PNC Licensing Examination Maternal, Child and Obstetric Nursing Syllabus

What are the standard absolute contraindications to combined oral contraceptives (give three)?

History of thromboembolism/DVT, breast cancer, uncontrolled hypertension, smoking over age 35, active liver disease, and known/suspected pregnancy.

What is the lactational amenorrhea method (LAM) and its three required criteria?

LAM uses exclusive breastfeeding as contraception. Required: (1) infant under 6 months, (2) exclusive/near-exclusive breastfeeding, and (3) amenorrhea (menses not yet returned).

Within what time frame is emergency contraception (levonorgestrel) most effective after unprotected intercourse?

As soon as possible, ideally within 72 hours (3 days) of unprotected intercourse; efficacy declines with time.

What are the three (classically four) stages of labour?

First stage: onset of true labour to full (10 cm) cervical dilatation. Second stage: full dilatation to delivery of the baby. Third stage: delivery of the baby to delivery of the placenta. (Fourth stage: the first 1-2 hours after delivery of the placenta - immediate recovery).

What are the two phases of the first stage of labour and the cervical dilatation that defines each?

Latent phase: 0 to about 4 cm (slow, irregular). Active phase: about 4-6 cm to 10 cm (faster, regular, stronger contractions).

What distinguishes true labour from false labour?

True labour: regular contractions that increase in intensity/frequency, cause progressive cervical dilatation and effacement, and are not relieved by rest. False labour (Braxton Hicks): irregular contractions, no cervical change, often relieved by walking or rest.

What is the average rate of cervical dilatation in the active phase of the first stage for a nullipara and a multipara?

Approximately 1 cm/hour for nulliparas and about 1.5 cm/hour for multiparas (Friedman's classic figures).

List the cardinal movements (mechanisms) of labour in order.

Engagement, descent, flexion, internal rotation, extension, external rotation (restitution), and expulsion.

What does cervical effacement mean and how is it expressed?

Effacement is the thinning and shortening of the cervix, expressed as a percentage from 0% (thick) to 100% (fully thinned/paper-thin).

What is fetal station and what does station 0 indicate?

Station is the level of the presenting part relative to the ischial spines, measured from -5 to +5 cm. Station 0 means the presenting part is at the level of the ischial spines (engaged).

What is a partograph and what is its purpose?

A partograph is a graphic record of labour progress (cervical dilatation, descent, contractions, fetal heart rate, maternal vitals) used to monitor labour and detect abnormalities early, with alert and action lines.

How often should the fetal heart rate be auscultated during the active first stage and during the second stage in a low-risk labour?

Every 15-30 minutes during the active first stage and every 5 minutes (or after each contraction) during the second stage.

What is a normal baseline fetal heart rate variability, and why is it significant?

Moderate variability of 6-25 bpm fluctuation is normal and reassuring, indicating an intact, well-oxygenated fetal autonomic nervous system.

Differentiate early, late, and variable fetal heart rate decelerations.

Early: mirror contractions, caused by head compression - benign. Late: begin after the contraction peak and return after it ends, indicate uteroplacental insufficiency - ominous. Variable: abrupt, variable timing/shape, caused by cord compression.

What three components are assessed in fetal scalp blood sampling, and what pH indicates fetal acidosis requiring delivery?

pH, base excess, and lactate are assessed. A fetal scalp pH below 7.20 indicates significant acidosis and need for expedited delivery.

Define the '5 P's' that influence the progress of labour.

Passage (pelvis/birth canal), Passenger (fetus), Powers (uterine contractions and maternal effort), Position (maternal posture), and Psyche (psychological state).

During conduct of a normal delivery, what is the purpose of the modified Ritgen maneuver?

It controls the delivery of the fetal head by applying upward pressure on the fetal chin through the perineum while restraining the occiput, allowing controlled extension and reducing perineal tearing.

What are the signs of placental separation in the third stage of labour?

A gush of blood, lengthening of the umbilical cord, the uterus rising and becoming firm/globular (Calkins' sign), and the uterus becoming ballottable above the umbilicus.

What is active management of the third stage of labour (AMTSL) and its three components?

