Managing Complications in Pregnancy and Childbirth: - IAWG

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S-2 Shock• Monitor vital signs (pulse, blood pressure, respiration,temperature).• Turn the woman onto her side to minimize the risk of aspiration ifshe vomits and to ensure that an airway is open.• Keep the woman warm but do not overheat her as this will increaseperipheral circulation and reduce blood supply to the vital centres.• Elevate the legs to increase return of blood to the heart (if possible,raise the foot end of the bed).SPECIFIC MANAGEMENT• Start an IV infusion (two if possible) using a large-bore (16-gaugeor largest available) cannula or needle. Collect blood for estimationof haemoglobin, immediate cross-match and bedside clotting (seebelow), just before infusion of fluids:- Rapidly infuse IV fluids (normal saline or Ringer’s lactate)initially at the rate of 1 L in 15–20 minutes;Note: Avoid using plasma substitutes (e.g. dextran). There isno evidence that plasma substitutes are superior to normalsaline in the resuscitation of a shocked woman and dextrancan be harmful in large doses.- Give at least 2 L of these fluids in the first hour. This is overand above fluid replacement for ongoing losses.Note: A more rapid rate of infusion is required in themanagement of shock resulting from bleeding. Aim to replace2–3 times the estimated fluid loss.Do not give fluids by mouth to a woman in shock.• If a peripheral vein cannot be cannulated, perform a venous cutdown(Fig S-1).• Continue to monitor vital signs (every 15 minutes) and blood loss.• Catheterize the bladder and monitor fluid intake and urine output.• Give oxygen at 6–8 L per minute by mask or nasal cannulae.
ShockS-3BEDSIDE CLOTTING TEST• Assess clotting status using this bedside clotting test:- Take 2 mL of venous blood into a small, dry, clean, plain glasstest tube (approximately 10 mm x 75 mm);- Hold the tube in your closed fist to keep it warm (± 37°C);- After 4 minutes, tip the tube slowly to see if a clot is forming.Then tip it again every minute until the blood clots and thetube can be turned upside down;- Failure of a clot to form after 7 minutes or a soft clot thatbreaks down easily suggests coagulopathy (page S-19).FIGURE S-1Venous cut-down
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WHO/RHR/00.7Distr: GeneralIntegrate
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©World Health Organization, 2000Th
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iiTable of contentsLoss of fetal mo
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ivPreface
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viIntroduction
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viiiHow to use the manualprocedure,
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xAbbreviations
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xiiList of diagnoses
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RAPID INITIAL ASSESSMENT C-1When a
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Rapid initial assessmentC-3Abdomina
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TALKING WITH WOMEN AND THEIR FAMILI
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EMOTIONAL AND PSYCHOLOGICAL SUPPORT
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Emotional and psychological support
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C-16 Emotional and psychological su
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C-16 Emergencies• If the woman is
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C-18 General care principles- after
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C-20 General care principlesaGloves
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C-22 General care principles- weari
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C-24 General care principles• Nev
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C-24 Clinical use of blood, blood p
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ANTIBIOTIC THERAPY C-35Infection du
Page 59 and 60: ANAESTHESIA AND ANALGESIA C-37Pain
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Page 63 and 64: Anaesthesia and analgesiaC-41TABLE
Page 65 and 66: Anaesthesia and analgesiaC-43MANAGE
Page 67 and 68: Anaesthesia and analgesiaC-45- Give
Page 69 and 70: Anaesthesia and analgesiaC-47Proced
Page 71 and 72: OPERATIVE CARE PRINCIPLES C-47The w
Page 73 and 74: Operative care principlesC-49• Ho
Page 75 and 76: Operative care principlesC-51HAEMOS
Page 77 and 78: Operative care principlesC-53- Plac
Page 79 and 80: Operative care principlesC-55A urin
Page 81 and 82: NORMAL LABOUR AND CHILDBIRTH C-57NO
Page 83 and 84: Normal labour and childbirthC-59- E
Page 85 and 86: Normal labour and childbirthC-61•
Page 93 and 94: Normal labour and childbirthC-69FIG
Page 95 and 96: Normal labour and childbirthC-71FIG
Page 99 and 100: Normal labour and childbirthC-75Not
Page 101 and 102: Normal labour and childbirthC-77Nev
Page 103 and 104: NEWBORN CARE PRINCIPLES C-77When a
Page 105 and 106: PROVIDER AND COMMUNITY LINKAGES C-7
Page 107 and 108: Provider and community linkagesC-81
Page 109: SHOCK S-1Shock is characterized by
Page 113 and 114: ShockS-5• If trauma is suspected
Page 115 and 116: VAGINAL BLEEDING IN EARLY PREGNANCY
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Page 127 and 128: S-18 Vaginal bleeding in later preg
Page 135 and 136: S-26 Vaginal bleeding after childbi
Page 145 and 146: HEADACHE, BLURRED VISION, CONVULSIO
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Headache, blurred vision, convulsio
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UNSATISFACTORY PROGRESS OF LABOUR S
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Unsatisfactory progress of labourS-
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MALPOSITIONS AND MALPRESENTATIONS S
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Malpositions and malpresentationsS-
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S-84 Shoulder dystociaFIGURE S-26As
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S-86 Shoulder dystocia
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S-88 Labour with an overdistended u
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S-94 Labour with a scarred uterus-
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S-96 Fetal distress in labour- If t
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S-98 Prolapsed cord- If breech pres
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S-100 Fever during pregnancy and la
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FEVER AFTER CHILDBIRTH S-107PROBLEM
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Fever after childbirthS-109Presenti
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Fever after childbirthS-111aGive he
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Fever after childbirthS-113• If t
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Fever after childbirthS-115- apply
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Fever after childbirthS-117• Remo
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ABDOMINAL PAIN IN EARLY PREGNANCY S
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Abdominal pain in early pregnancyS-
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Abdominal pain in early pregnancyS-
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S-120 Abdominal pain in later pregn
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S-126 Difficulty in breathingDIAGNO
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S-128 Difficulty in breathing- Give
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S-130 Difficulty in breathing
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LOSS OF FETAL MOVEMENTS S-131PROBLE
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Loss of fetal movementsS-133• Alt
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PRELABOUR RUPTURE OF MEMBRANES S-13
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Prelabour rupture of membranesS-137
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Prelabour rupture of membranesS-139
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IMMEDIATE NEWBORN CONDITIONS OR S-1
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Immediate newborn conditions or pro
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SECTION 3PROCEDURES
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P-2 Paracervical blocktry again. Ne
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P-4 Pudendal blockFIGURE P-2Perinea
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P-6 Pudendal block• Inject 10 mL
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P-8 Local anaesthesia for caesarean
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P-10 Local anaesthesia for caesarea
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P-12 Spinal anaesthesia• If the n
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KETAMINE P-13TABLE P-5Indications a
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EXTERNAL VERSION P-15• Review for
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INDUCTION AND AUGMENTATION OF LABOU
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Induction and augmentation of labou
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VACUUM EXTRACTION P-27Figure P-6 sh
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Vacuum extractionP-29• With the p
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Vacuum extractionP-31FAILURE• Vac
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FORCEPS DELIVERY P-33• Review for
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Forceps deliveryP-35- fetal heart r
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BREECH DELIVERY P-37• Review for
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Breech deliveryP-39• Hold the bab
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Breech deliveryP-41Note: Ask an ass
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Breech deliveryP-43extended at hip
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CAESAREAN SECTION P-43• Review fo
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Caesarean sectionP-45• Use two fi
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Caesarean sectionP-47• Hand the b
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Caesarean sectionP-49CLOSING THE AB
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Caesarean sectionP-51• Women with
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Caesarean sectionP-53• Grasp the
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P-54 SymphysiotomyAbduction of the
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P-56 Symphysiotomy• After separat
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P-58 Craniotomy and craniocentesis
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P-60 Craniotomy and craniocentesisA
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P-62 Dilatation and curettage- Take
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P-64 Dilatation and curettage- feve
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P-66 Manual vacuum aspiration• Di
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P-68 Manual vacuum aspiration• Qu
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CULDOCENTESIS AND COLPOTOMY P-69CUL
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Culdocentesis and colpotomyP-71•
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P-72 EpisiotomyFIGURE P-39Infiltrat
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P-74 Episiotomy- At the opening of
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P-76 Episiotomy
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P-78 Manual removal of placenta•
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P-80 Manual removal of placenta•
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P-2 Repair of cervical tears
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REPAIR OF VAGINAL AND PERINEAL TEAR
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P-84 Repair of vaginal and perineal
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CORRECTING UTERINE INVERSION P-91
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P-92 Correcting uterine inversionHY
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P-94 Correcting uterine inversion-
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P-96 Repair of ruptured uterus• S
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P-98 Repair of ruptured uterus• I
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UTERINE AND UTERO-OVARIAN ARTERY P-
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Uterine and utero-ovarian artery li
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POSTPARTUM HYSTERECTOMY P-103Postpa
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Postpartum hysterectomyP-105FIGURE
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Postpartum hysterectomyP-107• Clo
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Postpartum hysterectomyP-109POSTOPE
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P-110 Salpingectomy for ectopic pre
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P-112 Salpingectomy for ectopic pre
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INDEX A-3Abdominal distensiondiagno
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IndexA-5Atonic uterusdiagnosis, S-2
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IndexS-97transverse lie and, P-49tu
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IndexDescentassessment of, C-61Dext
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IndexFetal skull landmarks, C-62Fev
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Indexpostoperative care, P-108subto
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IndexA-15Maintenance fluid therapy,
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IndexA-17syphilis, management, S-15
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Indexgeneral management, S-25Pre-ec
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IndexA-21Stillbirthemotional consid
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IndexA-23anaesthesia options, C-45b
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Managing Complications in Pregnancy and Childbirth: - IAWG

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