy can lose heat by evaporation.
Radiation. This is the loss of heat from a newborn's skin to distant cold objects, such as
a cold window or wall etc.
Q4: (a) Define Obstructed labour? Discuss the causes of obstructed labor?
Definition:
Obstructed labor is one in where inspite of good uterine Contraction the progressive
descent of the presenting part is arrested due to mechanical obstruction.
causes:
The causes are:
• Fault in passage.
• Fault in passenger
Fault in the passage: It is of two type
1. Bony
• Contracted pelvis
• Cephalo pelvic disproportion
2. soft tissues obstruction: This include
• Cervical Dystocia due to prolapse or previous operative scarring.
• Cervical or broad ligament fibroid.
• Impacted ovarian tumor.
• A non gravida horn of a bicornuate uterus below the presenting part.
Fault in passenger: it includes
• Transverse lie
• Brow presentation
• Congenital malformation of the fetus.
• Big baby specially in high parity associated with deflexed head and occipito
posterior position.
• Impacted mentor posterior on abdomen.
• Big breech with pendulous abdomen.
• Compound presentation.
• Locked twins.
Q4: (b) Explain the concept of conception or fertilized ovum?
Introduction:
Fertilization is the result of the fusion of the male reproductive cell, the spermatozoon,
with the ovum or eggs cell which normally take place in the uterine tube following sexual
intercourse. a number of Spermatozoa are deposited in the vagina. they passed through
the cervix to uterus and found their way to uterine tubes.
Definition of fertilization:
Fertilization is the process of of fusion of the spermatozoon With the mature ovum.
Most common site fertilization is ampulla of uterine tube.
Explanation:
The union of sperm and egg produces Fertilization. This take about a week. As it
progresses, it is sub-divided by cell cleavage into a number of small cell 2,4,8,16 and so
on until cluster of cell occur called Morula at the most inner layer of uterus endometrium
and implantation is said to be occur.
PAPER: OBSTETRICS SESSION: March /April 2019
SUBJECTIVE PART
Marks)
1) Define the following.
a. Lochia alba
b. Extension
c. Birth canal
d. Meconium
e. Name the method of separation of placenta.
Ans:
a.Lochia alba:
Yellowish white in color, days 11_21 ; mostly leucocytes with decidua, epithelial
cells, and mucus.
b. Extension:
Movement that increase angle b/w two body parts is called extension.
c. Birth canal:
During child birth vagina ovary as birth canal extend from uterus to outside of
body.
d. Meconium:
The greenish black material present in fetal large intestine that is passed per
rectum during first three days of life.
E. Method of separation of placenta:
1. Shultze method
Start from Centre of placenta
2. Mathenis method
Start from edge of placenta
Q1 b. Define placenta, attachment of placenta and write down it’s development.
Ans: Definition:
Placenta is an organ which is the characteristics of true mammals during pregnancy
joining mother and off spring providing endocrine secretion and selective exchange of
soluble blood born substances through opposition of uterine and trophoblastic
vascularized part.
Attachment
The placenta is attached to the uterine wall and establishes connection between the
mother and fetus though the umbilical cord. it carries vital fetal functions and maintains
the pregnancy.
Development:
The placenta is developed from two sources.
1) fetal component/ fetal surface/ fetal source: it is the principal components which
develops from chorion frondosum .
2) Maternal component/ maternal surface: it consist of decidua basalis .
• on 11 day when the interstitial implantation is completed.
• The blastocyst is surrounded on all sides by lacunar spaces around the cord of
syncytial cells called trabeculae.
• Initially the ovum appears to be covered with a fine, downy hair, which consist of
the projections from the trophoblastic layer. These proliferate and branch from
about 3 weeks after fertilization, forming the chorionic villi. The villi become most
profuse in the area where the blood supply is richest, that is in the basal decidua.
This part of the torphoblast is known as the chorion frondosum and it will
eventually develop into the placenta.
• From the trabeculae, develops the stem villi on 13 day which connects the
chorionic plate with basal plate .
• Primary, secondary and tertiary villi develop from stem villi .
• Arterio capillary venous system in the mesenchymal core of each villi is
completed on 21 day .
• This makes connection with the intraembryonic vascular system through the
baby stalk.
• on the other hand the lacunar spaces become confluent with one another by 3rd
_4 th weeks.
• This forms a multi ocular receptacle lined syncytium and filled with maternal
blood.
• This space further become the future intervillous space.
Q3)a. What is Hagar’s sign?
Ans: Hagar’s sign
• It is demonstrated between 6_weeks.
• It is based on the fact that
• Upper part of the body of the uterus is enlarged by the growing fetus.
• Lower part is empty and soft
• Cervix is firm.
Q3 b Write down the fetal development from conception to 12 weeks of life.
Ans: from conception to 4th month:
• Fertilization occur zygote implants itself in the lining of the uterus.
• Rapid cell division occurs embryonic stage last from 2 weeks to 8 weeks.
• Cell differentiate into three distinct layers, the ectoderm, the mesoderm and the
endoderm. Nervous system begins to develop.
• Embryo is ½ inch long.
From 5th to 8th weeks:

