CLINICAL CASE RECORD

FOR THE STUDENTS OF

OBSTETRICAL NURSING
A Practical Record with Important Notes on Obstetrical Nursing Practice

DR. (MRS.) MOLLY BABU (RN RM, MN, Ph.D)

(Obstetric and Obstetrical Nursing)
Faculty
R.A.K. College of Nursing, University of Delhi
Lajpat Nagar, New Delhi - 110024

DR. (MRS.) SHOBHA GUSAIN (RN RM, MN)

Faculty
Ahilya Bai College of Nursing, University of Delhi
Lok Nayak Hospital, New Delhi - 110002

Foreword by
MS. SUREKHA SAMA (RN RM, M.Phil)
Ex-Registrar
Delhi Nursing Council, New Delhi - 110002

Books Pub
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KUMAR PUBLISHING HOUSE

Publishers of :
Medical and Nursing Books
PD-12 B, Vishakha Enclave, Opposite Maurya Enclave Police Quarters,
Near N.D. Market, Pitampura, Delhi - 110034 (India)
Tel.: 011-79601153 | Mob.: 9311111029, 9810124056, 9560511526
E-Mail: [email protected] | [email protected]
Website: www.kphnursingbook.com
First Edition : 2007 Reprint : 2016
Revised Edition : 2007 Third Edition : 2017
DR. (MRS.) MOLLY BABU (RN RM, MN, Ph.D)
(Obstetric and Obstetrical Nursing)
Reprint : 2008 Reprint : 2018 Faculty; R.A.K. College of Nursing (University of Delhi),
Reprint : 2009 Reprint : 2019 Lajpat Nagar, New Delhi—110024
Reprint : 2010 Reprint : 2020
Reprint : 2011 Reprint : 2021
Reprint : 2012 Reprint : 2022 DR. (MRS.) SHOBHA GUSAIN (RN RM, MN)
Second Edition : 2013 Faculty; Ahilya Bai College of Nursing (University of Delhi),
Reprint : 2014 Lok Nayak Hospital, New Delhi—110002
Reprint : 2015

Foreword by
© Authors MS. SUREKHA SAMA (RN RM, M.Phil)
Ex-Registrar; Delhi Nursing Council, New Delhi—110002

Contributor:
DR. (MRS.) MANJU CHHUGANI (RN RM, MN, Ph.D)
Faculty; Rufaida College of Nursing, Jamia Hamdard, New Delhi—110062

Mrs. Manju Chhugani has contributed the following Chapters:

Price : ` 595.00
Section No. Topics Pages No.
ISBN: 978-93-82428-59-6 3.4 Nursing Care During Labour 26
4.7 Role of a Midwife in Planned Parenthood 51
4.8 Cu-T Insertion/Assisted/Witnessed 54

All Rights reserved. No part of this publication may be reproduced, stored in

a retrieval system or transmitted in any form or by any means, i.e. electro-
mechanical, photocopying, recording or otherwise without the prior written
permission of the publisher.
Medical knowledge is constantly changing. As new information becomes
available, changes in procedures, equipment and the use of drugs become
necessary. The authors, the editors, the contributors and the publishers have,
as far as possible, taken due care to ensure that the information given in this
text is accurate. However, the readers are strongly advised to confirm that
the information, especially with regard to the use of drugs, procedures and
equipment, holds good.
The book has been published in good faith as per the manuscript provided
Typesetting by Satendra Singh by the authors. However the publisher, the printer, the authors and the editors
Edited by Mr. Prashant Gupta will not be held responsible for any inadvertent error(s). All disputes will be
subject to the jurisdiction of Delhi under the Constitution of India.