AMTSL reduces postpartum hemorrhage. Components: (1) a uterotonic (oxytocin 10 IU IM) within 1 minute of birth, (2) controlled cord traction, and (3) uterine massage after placental delivery.

What is the standard prophylactic uterotonic and dose given after delivery to prevent postpartum hemorrhage?

Oxytocin 10 international units intramuscularly, given within one minute of delivery of the baby.

How is the placenta inspected after delivery and why?

Both maternal (cotyledons) and fetal (membranes, cord vessels) surfaces are inspected for completeness to ensure no retained fragments remain, which could cause hemorrhage or infection. The cord should show 2 arteries and 1 vein.

Compare pharmacological pain relief options in labour: systemic opioids, regional (epidural), and inhaled analgesia.

Systemic opioids (e.g., pethidine/morphine): IM/IV, can cause neonatal respiratory depression. Regional epidural: local anesthetic via epidural catheter, excellent relief but may cause hypotension and prolonged second stage. Inhaled: nitrous oxide (Entonox), self-administered, mild relief.

What non-pharmacological methods can be used for pain relief in labour?

Breathing/relaxation techniques, position changes and ambulation, massage and counter-pressure, warm water/hydrotherapy, continuous labour support, and TENS.

What is the most common serious side effect of epidural analgesia and its nursing management?

Maternal hypotension. Management: preload/coload with IV fluids, position the mother in lateral tilt (avoid supine), monitor blood pressure frequently, and give vasopressors (e.g., ephedrine) if needed.

What does the term 'involution' mean in the postpartum period, and how fast does the uterus descend?

Involution is the return of the uterus to its non-pregnant size. The fundus descends about 1 cm (one fingerbreadth) per day, becoming non-palpable abdominally by about 10-14 days postpartum.

Describe the normal progression of lochia in the postpartum period.

Lochia rubra (red, days 1-3), lochia serosa (pinkish-brown, days 4-10), then lochia alba (whitish-yellow, days 10 up to 6 weeks).

What are the components of the postpartum BUBBLE-HE assessment?

Breasts, Uterus (fundus), Bladder, Bowel, Lochia, Episiotomy/perineum, Homans' sign (legs/DVT), and Emotional status.

What is the most common cause of immediate postpartum hemorrhage and its first-line management?

Uterine atony is the most common cause. First-line management: uterine fundal massage and oxytocin; ensure bladder is empty and give additional uterotonics (e.g., misoprostol, ergometrine) as needed.

How is postpartum hemorrhage (PPH) defined for vaginal and cesarean births?

Blood loss of 500 mL or more after vaginal delivery, or 1000 mL or more after cesarean delivery, within 24 hours (primary PPH).

List the '4 T's' causes of postpartum hemorrhage.

Tone (uterine atony), Trauma (lacerations/hematoma), Tissue (retained placenta/products), and Thrombin (coagulation disorders).

What are the WHO recommendations for initiation and duration of exclusive breastfeeding?

Initiate breastfeeding within the first hour of birth, exclusive breastfeeding for the first 6 months, then continued breastfeeding with complementary foods up to 2 years or beyond.

What is colostrum and why is it important for the newborn?

Colostrum is the thick, yellowish first milk produced in the first few days. It is rich in protein, antibodies (especially IgA), and is laxative (aids meconium passage), providing passive immunity and nutrition.

Which hormones control milk production and milk ejection (let-down), and what stimulates each?

Prolactin (from anterior pituitary) stimulates milk production; oxytocin (from posterior pituitary) causes the let-down/milk ejection reflex. Both are stimulated by infant suckling at the breast.

What are the signs of a good latch during breastfeeding?

Mouth wide open, lips flanged outward, more areola visible above than below, chin touching the breast, rhythmic suckling and audible swallowing, and no maternal nipple pain.

What is the recommended frequency of breastfeeding for a healthy newborn in the first weeks?

On demand, at least 8-12 times in 24 hours (roughly every 2-3 hours), including night feeds.

What are the components of the APGAR score and at what times is it assessed?