• Heart and blood vessels form.
• Head area develops rapidly.
• Eyes begin to form detail.
• Internal organs grow especially the digestive system.
• Sex organs develop rapidly and sex is distinguished.
• Arms and legs form and grow.
• Heart begins to beat faintly.
• Embryo is 1 inch long and weight 1/10 ounce.
From 9th to 12th weeks:

• Head growth occurs rapidly.
• Bone formation begins to form rapidly.
• The digestive organs begin to function.
• Arms, legs, and fingers make spontaneous movements.
• Fetus is 3 inches long and weight 1 ounce.
Q4)a. What is the composition of breast milk?
Ans: composition of breast milk:
Composition. Human milk
1. Calories. 67%
2. Water. 87%
3. Carbohydrates. 7.5%
4. Fats. 3.5%
5. Protein. 1.5%
6. Lacalburnin:. 60:40
Casein ration.
7. Minerals
Sodium. 15mg
Phosphate. 15mg
Calcium. 30mg
Iron. 0.5mg
Q4 B. Write down the modes of heat lose in the neonate.

Ans: modes of heat lose:
Newborn loses heat by four ways:
• Evaporation:
Soon after birth by evaporation of amniotic fluid from skin surface.
• Conduction:
By coming in contact with cold objects, cloth, tray, etc.
• Convection:
By air currents in which cold air replaces warm air around baby
open windows, fans.
• Radiation:
To colder solid objects in vacinity _ walls.

PAPER: OBSTETRICS SESSION: September/October 2020
SUBJECTIVE PART
Marks)
Q#01:Define obstructed labour And write down its causes and nursing
management.
Answer. Obstructed labour:
Labour is said to be obstructed when there is no advance of presenting part of good and
strong uterine contractions and there is also failure in cervical dilution, it is most
dangerous condition for both fetus and mother. Obstructed labor should no be allowed
to developed.
Causes:
Maternal causes
1. Contracted pelvis or CPD.
2. Tumor of the pelvis
3. Ovarian or uterine tumor.
4. Stenosis of vagina and cervix.
5. Tumor of rectum and bladder.
6. Formation of contraction ring.
Fetal causes
1. Large or macrocosmic baby.
2. Malposition
3. Mal presentation
4. Congenital abnormalities of fetus i.e. hydrop fetalus-hydrocephelic.
Management:
1. Good antenatal Care
2. Early diagnosis the cause and treat the cause.
3. Careful monitoring of labor
4. Early diagnosis of obstruction
5. Once the obstructed labor is diagnosed no manipulation or version should done as
there is danger of rupture.
6. Start I/V in fusion to correct dehydration.
7. Reassure the patient and her family.
8. Antibiotics to avoid infection.
9. Send blood for cross matching.
10. If fetus is alive he is likely to deliver asphyxiated so neonatologist should be
available.
11. Prepare patient for C- Section.
12. Retain catheter for 72 hours.
13. Care must be taken to correct ketoacidosis as paralytic uterus can cause.
Q#02:Define abortion and discuss the causes and management of habitual
abortion.
Answer. Abortion:
“Abortion is the termination of pregnancy before the period of viability which is
considered to occur at 28th week.”
Or
“Abortion is the process of partial or complete separation of the products of conception
from the uterine wall with or without partial or complete expulsion from the uterine cavity
before the age of viability (28 weeks).”
Habitual abortion:
It is defined as a sequence of three or more consecutive spontaneous abortion. It may
be primary or secondary following birth of viable pregnancy or MTP.
Causes:
The exact cause of habitual abortion is not known but there are certain factors
responsible for it. These are described below:
• Genetic chromosomal errors.
• Anatomical defect;
a. Cervical Incompetency
b. Uterine anomalies
3- uterine Infection
4 Endocrinal disorders
5- Immunological factors
6- Idiopathic
Nursing management of habitual abortion.
The treatment for habitual abortion is as follows:
1. If there are anatomic defects they are then corrected surgically.
2. For syphilis, penicillin therapy is given.
3. Hypothyroid state is treated by Eltroxin.
4. The anxiety of the mother is removed or alleviated.
5. While counselling a couple assure them that after three consecutive miscarriage the
chance of a successful pregnancy is high.
6. If there is uterine pathology then treat it,e.g. Metroplasty for double or bicornuate
uterus.
7. Advise the couples for genetic counselling if there are chromosomal abnormalities.
8. Advise the mother to take proper rest, i.e for a period of at least 2 weeks beyond the
expected time of abortion.
9. Advise the mother to avoid strenuous activities of Intercourse and traveling.
10. Ask the mother not to use these drugs:
a.Inj.profasi-Tab.Gastin- hCG 5000-10000
b. Inj.Prolutun depot-tab.Duvadilan or Yutopar.
11- Patient with cervical incompetence is treated by cervical Suture Operation.
12. The operation is done around 14 weeks to 16 weeks of pregnancy.
13. Advise the mother to avoid sex.
14. Reassure her.
15. Clear all her queries and allay her fear and anxiety.
16. Advise her for regular check-ups and follow up.
Q#03:Describe the complications associated with the multiple pregnancy.
Answer: Multiple pregnancy:
When more than one fetus simultaneously develops in the uterus it is called multiple
pregnancy.
Complications:
The complications are divided into two;
1. Maternal complications
2. Fetal complications
Maternal complications:
These are of three types:
a. Pregnancy
b. Labour
c. Puerperium
Complications during pregnancy:
1. Nausea and vomiting
2. Anemia- more common in twin pregnancy
3. Pre-eclampsia is increased three times over Singleton pregnancy.
4. Hydramnios is more common in uniovular twins and usually involves the second sac.
5. Antepartum haemorrhage
6. Mal presentation. It is more common in the second baby.
7. Preterm labour.
8. Mechanical distress.
During labour:
1. Early rupture of membranes and cord prolapse.
2. Prolonged labour.
3. Increase operative interferences.
4. Bleeding
5. Post partum haemorrhage
During Puerperium:
There is increased incidence of:
1. Sub involution
2. Infection
3. Failing lactation
Fetal complications:
1. Abortion rate is increased
2. Prematurity is seen.
3. Growth problems appear like IUGR.
4. Intra-uterine death of one fetus.
5. Fetal anomalies i.e. anencephaly, hydrocephaly, Down’s syndrome.
6. Asphyxia and stillbirth.
Q#04:Write down the causes of Cesarean section and explain its nursing
management.
Answer. Cesarean section:
“It is an operative procedure whereby the fetus after the end of 28 th week is delivered
through an incision on the abdominal and uterine wall.”
Causes:
1. Cephalopelvic disproportion.
2. Fetal distress
3. Mal presentation
4. Maternal diabetes
5. Breech presentation in primi gravida
6. Placenta Previa/ placenta abruption
7. Prolapsed cord
8. Ineffective uterine contractions
9. Multiple births
10. Previous Caesarean births
11. Other obstetrics emergencies and conditions
Nursing management:
Preoperative preparation:
1. Explain the procedure to the client.
2. Release her fear, feeling of powerlessness and disturbance in self concept
3. Provide emotional support to client and family.
4. Shave her abdomen and pubic area.
5. Insert retention catheter into bladder.
6. Administer preoperative medications as ordered.
7. Complete all preoperative charting responsibilities.
8. NPO (Not per oral)
Post operative preparation:
1. Assess for and maintain patient airway turn her face on side to facilitated secretions.
2. Check for presence or absence of gag reflex maintain artificially Airway in place until
3. Assess colour and temperature of skin, color of nailbeds and lips.
4. Monitor I/V infusions; condition of site type of solution and flow rate.
5. Encourage client to cough and deep breath after airway is removed.
6. If spinal anesthesia is used keep client flat and check for sensation and movement in
lower extremities.
6. Maintain vital signs.
7. Assess level consciousness/ return of sensation.
8. Maintain I/O chart
9. Give post operative medication as ordered.
10. Check fundal firmness and dressing for any bleeding, intactness and drainage.
11. Check I/V line and other drainage tibings and secure them properly.
12. Observe lochia for colour, amount clot.
13. Assess for bowel sound Every 4-hour.
14. Check for abdominal distention.
15. Keep client NPO as per order.
16. Encourage ambulation ASAP.
17. Assist mother with baby Care and handling as needed.

Time:1:30 hr. ROLL No _________
SUBJECTIVE PART
ANSWER THE QUESTION FOLLOWING TO THE STATEMENT. (40 MARKS)
Answer the following questions.
Q no.1. Differentiate between caput succedaneum and cephalohematoma?
Ans.Caput succedaneum:
Caput succedaneum is swelling of the scalp in a newborn. It is most often brought on by
pressure from the uterus or vaginal wall during a head-first (vertex) delivery. Swelling
and bruising usually occur on the top of the scalp where the head first enters the cervix
during birth.
Cephalohematoma:
Cephalohematoma is a minor condition that occurs during the birth process. Pressure
on the fetal head ruptures small blood vessels when the head is compressed against
the maternal pelvis during labor or pressure from forceps or a vacuum extractor used to
assist the birth.
Q. no.2. Discuss management of first stage of labor?
Ans: The management of first stage of labor is explained as below:
Principles of first stage of labor:
The following are the principles of first stage of labor:
• Non interference with watchful expectancy so as to prepare the patient for
smooth delivery in second stage of labor.
• To monitor carefully the progress of labor, maternal conditions and fetal behavior
in order to detect any deviation from normal.
Preliminaries:
It includes evaluation of current clinical condition.
• Inquiry is made about onset of labor pains.
• Inquiry is made about leakage of liquor.
• Thorough general examination is done .
• Thorough obstetrics examination is done
• Vaginal examinations are done.
• Antenatal records are checked.
• If any investigation done then reports are checked and note if there is any
treatment given.
Actual management:
Antiseptic and asepsis:
Scrupulous surgical cleanliness and asepsis is maintained before, during and after the
delivery.
General care of the patient:
Antiseptic dressing:
Antiseptic dressing of the external genetalia,vulval toileting and a bath is given
to the pregnant mother.
Encouragement and assurance:
The pregnant woman is assured and encouraged during the whole labor period
so that she may not loose her heart but keeps up the morale.
Constant supervision:
Constant supervision should be carried on so that the mother may not feel that
she is left alone. It also helps in detecting transition from normal to abnormal.
Care of the bowel:
In early stage soap and water enema or glycerin suppository is given.
Proper rest:
If the membranes are intact , the patient is allowed to walk about or to sit or lie
down during pains. This attitude prevents venacaval compression and encourages
descent of the head but if the membranes rupture early or when an analgesic drug is
given ,the mother should be in bed.
Diet:
Pregnant mother’s nutritional level and hydration status should be taken into
consideration. Mother should be given adequate fluids in the form of:
• Plain water.
• Salty lemon water.
• Soups.
• Fruit juice.
Food and oral fluids should be withheld as soon as active labor is established . If there
are chances of prolonged labour or active management then intravenous infusion with
5% dextrose is started.
Care of bladder:
Patient is encouraged to empty the bladder herself frequently as full bladder often
inhibits uterine contractions and may lead to subsequent bladder hypotonia and
infection. If the patient fails to pass urine in the first stage catheterization is to be done
with strict aseptic precautions using an autoclaved soft rubber catheter.
Relief of pain:
Analgesia should be minimally used in pregnancy but in case if there is need if
pain killers then inj. Pethidine 100mgI/M is given when the pains are well established
with cervix at least 2 fingers (3 cm) dilated. If necessary it is repeated after 4 hrs.
Tranquilizer drugs,i.e.
• Promazine (sparine) 25_50 mg
• Triflupromazine ( siquil) 5_10 mg
• Promethazine ( phenergan) 25_30 mg may be given along with pathidine .
• These drugs potentiate the action of pathidine so that total dose of pathidine
required may be reduced.
Noting the progress of labor:
The progress is best assessed using partogram.
It gives information about fetal and maternal conditions on a single sheet of paper . It
includes:
• Fetal heart rate
• Maternal temperature
• Pulse
• Blood pressure
• Details of vaginal examinations
• Strength of contractions in terms of the number in 10 minutes
• Fluid balance
• Urine analysis
• Drug administered
• State of membranes
• Oxytocin _ concentration in upper box and dose in lower box.
Position of mother:
During pregnancy the mother is given left lateral position as it :
• Relieves supine hypotensive syndrome
• Facilitates kidney function
• Relieves pressure from abdominal aorta.
Advices during first stage of labor:
• Deep breaths during contractions
• Not to bear down.
• Empty the bladder frequently.
To note the fetal wellbeing
• Fetal heart rate
• Continuous electronic fetal monitoring
Note evidence of maternal distress:
It includes:
• Recording 2 hrly pulse, blood pressure and temperature.
• Note quantity of urine passed and test for acetone
• Observation of tongue ( moist or dry)
• Anxious look with sunken eyes.
• Hot, dry vagina.
• Acetone smell in breath.
• Scanty high coloured urine with presence of acetone.
• Note the signs of maternal distress.
Note evidence of fetal distress:
It includes changes in rate , rhythm and quality of fetal heart rate and other biochemical
events. Even note for meconium stained amniotic fluid, fetal hyperactivity or absence of
activity, fetal tachycardia or bradycardia.
Q.no.3. Write down nursing management of threatened abortion?
Ans: A threatened abortion is defined as vaginal bleeding before 20 weeks gestational
age .
Nursing management of threatened abortion:
The management in case of threatened abortion is as follows:
• Assure the mother:
As there is no fetal malformation assure the mother that everything would be
fine. Clear all her doubts and queries. Never give false assurance.
• Complete bed rest:
• Advice the patient to have bedrest until the bleeding stops.