Name of the Student:

Name of the Institution:
Year:
Roll No.:

Published by :
NEELAM KUMAR
KUMAR PUBLISHING HOUSE
PD-12B, Vishakha Enclave, Opposite Maurya Enclave Police Quarters,
Near N.D. Market, Pitampura, Delhi - 110034 (India)
E-Mail: [email protected] | [email protected]
 PREFACE

The input of Obstetrical Nursing teachers and curriculum management

enable the students of Obstetrical Nursing to meet the unique requirements
for practical and clinical aspects of Obstetrics. The authors felt the need for
a comprehensive practical record for the students.
Obstetrical nursing is a balance between giving care and a woman’s ability
for self-care. Obstetrical Nursing students must be competent and skillful in
keeping updated knowledge in the subject. Their skill should be based on a
mixture of art and science.
As you know, we have already written ‘Case Book for Midwives—A Practical
Record with Nursing Process Approach to Midwifery Practice’—which was
published in 1998 (1st Edition); in 2000 (2nd Edition) and was reprinted in
sub-sequent years till 2006. The above-mentioned book was well accepted
among teachers and students of midwifery. The 1st Edition “Clinical Case
Record for Midwives: A Practical Record with Important Notes on
Midwifery” was written in 2007 keeping in view of the revised syllabus and
suggestions given by the midwifery teachers of Nursing Colleges and Schools.
The special feature of the 1st edition 2007 the Clinical Case Record for
Midwives was the inclusion of WHO modified partograph (2003) to record
cervical dilatation and descent of foetal head against the duration of labour
in hours, for the monitoring of labour in conducted cases which will enable
the midwifery students to use the skilled management of labour.
The important feature of the 2nd edition 2013 is the addition of neonatal
case record with special emphasis on neonatal assessment.
The 3rd edition of 2017 “Clinical Case Record for the Students of
Obstetrical Nursing—A Practical Record with Important Notes in
Obstetrical Nursing Practice”—is based on the revised syllabus for Nursing
Students in Obstetrical Nursing.
This includes the addition of contents on:
n Students Experience Record with Certification by the Authority
concerned on the completion of clinical experience.
n Certificate of Completed Requirements Certified by the Authority
concerned on the completion of requirements.
n Prenatal Scoring Schedule.
n Chapter on Nursing Care in Caesarean Mothers.
n Chapter on Nurses Responsibility in Resuscitation of the Newborn Baby.

Contd..........
 (iv)

Our main concern while writing this Case Record is to remember the
requirements of a Obstetrical Nursing Student, her development of knowledge
and skill in handling each and every woman in pregnancy, labour and
postpartum period. We hope that the minimum essential information added
in this book is as per the revised syllabus and it will benefit all basic levels of
Obstetrical Nursing training programmes as a practical record.
The authors shall feel obliged if any errors/suggestions are brought
to their notice for the improvement of this Clinical Case Record for
Obstetrical Nursing.

New Delhi, 2017   Dr. (Mrs.) Molly Babu

Dr. (Mrs.) Shobha Gusain
 FOREWORD

Provision of safe and skilled care to mothers during labour is the primary
responsibility of nurses who are prepared to take care of mothers during
antenatal, intranatal and postnatal period. The national goal of bringing
down the maternal mortality rate should be the goal of each nurse. Thus the
attendance of a skilled nurse is required for every mother in the institution
or in the community to meet the challenges of birth.
During the training of nursing students an attempt has been made to
prepare and design a book as well as include short notes to provide ready
practical solution to the students based on the revised Nursing Syllabus.
The book includes text and record of clinical competencies that each
student is expected to maintain during her course of study. All the nursing
students of various nursing programme can maintain this record book for
their curricular requirements. The book would also equip all the students
with required skills and knowledge that they are expected to practise in
obstetrical nursing.

Ms. Surekha Sama

Ex-Registrar
Delhi Nursing Council
New Delhi 110002
 Dedicated
to
Our Loving Parents,
Husband,
Children
and
Midwifery Students
 ACKNOWLEDGEMENT

