Obstetrics and Gynaecology Nursing Notes: ANC, Labour, PPH, Eclampsia and Family Planning

These obstetrics and gynaecology nursing notes cover the midwifery topics that appear in almost every AIIMS NORCET, staff nurse, CHO and ANM paper: the pelvis and fetal skull, diagnosis of pregnancy, antenatal care, labour and the partograph, PPH, pre-eclampsia, the puerperium, family planning, newborn care and maternal health schemes. OBG is a high-weightage subject, and many questions are now framed as labour room scenarios.

Pair these notes with our pediatric nursing notes for newborn topics and the community health nursing notes for MCH indicators.

Obstetrics and gynaecology nursing notes: what to focus on

The most tested areas are antenatal care, stages and management of labour, partograph, PPH and AMTSL, pre-eclampsia with magnesium sulphate, family planning methods and government schemes. Standard references are D.C. Dutta’s Textbook of Obstetrics, Myles Textbook for Midwives and Ministry of Health and Family Welfare guidelines.

Female pelvis and fetal skull

The pelvis is formed by two hip (innominate) bones, the sacrum and the coccyx. The true pelvis has an inlet (brim), cavity and outlet.

Pelvis type	Inlet shape	Note
Gynaecoid	Round	Most common female pelvis; ideal for delivery
Android	Heart shaped	Male type; deep transverse arrest, persistent occipito-posterior
Anthropoid	Long oval (AP diameter larger)	Face-to-pubis delivery more likely
Platypelloid	Flat (transverse oval)	Least common; difficult engagement

Important diameters

• Anatomical (true) conjugate: 11 cm. Obstetric conjugate: 10 cm (shortest AP diameter of the inlet). Diagonal conjugate: 12 cm (measured clinically; obstetric conjugate is about 1.5 to 2 cm less).
• Transverse diameter of inlet: 13 cm. Interspinous (bispinous) diameter: 10.5 cm (narrowest diameter of the pelvis). Intertuberous diameter at the outlet: 11 cm.
• Fetal skull: suboccipito-bregmatic 9.5 cm (well flexed vertex), occipito-frontal 11.5 cm (deflexed head), mento-vertical 14 cm (brow, largest), submento-bregmatic 9.5 cm (face). Biparietal diameter: 9.5 cm.

Signs of pregnancy and expected date of delivery

Category	Signs
Presumptive (subjective)	Amenorrhoea, morning sickness, frequency of micturition, breast changes, quickening (about 18 to 20 weeks in primigravida, 16 to 18 weeks in multigravida), Chadwick’s (Jacquemier’s) sign: bluish discolouration of vagina
Probable (objective)	Hegar’s sign (6 to 10 weeks), Goodell’s sign (softening of cervix), Osiander’s sign, Piskacek’s sign, Braxton Hicks contractions, ballottement, positive urine hCG test
Positive	Fetal heart sounds (Doppler from about 10 to 12 weeks), fetal parts and movements felt by the examiner, ultrasound visualisation of the fetus

Normal fetal heart rate is 110 to 160 beats per minute.

Naegele’s rule: EDD = first day of LMP + 9 months + 7 days (or LMP minus 3 months plus 7 days, plus 1 year). It assumes a regular 28-day cycle. Example: LMP 10 January 2026 gives EDD 17 October 2026.

Fundal height (Dutta): just above the symphysis at 12 weeks, at the umbilicus at about 24 weeks, at the xiphisternum at 36 weeks, and slightly lower at 40 weeks due to lightening. After 24 weeks, fundal height in centimetres roughly equals gestational age in weeks (plus or minus 2 cm).

Antenatal care schedule (GoI)

As per Government of India guidelines, every pregnant woman should have at least four antenatal visits, including registration. WHO (2016) recommends a minimum of eight contacts, and many states now encourage more frequent check-ups.