• Advise not to do the household work for at least one month especially heavy
strenuous work and exercises.
• Advise her not to engage in sexual activity through out the pregnancy.
• Advise her to avoid excitement.
Vulval swabbing:
• Vulval swabbing should be performed at least twice daily while the discharge
persists in order to minimize discomfort. If brownish discharge or bleeding is
present then clean the vulva and perineum.
• Advise the patient to preserve the vulval pads or anything expelled out per
vaginum for inspection.
• Vulval toileting is done using antiseptic lotions,e.g.hibitanr 1:2000.
Drugs:
• For poor sleep and anxiety give the mother
Tab diazepam or tab calm pose or tab valium (5_10 mg) before night meal).
• For good bowel activity give her mild laxative. milk of magnesia at bed time.
• Never give enema .Mild purgatives or suppositories may be used after 48 hrs. if
the client is constipated.
• Never give any drug for threatened abortion except the above mentioned drugs.
Drugs not prescribed are:
(Inj . Profasi,inj. Prolusion depot, tab. Gestin ,natural muconized, progesterone tab .
Duvadilin, yutoper) because the progesterone level in viable early threatened abortion
remains same as that of early pregnancy.
Ask to report if:
• Bleeding becomes more.
• Pain becomes aggravated.
Routinely note the:
• Pulse
• Blood pressure
• Temperature
• Amount of bleeding
• This is done because threatened abortion may transforms into missed abortion
or inevitable abortion and it may go up to full term, if treatment and care is given
in time.
At the end of first week pelvic ultrasound is done:
It would show two things:
• If there is live fetus continue with the pregnancy but carefully.
• If there is blighted ovum go for suction and evacuation.
Speculum examination:
It is done to exclude local lesions and to note the state of cervical os. Vaginal
examinations is not done or is to be avoided.
Diet:
High fiber diet is given to prevent constipation . Good feeding is encouraged and
supplements given ,i.e. Ferrous sulphate 200 mg .bd .folic acid 5 mg / day.. The client
is provided diet that contains high protein and vitamin E.
Q.no.4. Discuss the mild and severe birth asphyxia?
Birth asphyxia, defined as the failure to establish breathing at birth, accounts for an
estimated 900,000 deaths each year and is one of the primary causes of early neonatal
mortality. The most common cause of perinatal asphyxia is complications during
childbirth.
difference between mild and severe birth asphyxia:
In mild or moderate cases, babies may recover fully. However, in severe cases,
birth asphyxia can cause permanent damage to the brain and organs or be fatal.
Birth asphyxia rates are lower in developed countries, with a rate of 2 in 1,000 births
Q.no.5. Write down causes of breast engorgement it’s nursing management and
how can it be prevented?
Ans: Breast engorgement:
Definition :
breast engorgment is a venous congestion of the breast occurring from 3rd day of the
puerperium or breast engorgment is the common complication of puerperal period due
to exaggerated normal venous and lymphatic engorgment in the breast tissues.
Nursing management.
The treatment include :
• support of the breast with a binder or brassiere. Administration of
analgesics for pain.
• Expression of milk by a breast pump manually eases the pain and discomfort.
• The baby should be put to breast regularly after manual expression of milk.
• To administer tab Bromocriptin mesilate (Parlodel) 2.5 mg daily for 2to 3 days in
case where breast remain tight inspite of suckling and expression.
• Good breast support is to be worn continously warm moist compresses a warm
shower or use of an oxytocin Nasal spray (as prescribed) helps to enhance the
let down reflex and the flow of milk.
• non nursing mother may get relieve by snug breast binders supportive brassiere
the application of ice caps to the breast and analgesics.
• Those mother who have been ordered pumping the breast should be taught the
procedure and advised below :
➢ Donor carry out the procedure routinely to relieve engorgment in non nursing
mother because emptying the breast stimulates more milk production.
The position used should be sitting or side position with her hands and breast
freshly washed.
➢ any equipment that touches her breast should be collected in a sterilized before
use .
➢ If the milk is saved for the baby, it should be collected in a sterile container using
aseptic techniques.
➢ A record of the amount of milk is maintained. Explain the mother, the colour of
milk to allay the distress I, e colostrum =mostly creamy or orange. Human milk is
more bluish than cow milk.
Preventions:
You may be able to prevent engorgement if you keep milk moving out of your breasts
and take care not to let your breasts become overfilled.
1. Breastfeed whenever you notice signs that your baby is hungry, such as
eagerly sucking on fingers or rooting. ...
2. Make sure that your baby is latching on and feeding well.
Q.no.6. Enlist the importance of postnatal care for mother and infant?
Ans.
Definition of postnatal Care:
It is defined as the systemic examination of the mother and the baby and appropriate
advice given to the mother during postpartum period.it is done at least twice during
puerperium.
Aims and objectives:
1:To assess the health status of mother and to detect any medical like diabetes
hypertension.
2:To note the progress of the baby and solve feeding problems.
3: To give knowledge about immunization schedule.
4: To impart family planning guidance.
Advantages:
It help to detect at earliest any medico gynecological disability.
To judge the progress of the baby.
To motivate and help the couple in acceptance of family planning method.
Procedure:
The postnatal examination include:
➢ Examination of the mother.
➢ Examination of the baby.
➢ Advice given to the mother.
Examination of the mother:
1: Inquire about any new ailment
2:Inquire about appetite.
Inquire about bowel and bladder habits.
3: ask about backache.

