Managing Complications in Pregnancy and Childbirth: - IAWG

S-16 Vaginal bleeding in early pregnancypregnancy, blood is contaminated with amniotic fluid, etc. and shouldnot be used for autotransfusion). The blood can be collected prior tosurgery or after the abdomen is opened:• When the woman is on the operating table prior to surgery and theabdomen is distended with blood, it is sometimes possible to inserta needle through the abdominal wall and collect the blood in adonor set.• Alternatively, open the abdomen:- Scoop the blood into a basin and strain through gauze toremove clots;- Clean the top portion of a blood donor bag with antisepticsolution and open it with a sterile blade;- Pour the woman’s blood into the bag and reinfuse it through afiltered set in the usual way;- If a donor bag with anticoagulant is not available, add sodiumcitrate 10 mL to each 90 mL of blood.SUBSEQUENT MANAGEMENT• Prior to discharge, provide counselling and advice on prognosisfor fertility. Given the increased risk of future ectopic pregnancy,family planning counselling and provision of a family planningmethod, if desired, is especially important (Table S-3, page S-13).• