2012 Midwifery Licensure Exams FUNDAMENTALS OF HEALTH CARE Weight: 20 %

Subject Coverage and Competencies Based on Board of Midwifery CMO No. 33 1. PRENATAL a. Assessment of major discomforts and relief measures b. Performs Leopold's maneuvers c. Performs auscultation d. Compute for EDC and AOG e. Administer tetanus toxoid f. Conducts health education/counselling in relation to: hygiene, diet, exercise, and preparation for delivery 2. LABOR AND DELIVERY a. Monitor the progress of labor b. Recognize early detection of abnormality c. Performs a) Catheterization b) Hand washing c) Gloving and draping d) Internal examination e) Suturing f) IVF insertion d. Administers oxytocin in labor e. Early detection of minor and serious complications during delivery a) Monitor and evaluate outcome of pregnancy b) Refers urgently any complication identified 3. POSTPARTUM a. Monitor and evaluate mothers condition b. Perform postpartum care c. Conduct health teaching and counselling on: a) Breastfeeding, family planning, diet, exercise, and hygiene b) Plans and conducts home visits following proper protocol 4. MIDWIFERY PROCEDURES a. Health Care Process a) Collect data b) Take OB history and medical history c) Asses patients condition d) Refer for laboratory examination b. Vital Signs a) Take temperature b) Take pulses c) Observe and count respiration d) Take blood pressure

e) Observe level of consciousness c. Drug Administration a) Discuss classification of drugs b) Identify names and uses of drugs c) Follow types of medication orders d) Administer drugs through proper routes e) Discuss actions/effects of drugs f) Identify proper abbreviation g) Identify commonly used drugs during pregnancy d. Preventive and comfort measures a) Give appropriate bed bath b) Prepare bed for the patient c) Perform perineal care d) Give health teaching on rest, sleep, personal hygiene, and position. e) Conduct health education on proper nutrition and elimination f) Perform hot and cold application g) Perform cord care h) Perform aseptic technique e. Common Emergency Measures a) Manage minor bleeding/hemorrhage b) Give comfort measures to fracture/sprain c) Give first aid to wounds and burns d) Manage shock and unconsciousness e) Give first aid during convulsion during labor f. Principles of Bacteriology a) Defines vocabulary word b) Identify principal group of microorganism c) Identify diseases caused by microorganism _____________________________________________________ Focused Antenatal Care Is based on the premise that every pregnancy is at risk for complications All women should receive the same basic care including identifying complications Involves a minimum of 4 visits in normal or uncomplicated pregnancies It stresses quality rather than number of visit & has essential goal-directed elements including screening for diseases that complicate pregnancy (pre-eclampsia & anemia) It also reduces cost, lessens workload & provides more time to interact with patients thereby improving quality of care

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Focused Antenatal Care Components 1. General Assessment of the Pregnant Woman 2. Screening for diseases that complicate pregnancy: hypertension, anemia, syphilis 3. Preventive measures: tetanus immunization, iron, folic acid supplementation 4. Health Education: self-care, nutrition & danger signs of pregnancy 5. Birth Plan Objectives: 1. Detection of diseases which may complicate pregnancy. 2. Education of women on danger & emergency signs & symptoms 3. Preparation of the woman & her family for childbirth Steps to follow: I. IMMEDIATE ASSESSMENT for emergency signs (QUICK CHECK): Unconscious/Convulsing Vaginal bleeding Severe abdominal pain Looks very ill Severe headache with visual disturbance Severe difficulty in breathing Fever Severe vomiting II. Make the woman comfortable Greet her, make sure she is comfortable & ask how she is feeling If first visit, register the woman & issue a Mother & Child Book/Home Based Maternal Record III. Assess the pregnant woman First Visit: How old is patient? Past medical history? Obstetrical history: Gravidity? LMP? AOG? Ask about or check record for prior pregnancies: convulsion, stillbirth or death in the first day, heavy bleeding during or after delivery, prior cesarean section, forceps or abortion ON ALL VISITS: Check duration of pregnancy (AOG)

Ask for bleeding/danger signs during this pregnancy Check record for previous treatments received during this pregnancy Prepare birth & emergency plan Ask patient if she has other concern Give education & counseling on family planning THIRD TRIMESTER Leopolds exam, fetal heart beat Give education & counseling on family planning Remember: Do not perform vaginal exam as a routine prenatal care procedure. Always record findings. All pregnancies are at risk. Encourage all pregnant women to deliver in the facility. Refer patients with abnormal findings to the doctor or to higher facility. IV. Get the baseline laboratory information of the woman on the first or following the first visit. Hemoglobin, blood type Urinalysis Screen for diseases that may complicate pregnancy: check for pallor or anemia Ask about getting tired easily or shortness of breath during routine work, drowsiness, palpitations, headaches these may indicate anemia

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First visit: o Check hemoglobin & blood type [normal Hb cut-off level for pregnant woman is 11g/dl. o if 90mmHg, especially if with severe headache, blurred vision & epigastric pain & urine protein signs of severe pre-eclampsia REFER IMMEDIATELY! Screen for diseases that may complicate pregnancy: Check for gestational diabetes ASK ABOUT: Family history (1st degree) of diabetes & history of obesity Past pregnancy for difficult labor, large babies, congenital malformation & unexplained fetal death LOOK FOR: Signs of maternal overweight or obesity Polyhydramnios Signs of large baby or fetal abnormality Vaginal infection

500 mg single dose once in 6 months after 1st trimester Give iron & folate supplementation to prevent anemia & neural tube defects: Ferrous sulfate 320 mg (60 mg elemental iron) & 250 mcg folate If Hgb