4: check the amount of vaginal discharge.
5: routine examination is done.it include
• Weight checking
• Recording of blood pressure.
• Pallor .
• Tone of abdominal muscles is noted.
• Breast examination.
If indicated pelvic examination is done to Note.
• Nature of perineal wound.
• Any prolapse.
• Street incontinence.
• Any discharge .
• Uterine size .
• Tone of pelvic muscles.
Laboratory examination are done.it include :
• Examination of uterine for protein and UTI.
• Mid stream urine is collected for bacterialogical examination.
• Blood for HB estimation.
• Examination of the baby in this assessment and immunization are done.
These are following:
• General advice:
• If the patient is in sound health and the period has been eventful she is allowed
after a variable period.
• Postpartum exercise should be done at least 4-6 weeks.
• To improve the health status dietary habits supplementary therapy May be
prescribed.
• To evaluate the progress of the baby periodically in the pediatric unit and to
continue breast feeding for not less than 10 months.
Family planning guidance :
✅ Family planning guidance should be given to the parents and tell them the
importance of spacing and limitation of births. The acceptance of small family norms not
only benefit the patient and the family but also the nation as a whole . appropriate
contraceptive methods should be prescribed which are suitable and acceptable to the
patient.
Postnatal exercise:
After delivery The mother should continue the postnatal exercise is order to strengthen
her abdominal and pelvis muscle correct her posture reduce fat and maintain her body
shape.
Q.no.6. Define the following:
Menopause:
Menopause is a point in time 12 months after a woman's last period. The years
leading up to that point, when women may have changes in their monthly cycles, hot
flashes, or other symptoms, are called the menopausal transition or perimenopause.
The menopausal transition most often begins between ages 45 and 55.
Embriotomy:
The act of cutting a foetus into pieces within the womb, so that it can be
removed.
Mastitis:
Mastitis is an inflammation of breast tissue that sometimes involves an infection.
The inflammation results in breast pain, swelling, warmth and redness. You might also
have fever and chills. Mastitis most commonly affects women who are breast-feeding
(lactation mastitis).
Retraction:
the state of uterine muscle fibers remaining shortened after contracting during
labour. This results in a gradual progression of the fetus downwards through the pelvis.
The basal portion of the uterus becomes thicker and pulls up the dilating cervix over the
presenting part.
Lochia serosa:
Lochia serosa is the term for the second stage of lochia. You can expect:
Pinkish brown discharge that's less bloody looking. Thinner and more watery than
lochia rubra.