Visit	Timing
1st (registration)	Within 12 weeks, as soon as pregnancy is suspected
2nd	14 to 26 weeks
3rd	28 to 34 weeks
4th	36 weeks to term

Essential ANC components

• History, weight, BP, abdominal examination, fetal heart sounds.
• Investigations: haemoglobin, blood group and Rh, urine for albumin and sugar, syphilis screening, HIV, HBsAg, blood sugar.
• GDM screening: 75 g oral glucose irrespective of fasting state, 2-hour plasma glucose of 140 mg/dL or more indicates GDM (DIPSI method used in GoI guidelines); done at the first visit and again at 24 to 28 weeks.
• IFA: one tablet (60 mg elemental iron and 500 mcg folic acid) daily from the second trimester for at least 180 days, continued for 180 days after delivery (Anaemia Mukt Bharat). Folic acid 400 mcg daily in the first trimester.
• Calcium supplementation after the first trimester, continued during lactation; albendazole 400 mg single dose in the second trimester.
• Td: two doses 4 weeks apart (Td-1 early in pregnancy, Td-2 four weeks later), or one booster dose if vaccinated within the last 3 years.
• Anaemia in pregnancy: haemoglobin below 11 g/dL; severe anaemia below 7 g/dL.

Stages of labour

Stage	From and to	Average duration
First	Onset of true labour pains to full cervical dilatation (10 cm)	About 12 hours in primigravida, 6 hours in multipara
Second	Full dilatation to birth of the baby	About 2 hours in primigravida, 30 minutes in multipara
Third	Birth of the baby to expulsion of placenta and membranes	About 15 minutes (up to 30 minutes)
Fourth	First hour after delivery of the placenta	Observation for PPH

The first stage has a latent phase and an active phase (traditionally from 4 cm; WHO 2018 recommendations use 5 cm). True labour pains are regular, progressively stronger, felt in the back radiating to the front, with cervical dilatation and a “show”. False labour pains are irregular, relieved by rest or sedation and cause no cervical change.

Mechanism of normal labour (vertex, LOA): engagement, descent, flexion, internal rotation, crowning, extension, restitution, external rotation and expulsion.

Signs of placental separation: uterus becomes globular, firm and rises in the abdomen, lengthening of the cord and a sudden gush of blood. Schultze method (central separation, fetal surface first) is more common; Matthews Duncan method (marginal separation, maternal surface first) has more blood loss.

Partograph

The WHO modified partograph is a graphic record of labour started in the active phase (at 4 cm).

• Alert line: starts at 4 cm and represents 1 cm per hour dilatation. Action line: parallel and 4 hours to the right of the alert line.
• Fetal condition: FHR every 30 minutes; liquor (I intact, C clear, M meconium stained, B blood stained, A absent); moulding (0, +1, +2, +3).
• Progress of labour: cervical dilatation marked “X”, descent of the head in fifths palpable marked “O”, contractions in 10 minutes and duration (less than 20, 20 to 40, more than 40 seconds).
• Maternal condition: pulse every 30 minutes, BP every 4 hours, temperature every 2 hours, urine output, drugs and oxytocin.

Crossing the alert line means referral or closer review; reaching the action line needs active intervention.

APGAR score

Sign	0	1	2
Appearance (colour)	Blue or pale all over	Body pink, extremities blue	Completely pink
Pulse (heart rate)	Absent	Below 100/min	100/min or more
Grimace (reflex irritability)	No response	Grimace	Cry, cough or sneeze
Activity (muscle tone)	Limp	Some flexion	Active movement
Respiration	Absent	Slow, irregular, weak cry	Good, strong cry

Scored at 1 and 5 minutes. 7 to 10 is normal, 4 to 6 moderate depression, 0 to 3 severe depression. Resuscitation is never delayed to calculate the APGAR score.

Postpartum haemorrhage and AMTSL

PPH is blood loss of 500 ml or more after vaginal birth, 1,000 ml or more after caesarean section, or any blood loss that causes haemodynamic instability. Primary PPH occurs within 24 hours; secondary PPH occurs after 24 hours up to 6 weeks. Causes are the “4 Ts”: Tone (uterine atony, the commonest), Trauma, Tissue (retained placenta) and Thrombin (coagulation disorders).

Active management of the third stage of labour (AMTSL)

1. Uterotonic within 1 minute of birth: oxytocin 10 IU IM is the drug of choice (misoprostol 600 mcg orally if oxytocin is not available).
2. Controlled cord traction with counter-traction above the pubis, only when the uterus contracts.
3. Uterine massage after delivery of the placenta, and checking uterine tone regularly over the next 2 hours.

Delayed cord clamping (1 to 3 minutes) is now recommended for all babies who do not need resuscitation.

Management of PPH

• Call for help, uterine massage, two wide-bore IV lines, blood for grouping and cross-matching, catheterise the bladder.
• Oxytocin infusion; tranexamic acid 1 g IV within 3 hours of birth.
• Methylergometrine 0.2 mg IM is contraindicated in hypertension and heart disease. Carboprost (PGF2 alpha) is contraindicated in bronchial asthma.
• Bimanual uterine compression, uterine balloon tamponade, non-pneumatic anti-shock garment, and surgical measures if needed.

Pre-eclampsia, eclampsia and magnesium sulphate

• Gestational hypertension: BP 140/90 mmHg or more after 20 weeks without proteinuria.
• Pre-eclampsia: hypertension after 20 weeks with proteinuria (300 mg or more in 24 hours) or signs of end-organ involvement.
• Severe features: BP 160/110 or more, severe headache, visual disturbance, epigastric pain, oliguria, low platelets, HELLP syndrome.
• Eclampsia: pre-eclampsia with convulsions.
• Antihypertensives used in pregnancy: labetalol, nifedipine, methyldopa. ACE inhibitors are contraindicated. Delivery is the definitive treatment.

Magnesium sulphate (drug of choice for eclampsia)

Regimen	Loading dose	Maintenance
Pritchard (IM)	4 g of 20% solution IV slowly over 5 to 15 minutes plus 10 g of 50% solution deep IM (5 g in each buttock)	5 g of 50% solution deep IM every 4 hours in alternate buttocks
Zuspan (IV)	4 to 6 g IV over 15 to 20 minutes	1 to 2 g per hour IV infusion

Continue for 24 hours after delivery or the last convulsion, whichever is later. Before each dose check that the patellar reflex is present, respiratory rate is at least 16 per minute and urine output is at least 30 ml per hour (100 ml in 4 hours). The antidote is 10 ml of 10% calcium gluconate IV over 10 minutes. Loss of patellar reflex is the earliest sign of toxicity.

High-risk pregnancy

• Age below 18 or above 35 years, height below 145 cm, grand multiparity.
• Severe anaemia, hypertension, diabetes, heart disease, HIV, Rh-negative mother.
• Previous caesarean section, stillbirth, recurrent abortion or PPH.
• Multiple pregnancy, malpresentation, antepartum haemorrhage, polyhydramnios, IUGR.

High-risk women are identified at ANC visits, recorded in the MCP card and followed up under PMSMA and extended PMSMA.

Puerperium

The puerperium is the period of 6 weeks after delivery when the reproductive organs return to the non-pregnant state.

• Involution: fundus is at the umbilicus soon after delivery, descends by about 1 cm (one finger breadth) per day, and is no longer palpable abdominally by about 10 to 14 days.
• Lochia: rubra (red) days 1 to 4, serosa (pinkish) days 5 to 9, alba (white) from about day 10 and may last up to 3 to 6 weeks. Foul-smelling lochia suggests infection.
• Complications: puerperal sepsis, breast engorgement and mastitis, thrombophlebitis, postpartum blues (transient, peaks around day 3 to 5), postpartum depression and puerperal psychosis.
• Postnatal check-ups (GoI): at least within 24 hours, on day 3, day 7 and at 6 weeks.

Family planning methods and programmes

Method	Key facts
Condom (Nirodh)	Barrier method; also protects against STIs
IUCD: Cu T 380A / Cu T 375	Effective for 10 years and 5 years respectively; PPIUCD inserted within 10 minutes of placental delivery or within 48 hours
Combined oral pill (Mala-N)	Daily pill; contraindicated in thromboembolism, liver disease, breast cancer
Centchroman (Chhaya)	Non-steroidal weekly pill: twice a week for the first 3 months, then once a week
Injectable MPA (Antara programme)	150 mg IM every 3 months
Emergency contraception	Levonorgestrel 1.5 mg within 72 hours of unprotected intercourse
LAM	Effective only with exclusive breastfeeding, amenorrhoea and baby below 6 months
Tubectomy	Minilaparotomy or laparoscopic; permanent female method
Vasectomy (NSV)	Not immediately effective; use backup contraception for 3 months or until semen analysis is negative

India launched the world’s first national family planning programme in 1952. Mission Parivar Vikas (2016) targets high-fertility districts.

