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

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2.6.4.6 Management during labor Management of Pre-Eclampsia during labor: a Induction of labor b Augmentation of labor c Continue Antihypertensive d Prophylactic MagSulf in severe cases e Prophylactic ventouse/forceps delivery f Syntocinon in III stage of labor Management of Eclampsia during labor: a Magsulph is the drug of choice - Table 7: Regimens of MgSO4 for the management of sever Pre-eclampsia & Eclampsia Regimen Loading dose Maintenance dose Intramuscular (Pritchard) ONLY AT L2 Intravenous(Zuspan) With infusion pump 4gm I/V over 3-5 min followed by 10 gm deep I.M (5 gm in each buttock) ie.4 ampoules diluted in 12ml of distilled water to be given slow IV over 3-5 min Then 5 ampoules in each buttock 4-6 gm IV 5 ampoules in 10 ml of distilled water to be given IV slowly over 15-20 minutes TRANSFER LO/L1 TO AT L0/L1: 5gmI.M.4 hourly in each buttock 1-2 gm per hour I/V infusion 10 ampoules in 500ml slowly at the rate of 50ml/hr (1gm/hr) b Nifedipine or Labetolol (DOSE PRESCRIBED EARLIER) c General Care d CS - earlier than later if vaginal delivery is not possible in the next 5 to 6 hrs e If patient is comatose for more than 12 hrs after Magsulph therapy then exclude Cerebro Vascular Accident by CT scan f Fluid therapy: 60-80 ml per hour with Ringer lactate solution. DO NOT OVERLOAD 48
Monitoring of MagSulf Therapy Magnesium sulphate- Administration of the drug: For the loading dose, give Inj. Magnesium sulphate 4 g (20 ml of 20% solution), slow IV, at the rate of 1 ml every minute. Magnesium sulphate should not be given as a bolus. (The woman may feel warm during the injection.) Thereafter, also administer Inj. Magnesium sulphate IM. Initially, 5 g should be injected into each gluteus muscle (10 ml of 50% solution, in each buttock), deep IM, with 1 ml of 2% Lignocaine in the same syringe. In the absence of the doctor or trained staff, Inj. Magnesium sulphate may be given through the IM route only. If convulsions recur: After 15 minutes, give an additional 2 g of Magnesium sulphate (10 ml of 20% solution) IV over 20 minutes. If the convulsions still continue, give Diazepam. If referral is delayed for long, or the woman is in the late stage of labor, continue treatment as below: Give 5 g of 50% Magnesium sulphate solution IM with 1 ml of 2% Lignocaine every 4 hours alternately in each buttock. Catheterize her and refer her to L0/L1 hospital immediately. Before giving the next dose of Magnesium sulphate, ensure that: * The urine output is at least 100 ml per 4 hours; * Knee jerk reflexes are present; * The RR is at least 16 breaths / minute. • Postpone the next dose if the above criteria are not met. Advantage: Magnesium sulphate has been shown to be more effective than Diazepam or Phenytoin in preventing the recurrence of fits. Disadvantage: Magnesium sulphate can cause respiratory depression in the mother and fetus. This is why a rapid IV infusion should be avoided. Precautions: • Do NOT give 50% Magnesium sulphate solution IV without diluting it to 20%. • Do NOT give a rapid IV infusion of Magnesium sulphate as it can cause respiratory failure or death. • If respiratory depression occurs (RR
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 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: • Continue pregnancy up to term w
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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