Obstetrics Manual for Merrygold Hospitals - State Innovations in ...

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Unit 1.4 Ailments Symptoms, Signs, Probable Diagnosis of Common Learning Objectives • To know about the symptoms, signs and management of common ailments during pregnancy. 1.4.1 Common Ailments during pregnancy The table given below gives a clear picture about the common ailments during pregnancy, their signs and symptoms and recommended actions to be taken. Table 1: Common ailments during Pregnancy Symptoms Signs/investigations Most probable diagnosis Action(s) to be taken Vomiting during the first trimester May be physiological Advise the woman to eat small frequent meals; chew before swallowing; avoid greasy food; eat lots of green vegetables and drink plenty of fluids. If vomiting is excessive in the morning, ask her to eat dry foods such as biscuits or toast after waking up in the morning. Excessive vomiting, especially after the first trimester The woman may be dehydrated Hyperemesis gravidarum Refer to protocol on Hyperemesis Gravidarum. Palpitations, easy fatigability, breathlessness at rest Swelling of one or both feet or tightening of rings on fingers and toes. BP normal. Puffiness of the face, generalized body oedema Conjunctival and/or palmer pallor present Hb level 140/90 mmHg. Proteinuria absent Severe anaemia Hypertensive disorder of pregnancy Refer to protocol on Anemia during pregnancy Rest with feet up Manage as per clinical protocol given for PIH 16
- BP >140/90 mm Hg Proteinuria present - Pre-Eclampsia - Advise her on the danger signs of imminent eclampsia and eclampsia Heartburn and nausea Reflux - Advise the woman to avoid spicy and rich foods. - Ask her to take cold milk during attacks. - If severe, antacids may be prescribed. Increased frequency of urination up to 10 - 12 weeks of pregnancy. No burning during micturition. - Increased frequency of urination after 12 weeks, or persistent symptoms, or burning on - Tenderness may be present at the sides of the abdomen and back - Body temperature may be raised May be physiological due to pressure of the gravid uterus on the urinary bladder Urinary tract infection (UTI) Reassure her that it will be relieved on its own. Refer to protocol on Urinary tract infection urination Constipation Physiological Advise the woman to take more fluids, leafy vegetables and a fiber-rich Diet. If not relieved, give her Isabgol, 2 tablespoonfuls to be taken at bedtime, with water or with milk. Do NOT prescribe strong laxatives as they may start uterine contractions Bleeding P/V, before 20 weeks of gestation Check the pulse and BP to assess for shock Threatened abortion / spontaneous abortion / hydatidiform mole / ectopic pregnancy Refer to protocol on Bleeding in Early pregnancy - Ask for history of violence -Spontaneous abortion due to violence Put her in touch with local support groups 17
Page 1 and 2: Obstetrics Manual for Merrygold Hos
Page 3 and 4: Acknowledgement Manual on Obstetric
Page 5 and 6: Abbreviations AIDS ANC ANM APH ASHA
Page 7 and 8: List of Figures No. Figure Page 1 D
Page 9 and 10: MODULE 1 Care & Management During A
Page 11 and 12: You can confirm the pregnancy by
Page 13 and 14: • Malpresentation, such as breech
Page 15: Unit 1.3 Advice during Ante- Natal
Page 19 and 20: Unit1.5 Protocols for Antenatal car
Page 21 and 22: Unit 1.6 Protocol on Birth Prepared
Page 23 and 24: About this Module In this module, w
Page 25 and 26: Key to Case Study: 1. The patient h
Page 27 and 28: Unit 2.2 Anaemia in Pregnancy Learn
Page 29 and 30: hypoxia • Pneumonia or any other
Page 31 and 32: • Light bleeding • Abnormal pai
Page 33 and 34: Unit 2.4 Ante Partum Hemorrhage Lea
Page 35 and 36: 2.4.2.3 Methods of delivery are as
Page 37 and 38: such as infusion of fresh frozen pl
Page 39 and 40: Unconscious or convulsing Dangerous
Page 41 and 42: • bleeding after childbirth (e.g.
Page 43 and 44: • If the woman’s condition impr
Page 45 and 46: - The front of the legs (pre-tibial
Page 47 and 48: • Continue pregnancy up to term w
Page 49 and 50: Monitoring of MagSulf Therapy Magne
Page 51 and 52: Ergometrine (including syntometrine
Page 53 and 54: Unit 2.7 Premature Pre - Labor Rupt
Page 55 and 56: Unit 2.8 Preterm Labor Learning Obj
Page 57 and 58: • If fetal distress is present an
Page 59 and 60: Unit 2.9 Management of Breech Prese
Page 61 and 62: MODULE 3 Care & Management of Labor
Page 63 and 64: canula only. b Active management of
Page 65 and 66: Fig 2: Sample modified WHO Partogra
Page 67 and 68:
Fig 3: Partograph for Exercise 1 67
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
B) Decision about the mode of deliv
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• If the cervix is fully dilated
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Fig 6: Continuous Electronic Fetal
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Record keeping: • Check date / ti
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CORD NOT PULSATING If the cord is n
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6. CPD-pelvimetry not useful in pre
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• Placenta removed by controlled
Page 87 and 88:
Unit 3.6 Vaginal Birth after Caesar
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3.6.6 VBAC in Special Circumstances
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MODULE 4 Care & Management of Third
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B) Controlled Cord Traction • Cla
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Fig 7: Exposing Perineal tear Apply
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Fig 10: Repairing the skin Note- Re
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4.2.2 Prevention & Management of Po
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4.2.3 Case Study 1 - Retained Place
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mainly due to ergometrine. Ergometr
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Unit 4.3 Post Partum Care Learning
Page 107 and 108:
• The woman needs sufficient rest
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C) Give Plenty of fluids: The aim o
Page 111:
References 1. Royal College of Obst
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