SUBJECTIVE PART
Marks)
Q:1 Define the following:
Embryo:
After conception till first 8 weeks of life in uterus baby called embryo.
Ovulation:
Every month ovarian graafian follicles mature under the influence of follicle stimulating
hormone (FHS) and release ovum this process called ovulation.
Menopause:
End of woman reproductive life when ovulation and menstruation cease and the woman
is no longer able to bear children. It can occur at any age between the middle thirties
(30) end and the late fifties (50).
Eclampsia:
Eclampsia means to flush out with all signs of pre-eclampsia. It is condition
characterized by convulsion or fits and coma. It may occur in antepartum, intrapartum,
and postpartum period .
Antenatal care:
Care of pregnant woman before the onset of labour is called antenatal care. It is
preventive branch of obstetrics and constituents supervision of a woman through out
pregnancy to ensure healthy mother and baby both.
Q:2 Define family planning, write down aims of family planning :
Family planning:
Family planning is the planning by the individual or couples on the basis of knowledge,
attitude and responsible decisions to have only the children they want , when they want
them. Family planning includes not only planning of births but the welfare of whole
family by means of total health care.
Aims of family planning
• The bring about wanted births.
• To avoid unwanted births.
• To promote the adoption of small family norms on the basis of voluntary
acceptance by educating and motivating the sexually active and fertile couple.
• To promote the use of spacing methods.
• To ensure adequate supply of contraceptives to All eligible couples within easy
reach.
• To regulate the interval between the pregnancies.
• To rise the marriageable age of the boys and girls the standard being 21 for men
and 18 for woman .
Abortion:
it is an expulsion or extraction of all or any part of placenta and membrane without
identifiable or with a fetus alive or dead before 24 weeks of gestation.
Types of abortion:
1)Spontaneous abortion.
It is defined as the loss of a pregnancy before fetal viability (22-24 weeks of gestation)
The stages of spontaneous abortion may include:
2) Threatened abortion.
There is a threat to pregnancy. It may continue or become inevitable or missed.
3) inevitable abortion.
Pregnancy will not continue and will proceed to incomplete/ complete abortion.
4) incomplete abortion.
Products of conception are partially expelled.
5) complete abortion.
Products of conception is completely expelled out.
6) induced abortion.
It is defined as a process by which pregnancy is terminated before fetal viability.
7) septic abortion.
Septic abortion is defined as abortion complicated by infection. Sepsis may result
from infection it organisms rise from the lower genital tract following either
spontaneous or unsafe abortion. Sepsis is more likely to occur if there are
retained products of conception and evacuation has been delayed. Sepsis is a
frequent complication of unsafe abortion involving instrumentation.
8) Habitual abortion.
Three or more consecutive pregnancies end up in spontaneous abortion.
9) Missed abortion.
Fetus dies in uterus, but is not expelled and retained for some time.
Q:3 Differentiate false and True labor :
True labor:
There are following signs and symptoms of true labour pains.
• Painful uterine contraction:
Fundal dominance: contraction start in the fundus near one of the corner and spread
across and downward. This pattern permits the cervix to dilate and the contracting
fundus to expel the fetus.
• Show
A term used to denote the blood stained mucoid discharge at onset of labor, which
comes from cervical canal plug. It is also called operculum.
• Cervical dilation and effacement:
Effacement refers to the taken of the cervix . It may occur late in pregnancy or may not
take place until labor begins. In primi gravida the cervix will not dilate until effacement is
complete . whereas in multigravida effacement and dilation may occur simultaneously.
• Formation of upper and lower uterine segment:
By the end of pregnancy the body of the uterus has divided into two segments. The
upper segment is mainly concern with contractions and is thick and muscular while the
lower segment is prepared for distention and dilation and is thinner.
• Formation of fore water bag:
As the lower segment stretches the chorion become detected from it and increased
intrauterine pressure cause this loosen part of sac of fluid to bulge downward into the
dilating internal os.
• Rupture of membrane:
Membrane ruptured at the end of the second stage of labor when the cervix is fully
dilated and no longer support the bag of fore water.
False labour:
There are following signs and symptoms of false labor:
• False pains are found in primigravida than in parous women.
• It usually appears prior to onset of true labour pain by one or two weeks in
primigravida and by a few days in multipara.
• Women feels pain and discomfort in the abdomen and these are mistaken for
labor pain.
• False pains have got following features:
• It is dull in nature and usually confined to lower abdomen and groin.
a)It is continuous and unrelated with hardening of uterus.
b)It has no effect on dilation of cervix.
c)It is usually relieved by enema and administration of sedatives
• The causes of such pains are:
a)Stretching of the cervix and lower uterine segment with consequent irritation of the
neighboring ganglia.
b)It may also result from lower uterine segment and cervix resisting the unduly taking up
process which proceeds the onset of true labour.
Q3 b) Mechanism of labor:
Mechanism of labour is defined as the series of movements that the fetus undergoes
during its passage through the birth canal during the childbirth .
Descent:
Descent means progression of the fetus toward the pelvic outlet. Descent is the
Cardinal movement of the labour. It is continues and all other movements occur
simultaneously with descent.
Flexion :
There is flexion of the head at the neck and descent make the smaller
suboccipitobregmatic diameter to engage in the right oblique diameter of the pelvic inlet.
The denominator is the occiput which lies against the ischiopelvic bones.
Internal rotation:
internal rotation with progressive descent and flexion the pelvic floor. Because of the
gutter like forward inclination of the pelvic floor the occiput undergoes an internal
rotation through 1/ 8 of a circle and lies under the symphysis pubis. This is achieved
with a twist at the neck .
Extension of head:
Extension of head with further descent the head is born by a process of extension.
External rotation:
It is the visible pensive movement of head due to untwisting of neck sustained during
internal rotation. Movement of rectitude occur in rotating head through 1/8 of circle in
directions opposite to that of internal rotation.
Q:4 Define pregnancy describe how we can diagnose a pregnancy:
The period after the conception till the labour is term as pregnancy it’s duration 280
days 40 weeks and 9 months.
There are both signs and symptoms of pregnancy.
• In first trimester of pregnancy the first sign of pregnancy is most often a missed
menstrual period. If a sexually active women’s periods are generally regular.
Missing a period for a week or more is presumptive evidence of pregnancy.
• Early symptoms of pregnancy also include feeling of breast swelling and
tenderness and nausea sometimes with vomiting.
• Morning sickness is not always in the morning.
• Many women become fatigue early in pregnancy, and also some may feel
abdominal enlargement (bloating).
• Early in pregnancy the woman may feel she has to urinate frequently, especially
at night time and she may leak urine with a cough, sneeze or laugh. This is also
normal later in pregnancy and is not a problem.
• Other changes characteristics of pregnancy include the deepening color of the
areola, increase body temperature, the mask of pregnancy ( darkening of skin on
the forehead bridge of the nose or cheekbones). And the dark line going down
from the middle of the central abdomen area to the pubic area.