Praise and glory to Almighty God for HIS abiding grace bestowed on us
throughout this book and making it a successful reality!
The authors wish to thank the significant inspirators/motivators who are
the following members.
We wish to acknowledge with our sincere thanks to contributor,
Dr. Manju Chhugani, Faculty, Rufaida College of Nursing, Jamia Hamdard,
New Delhi, for her contribution to the 3 topics and also her valuable suggestions.
The authors are thankful to Dr. Asha Sharma, Ex-President, Delhi Nursing
Council, who persuaded and supported us to write the Clinical Case Record for
Midwives. We are indebted to express our sincere thanks to Ms. Surekha Sama,
Ex-Registrar; Delhi Nursing Council, New Delhi, for forwarding the case book
and also providing inspiration, motivation and encouragement to complete
the first edition of “Clinical Case Record for Midwives” in 2007.
A word of commendation is expressed to all the Midwifery Teachers of
various Nursing Colleges and Schools in Delhi for providing their valuable
suggestions.
We express all heartfelt gratitude to our family, husband, children and
parents for the inspiration and support given by them during the entire process
of writing this manuscript.
In preparing this “Clinical Case Record for Midwives” we have referred the
following books and Journal. We wish to acknowledge a cordial appreciation
and gratitude to all of them including the related authors who are as follows:
F Benett and Brown: Myles Textbook for Midwives.
F Beischer, Mackay and Calditz: Obstetrics.
F Dutta: Textbook of Obstetrics.
F Dawn: Text book of Obstetric and Neonatology.
F Jenson and Bobak: Essentials of Maternity Nursing.
F May and Mahlmester: Comprehensive Maternity Nursing.
F Mudliar and Menon: Clinical Obstetrics.
F Rosemary and Bailey: Obstetrical and Gynaecological Nursing.
F Reeder: Maternity Nursing.
F Dutta S. and Das X.S.: Journal Article.
F http://www.nihfw.org
We are profoundly indebted to WHO Press, World Health Organization
Geneva, Switzerland, for granting permission to print Partograph (1996 Module)
 (viii)

and Modified Partograph 2003 respectively in the Clinical Case Record for
Midwives [Source 1: World Health Organization. Maternal Health and Safe
Motherhood Programme: Obstructed Labour Module (WHO/FRH/MSM/ 96.3,
page 52–53)] and (Source 2: Integrated Management of Pregnancy and
Childbirth: Managing Complications in Pregnancy and Childbirth: A Guide for
Midwives and Doctors, Page C-67, 2003, WHO/RHR/00.7).
“Clinical Case Record for the Students of Obstetrical Nursing—A
Practical Record with Important Notes in Obstetrical Practice”, (2017)
the authors like to thank all those teachers in obstetrical nursing for their
suggestions.
Last but not least, we extend our sincere thanks to Mr. Ashok Kumar (Director)
and Mrs. Neelam Kumar (Publisher), for encouraging, co-operating, being
so kind and positive to publish this book “Clinical Case Record for the
Students of Obstetrical Nursing”, (3rd edition) and also the whole staff of
KUMAR PUBLISHING HOUSE, Delhi, for transforming the manuscript
into a fine book. We will always appreciate the constructive suggestions.

Dr. (Mrs.) Molly Babu

Dr. (Mrs.) Shobha Gusain
 AUTHOR’S LIST OF TOPICS

Author’s Name Topic Page No.

Dr. (Mrs.) Molly Babu
Certificate of Completed Requirements in Obstetrical Nursing 01
Student Experience Record in Obstetrical Nursing 02
Performa for Procedures Performed/Assisted/Observed 03–06
in Obstetrical Nursing
2.2 Prenatal Scoring System 16
2.3 Nursing Diagnosis 16
3.1 Physiology of Labour 18
3.3 Nursing Assessment, Diagnosis and use of Partograph in Labour 21
3.6 Management of Episiotomy 30
3.7 Perineal Tear and Management 35
4.1 Postnatal Assessment of Mother 38
4.3 Postnatal Exercises 43
4.4 Perineal Care 45
4.5 Assessment of Newborn and Care
  46
4.6 Baby Bath 49
5.1 Drugs used in Obstetrics 56
5.2 Ultrasonography in Obstetrics 58
6.3 Instruments used in Obstetrics 61
6.4 Nursing Care of Mother with Caesarean Section 62
6.5 Birth Injuries of Newborn Baby 64

Dr. (Mrs.) Shobha Gusain

1.1 Foetal Skull 07
1.2 Gynaecoid Pelvis 09
2.1 Antenatal Assessment 12
2.4 Advice to Pregnant Woman in Antenatal Period 16
3.2 Cardinal Movements of Labour 19
3.5 Examination of Placenta, Membranes and Cord 28
4.2 Normal Puerperium and Management 40
6.1 Abnormalities of Pregnancy 59
6.2 Mechanism of Mal-Positions and Mal-Presentations 59
6.6 Resuscitation Newborn Baby 68
 (x)

Authors’ Name Topic Page No.