Maternal health schemes and MCH indicators

Scheme	Key points
Janani Suraksha Yojana (JSY), 2005	Cash assistance to promote institutional delivery, under NHM
Janani Shishu Suraksha Karyakram (JSSK), 2011	Free delivery including caesarean section, free drugs, diagnostics, diet, blood and transport; also covers sick infants
Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), 2016	Free assured ANC by specialists on the 9th of every month for women in the second and third trimester
Extended PMSMA, 2022	Tracking and follow-up of high-risk pregnancies with incentives for the woman and ASHA
Pradhan Mantri Matru Vandana Yojana (PMMVY)	Maternity benefit (cash) for the first child, and for a second child if it is a girl

Latest indicators: India’s MMR was 88 per 1,00,000 live births (SRS special bulletin 2021 to 2023, released 2025), IMR 25 per 1,000 live births and TFR 1.9 (SRS Statistical Report 2023, released September 2025).

Essential newborn care

• Dry the baby immediately, keep warm with skin-to-skin contact, clear airway only if needed.
• Delayed cord clamping, clean and dry cord care.
• Initiate breastfeeding within 1 hour; exclusive breastfeeding for 6 months.
• Vitamin K 1 mg IM (0.5 mg if birth weight below 1,000 g).
• Birth doses: BCG, OPV-0 and Hepatitis B; record weight (low birth weight is below 2,500 g); delay bathing.
• Normal newborn: heart rate 120 to 160/min, respiratory rate 40 to 60/min, temperature 36.5 to 37.5 degrees C, head circumference about 33 to 35 cm.

Quick revision points

• Most common pelvis: gynaecoid. Narrowest diameter: interspinous (10.5 cm).
• Obstetric conjugate is 10 cm; diagonal conjugate is 12 cm.
• Smallest presenting diameter: suboccipito-bregmatic (9.5 cm).
• Hegar’s sign appears at 6 to 10 weeks.
• Naegele’s rule: LMP + 9 months + 7 days.
• Minimum ANC visits under GoI guidelines: 4.
• Normal FHR: 110 to 160 per minute.
• Action line is 4 hours to the right of the alert line.
• Most common cause of PPH: uterine atony.
• Drug of choice in AMTSL: oxytocin 10 IU IM.
• Drug of choice for eclampsia: magnesium sulphate; antidote: calcium gluconate.
• Methylergometrine is contraindicated in hypertension.
• Cu T 380A is effective for 10 years.
• PMSMA day: 9th of every month.
• Vitamin K dose for a term newborn: 1 mg IM.

Test these facts with the NORCET test series or ANM test series, and follow a structured plan with our NORCET preparation strategy. CHO and ANM aspirants can also explore the CHO courses and ANM courses.

Frequently asked questions

Which OBG topics are most important for AIIMS NORCET?

Labour management, partograph, AMTSL and PPH, pre-eclampsia and magnesium sulphate, antenatal care, family planning and newborn care are the most frequently tested areas. Many questions are now scenario based.

Which book is best for obstetrics nursing?

D.C. Dutta’s Textbook of Obstetrics and Myles Textbook for Midwives are standard references. For schemes and schedules, follow the latest Ministry of Health and Family Welfare guidelines.

How many ANC visits are recommended in India?

Government of India guidelines recommend a minimum of four antenatal visits, with the first one within 12 weeks. WHO recommends at least eight contacts during pregnancy.

What should be checked before giving magnesium sulphate?

Check that the patellar reflex is present, respiratory rate is at least 16 per minute and urine output is at least 30 ml per hour. Keep 10% calcium gluconate ready as the antidote.