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

More documents

Recommendations

Info

Unit 2.5 Rapid Initial Assessment & Management of Shock Learning Objectives: • How to assess and determine the degree of illness of a woman who presents with problems. • Symptoms, signs and management of shock 2.5.1 Protocol on Rapid Initial Assessment When a woman of childbearing age presents with a problem, rapidly assess her condition to determine her degree of illness. Table 5: Protocols on rapid initial assessment Assess Danger Signs Consider Airway and breathing LOOK FOR: • Cyanosis (blueness) • Respiratory distress EXAMINE: • Skin: pallor • Lungs: wheezing or rales • Severe anaemia • Heart failure • Pneumonia • Asthma Circulation (signs of shock) Vaginal bleeding (early or late pregnancy or after childbirth) EXAMINE: • skin: cool and clammy • pulse: fast (110 or more) and weak • blood pressure: low (systolic less than 90 mm Hg) ASK IF: • pregnant, length of gestation • recently given birth • placenta delivered EXAMINE: • vulva: amount of bleeding, placenta retained, obvious tears • uterus: atony • bladder: full • Shock • abortion • ectopic pregnancy • molar pregnancy • Abruptio placentae • Ruptures uterus • Placenta praevia • Atonic uterus • Tears of cervix and vagina • Retained placenta • Inverted uterus 38
Unconscious or convulsing Dangerous fever DO NOT DO A VAGINAL EXAM AT THIS STAGE ASK IF: • Pregnant, length of gestation EXAMINE: • Blood pressure: high (diastolic 90 mm Hg or more) • Temperature: 38oC or more ASK IF: • weak, lethargic • frequent, painful urination EXAMINE: • temperature: 38oC • unconscious • neck: stiffness • lungs: shallow breathing, consolidation • abdomen: severe tenderness • vulva: purulent discharge • breasts: tender • Eclampsia • Malaria • Epilepsy • Tetanus • urinary tract infection • malaria • metritis • pelvic abscess • peritonitis • breast infection • complications of abortion • pneumonia Abdominal Pain ASK IF: • pregnant, length of gestation • blood pressure: low (systolic less than 90 mm Hg) • pulse: fast (110 or more) • temperature: 38oC or more • uterus: state of pregnancy • ovarian cyst • appendicitis • ectopic pregnancy • possible term or preterm labor • amnionitis • abruption placentae • ruptured uterus This list does not include all the possible problems that a woman may face in a pregnancy or the puerperal period. It is meant to identify those problems that put the woman at greater risk of maternal morbidity and mortality. The woman also needs prompt attention if she has any of the following signs: 39
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 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: such as infusion of fresh frozen pl
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
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?