Dr. (Mrs.) Molly Babu and Dr. (Mrs.) Shobha Gusain

Chapter 7 Practical Record 71–428
7.1 Normal Delivery Witnessed 73–75
7.2 Abnormal Delivery Witnessed 77–81
7.3 Obstetrical Operation Witnessed 83–87
7.4 Caesarean Section Witnessed 89–95
7.5 Antenatal Cases 97–187
7.6 Vaginal Examination 189–194
7.7 Conducted Cases with Partograph 195–275
7.8 Episiotomy and Suturing 277–287
7.9 Neonatal Resuscitation Cases 289–299
7.10 Postnatal Cases 301–421
7.11 Cu-T Insertion/Assisted/Witnessed 423–428
 CONTENTS

Chapter Title Page No.

Certificate of Completed Requirements in Obstetrical Nursing 01

Student’s Experience Record in Obstetrical Nursing 02
Proforma for Procedures Performed/Assisted/Observed in Obstetrical Nursing 03–06

CHAPTER 1 RELATED ANATOMY 07–11

1.1 Foetal Skull 07
1.2 Gynaecoid Pelvis 09

CHAPTER 2 ANTENATAL CARE 12–17

2.1 Antenatal Assessment 12
2.2 Prenatal Scoring System 16
2.3 Nursing Diagnosis 16
2.4 Advice to Pregnant Woman in Antenatal Period 16

CHAPTER 3 INTRANATAL CARE 18–37

3.1 Physiology of Labour 18
3.2 Cardinal Movements of Labour 19
3.3 Nursing Assessment, Diagnosis and use of Partograph in Labour 21
3.4 Nursing Care During Labour 26
3.5 Examination of Placenta, Membranes and Cord 28
3.6 Management of Episiotomy 30
3.7 Perineal Tear and Management 35

CHAPTER 4 POSTNATAL CARE 38–55

4.1 Postnatal Assessment of Mother 38
4.2 Normal Puerperium and Management 40
4.3 Postnatal Exercises 43
4.4 Perineal Care 45
4.5 Assessment of Newborn and Care 46
4.6 Baby Bath 49
4.7 Role of a Midwife in Planned Parenthood 51
4.8 Cu-T Insertion/Assisted/Witnessed 54
 (xii)

Chapter Title Page No.

CHAPTER 5 DRUGS AND ULTRASONOGRAPHY IN OBSTETRICS 56–58

5.1 Drugs used in Obstetrics 56
5.2 Ultrasonography in Obstetrics 58

CHAPTER 6 ABNORMAL OBSTETRICS AND NEONATOLOGY 59–69

6.1 Abnormalities of Pregnancy 59
6.2 Mechanisms of Mal-Positions and Mal-Presentations 59
6.3 Instruments used in Obstetrics 61
6.4 Nursing Care of Mother with Caesarean Section 62
6.5 Birth Injuries of the Newborn Baby 64
6.6 Resuscitation Newborn Baby 68

CHAPTER 7 PRACTICAL RECORD 71–428

Practical Record Outline 71
7.1 Normal Delivery Witnessed 73–75
7.2 Abnormal Delivery Witnessed 77–81
7.3 Obstetrical Operation Witnessed 83–87
7.4 Caesarean Sections Witnessed 89–95
7.5 Antenatal Cases 97–187
7.6 Vaginal Examination 189–194
7.7 Conducted Cases with Partograph 195–275
7.8 Episiotomy and Suturing 277–287
7.9 Neonatal Resuscitation Cases 289–299
7.10 Postnatal Cases 301–421
7.11 Cu-T Insertion/Assisted/Witnessed 423–428