PAPER: OBSTETRICS SESSION: SEP OCT 2022
SUBJECTIVE PART
Marks)
1). Define the following terms.
1. Ovulation
2. Fontanelle
3. Funis
4. Restitution
5. Progesterone
Ans: Ovulation:
Every month ovarian graafian follicles mature under the influence of follicle
stimulating hormone and release ovum this process called ovulation.
Fontanel’s:
The fontanel’s are membranous space formed where two or more sutures
meet.
Funis:
The funis/umbilical cord extends from fetus to the placenta and transmits the
umbilical blood vessels two arteries and one vein. These are enclosed and
protected by Wharton’s jelly. The whole cord is covered in a layer of amnion.
Which is continuous with the amniotic covering of placenta.
Restitution:
It is visible passive movement of head due to untwisting of neck sustained
during internal rotation. Movement of restitution occurs rotating the head through
1/8th of a circle in direction opposite to that of internal rotation.
Progesterone:
This has a general smooth muscle relaxant effect. It inhibits the release of
prostaglandin in the myometrium, decidua, and reduced the myometrial activity.
Q2). Describe physiological changes during pregnancy in following.
• Uterus
• Breast
• Cardiovascular system
Uterus:
After conception the uterus develop to provide nutritive and protective environment in
which the fetus will develop And grow.
Uterine layer:
Decidua:
The decidua is name given to the endometrium during pregnancy. The decidua provides
a glycogen rich environment for blastocyst until the trophoblastic cells begin to form
placenta.
Myometrium:
• Inner circular
• Middle oblique
• Outer longitudinal
• During pregnancy the muscle layers become more differentiated and
organized for their parta in expelling the fetus at term.
Perimetrium:
This does not totally cover the uterus, being deflected over the bladder anteriorly to
form the uterovesical pouch and over the rectum posteriorly to form pouch of Douglas.
This management allows for the unrestricted growth of uterus.
Breast:
All breast changes are the result of increased hormones activity. Estrogen develops
the duct system and progesterone the glandular tissue.
They prepare the nipple for subsequent breast feeding prolactin stimulates the
production of colostrum.
Cardiovascular system:
Heart:
Due to an increase in work load the heart may increase in size. It may also be displaced
upward and to the left , rotating anteriorly because of the increasing pressure from the
growing Uterus.
Plasma volume:
From 10th week of pregnancy a normal increase in circulating plasma is co_ related with
fetal well being and good outcome of pregnancy, it’s maximum level of approximately
50% above non_ pregnant value by 32_34 week and maintained until term.
Red blood mass:
Increase in response to the extra oxygen requirement made by maternal and placental
tissue.
Blood pressure:
Blood pressure is depend on several factors the increased cardiac output tends to raise
the blood pressure whereas decreased peripheral resistance tends to cause lowering of
the blood pressure. Decrease in peripheral resistance in pregnancy is due to the
reduced varicosity of blood and vasodilation caused by the relaxing effect of
progesterone.
Q3). Discuss the minor ailments in pregnancy, causes and nursing management
in detail.
Ans: Minor ailments:
• Pelvic pain
• Urinary frequency
• Ankle edema
• Varicosities
• Heart burn
• Constipation
• Low back pain
• Skin changes
• Increased vaginal discharge
• Increased emotional vulnerability
Q4)a. What are the specific features of true labor pain?
Ans: Features true labor pain:
•Painful uterine contraction:
Fundal dominance: contraction start in the fundus near one of the corner
and spread across and downward. This pattern permits the cervix to dilate
and the contracting fundus to expel the fetus.
• Show
A term used to denote the blood stained mucoid discharge at onset of