Appearance (color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. Each scored 0-2 (max 10); assessed at 1 and 5 minutes after birth.

What APGAR score range indicates a newborn needs no intervention versus needs active resuscitation?

7-10 indicates good condition (routine care); 4-6 indicates moderate distress (needs stimulation/support); 0-3 indicates severe distress requiring immediate active resuscitation.

What are the immediate (golden minute) priorities of newborn care at birth?

Dry and provide warmth, clear the airway if needed, stimulate, assess breathing and heart rate, and initiate skin-to-skin contact; delay cord clamping if the baby is vigorous.

What is the normal newborn respiratory rate and heart rate range?

Respiratory rate 30-60 breaths per minute; heart rate 110-160 beats per minute.

Why and when is vitamin K given to newborns?

Vitamin K (1 mg IM) is given within the first hour(s) after birth to prevent vitamin K deficiency bleeding (hemorrhagic disease of the newborn), as newborns have low vitamin K stores and sterile gut.

What is the first step (initial steps within 30 seconds) of neonatal resuscitation?

Provide warmth, position the head (sniffing/neutral position) and clear the airway if needed, dry, and stimulate the baby - while assessing breathing and heart rate.

In neonatal resuscitation, what heart rate threshold indicates the need to begin positive pressure ventilation (PPV)?

If the newborn is apneic/gasping or the heart rate is below 100 beats per minute after the initial steps, begin positive pressure ventilation.

In neonatal resuscitation, at what heart rate are chest compressions started, and at what compression-to-ventilation ratio?

Chest compressions are started if the heart rate remains below 60 bpm despite 30 seconds of effective PPV, using a 3:1 compression-to-ventilation ratio (90 compressions and 30 breaths per minute).

What is the dose and route of epinephrine (adrenaline) in neonatal resuscitation?

Epinephrine 0.01-0.03 mg/kg (1:10,000 solution) intravenously/intraosseously, preferred via umbilical vein; it is given when the heart rate remains below 60 bpm despite adequate ventilation and chest compressions.

What is the recommended initial oxygen concentration for resuscitating a term newborn, and why?

Room air (21% oxygen) for term infants, titrating up using pulse oximetry, because excessive oxygen can cause oxidative injury; supplemental oxygen is added only if saturations remain low.

How is gestational/pregnancy-induced hypertension defined?

New-onset blood pressure of 140/90 mmHg or higher on two occasions at least 4-6 hours apart, after 20 weeks of gestation, in a previously normotensive woman, without proteinuria or end-organ involvement.

What is the diagnostic triad/criteria for preeclampsia?

New-onset hypertension (BP greater than or equal to 140/90) after 20 weeks gestation plus proteinuria (greater than or equal to 300 mg/24h) OR other end-organ dysfunction (e.g., thrombocytopenia, renal/liver impairment, neurological symptoms, pulmonary edema).

How is severe preeclampsia distinguished from mild preeclampsia?

Severe features include BP greater than or equal to 160/110, severe headache, visual disturbances, epigastric/RUQ pain, thrombocytopenia, elevated liver enzymes, renal impairment, or pulmonary edema.

What is eclampsia?

The onset of generalized tonic-clonic seizures (convulsions) in a woman with preeclampsia, not attributable to other causes; it is an obstetric emergency.

What is the drug of choice to prevent and treat eclamptic seizures, and what is the monitoring concern?

Magnesium sulfate (MgSO4) is the drug of choice. Monitor for signs of magnesium toxicity: loss of deep tendon (patellar) reflexes, respiratory depression (under 12/min), and reduced urine output (under 30 mL/h).

What is the antidote for magnesium sulfate toxicity?

Calcium gluconate (10 mL of 10% solution given slowly IV).

What does the HELLP syndrome stand for and which condition is it associated with?

Hemolysis, Elevated Liver enzymes, and Low Platelets - a severe variant/complication of preeclampsia.

What are the first-line antihypertensive drugs used in severe pregnancy-induced hypertension?

Labetalol, hydralazine, and oral nifedipine are first-line agents to control acute severe hypertension in pregnancy. (ACE inhibitors and ARBs are contraindicated.)