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

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Complete abortion • Check for any retained products of conception by USG and / or bleeding • No further management is required if the condition of the woman is stable. Septic abortion • Give Paracetamol (1 tablet of 500 mg) to control fever (temperature > 38 o C) • Examine for the presence of any foreign body in the vagina • Thoroughly irrigate the vagina to remove any herbs, local medications or caustic substances • Give the following antibiotics: Inj. Ampicillin 2 g IV, every 6 hours, PLUS Inj. Gentamicin 5 mg/kg body weight, IV, every 24 hr PLUS Inj. Metronidazole 400 mg in 100 ml infusion bottle to be given IV every 8 hrs, until the woman is afebrile for 48 hrs (To avoid phlebitis, change the infusion site every three days or at the first sign of inflammation) • If the bleeding is minimal, evacuate the uterus after 48 hrs of antibiotic coverage, preferably use MVA 32
Unit 2.4 Ante Partum Hemorrhage Learning Objectives: At the end of the session we will be able to: • Understand the differential diagnosis of ante-partum hemorrhage. • Discuss the protocol to be followed for APH cases. Session Duration: 120 minutes 2.4.1 Definitions Vaginal bleeding occurring after 20 weeks of pregnancy or during labor (but before delivery of the baby) is known as antepartum haemorrhage (APH). A woman with APH, if not managed in time, can bleed to death within 12 hours of the start of bleeding. It is an important cause of maternal mortality. Table 4: Differential Diagnosis of Antepartum Heamorrhage Criteria Placenta Praevia Abruptio Placentae Uterine Rupture Nature of the bleeding • Painless, causeless and recurrent • The bleeding is always revealed • Painful, pain is often localized to start with and later becomes generalized, attributed to pre- eclampsia or trauma and is continuous. • The bleeding is revealed, concealed, or usually mixed • The bleeding often occurs after the woman has been in labor for a long time • The bleeding may be concealed or mixed General condition and anaemia Proportional to the amount of blood loss. Out of proportion to the visible blood loss in the concealed variety Out of proportion to the visible blood loss Feature of the uterus Not relevant Present in one-third of cases Not relevant Height of the uterus • Proportional to • May be disproportionately the gestational enlarged in the concealed age type Feel of the uterus Soft and relaxed May be tense, tender and rigid Uterine contour nor felt, occasionally, the uterus is felt separately on to one side Malpresentation • Common: the head is high and floating • Unrelated: head may be engaged • Feotal parts felt superficially: malpresentation may be present Localization of placenta Placenta is in the lower segment of Placenta is in the upper segment The placenta may be attached to the uterus or 33
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 and 16: Unit 1.3 Advice during Ante- Natal
Page 17 and 18: - BP >140/90 mm Hg Proteinuria pres
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: • Light bleeding • Abnormal pai
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 73 and 74: B) Decision about the mode of deliv
Page 75 and 76: • If the cervix is fully dilated
Page 77 and 78: Fig 6: Continuous Electronic Fetal
Page 79 and 80: Record keeping: • Check date / ti
Page 81 and 82: CORD NOT PULSATING If the cord is n
Page 83 and 84:
6. CPD-pelvimetry not useful in pre
Page 85 and 86:
• Placenta removed by controlled
Page 87 and 88:
Unit 3.6 Vaginal Birth after Caesar
Page 89 and 90:
3.6.6 VBAC in Special Circumstances
Page 91 and 92:
MODULE 4 Care & Management of Third
Page 93 and 94:
B) Controlled Cord Traction • Cla
Page 95 and 96:
Fig 7: Exposing Perineal tear Apply
Page 97 and 98:
Fig 10: Repairing the skin Note- Re
Page 99 and 100:
4.2.2 Prevention & Management of Po
Page 101 and 102:
4.2.3 Case Study 1 - Retained Place
Page 103 and 104:
mainly due to ergometrine. Ergometr
Page 105 and 106:
Unit 4.3 Post Partum Care Learning
Page 107 and 108:
• The woman needs sufficient rest
Page 109 and 110:
C) Give Plenty of fluids: The aim o
Page 111:
References 1. Royal College of Obst
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