labor, which comes from cervical canal plug. It is also called operculum.
• Cervical dilation and effacement:
Effacement refers to the taken of the cervix . It may occur late in

pregnancy or may not take place until labor begins. In primi gravida the
cervix will not dilate until effacement is complete . whereas in multigravida
effacement and dilation may occur simultaneously.
• Formation of upper and lower uterine segment:

By the end of pregnancy the body of the uterus has divided into two
segments. The upper segment is mainly concern with contractions and is
thick and muscular while the lower segment is prepared for distention and
dilation and is thinner.
• Formation of fore water bag:
As the lower segment stretches the chorion become detected from it and increased
intrauterine pressure cause this loosen part of sac of fluid to bulge downward into the
dilating internal os.
Rupture of membrane:
Membrane ruptured at the end of the second stage of labor when the cervix is fully
dilated and no longer support the bag of fore water.
Q4 B Write down a difference between the cephalohematoma and caput
succedaneum.
Ans: cephalohematomas
Cephalohematoma is an area of bleeding underneath one of the cranial bones. It often
appears several hours after birth as a raised lump on the baby head. The body
reabsorbs the blood. Depending on the size most cephalohematoma takes two weeks
to three months to disappear completely. If the area of bleeding is large, some babies
may develop jaundice as the red blood cells break down.
Caput succedaneum :
This is the swelling in the skull due to oedema within subcutaneous layer of scalp
caused by pressure due to dilation of cervix on head at rapidly disappears within a few
days after delivery.

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NURSING EXAMINATION BOARD PUNJAB, LAHORE

TIME: 1:30 HOURS. ROLL NO: ____________

Q.No.5 ANSWER THE QUESTION ACCORDING TO THE STATEMENT:

Q#1: Write down the complications of second stage of labor?

Counseling services on nutrition complementary feeding and immunization.

Counseling regarding contraceptive and resumption of sexual activity.

To restore of normal status of mother.

To take care of breastfeeding and promote lactation.

To motivate mother for contraceptive acceptance.

Help in uterine drainage.

Provide a sense of well being.

Tab.Diazepam 5 mg orally at bed time.

Tab .phenobarbitone 30 -60 mg at bed time.

Drug the first week of puerperium asepsis must be maintained.

• Amenorrhea (no period)

Q.2(A) Enlist the impending signs of eclampsia?

Q.2(B) Enlist the complications of placenta previa?

Q.4(A) Write the advantages of breastfeeding for mother and baby?

Q .no.2.Describe the major categories of hypertension during pregnancy?

• Placental edge bleed

NURSING EXAMINATION BOARD PUNJAB, LAHORE

1. Primary lesion (chancre):

• This phase is also called follicular phase or stage of repair And

Ans. SEPTIC ABORTION

Q4.A.Causes of anemia during pregnancy?

NURSING EXAMINATION BOARD PUNJAB, LAHORE

Caput is a severe swelling of the soft tissues Cephalohematoma is an area of bleeding

Q2: Define the Following terms: (Each carry 2 marks)

From 5th to 8th weeks:

From 9th to 12th weeks:

Q4 B. Write down the modes of heat lose in the neonate.

NURSING EXAMINATION BOARD PUNJAB, LAHORE

NURSING EXAMINATION BOARD PUNJAB, LAHORE

3: ask about backache.

NURSING EXAMINATION BOARD PUNJAB, LAHORE

NURSING EXAMINATION BOARD PUNJAB, LAHORE

A term used to denote the blood stained mucoid discharge at onset of

• Cervical dilation and effacement:

Effacement refers to the taken of the cervix . It may occur late in

• Formation of upper and lower uterine segment:

• Formation of fore water bag:

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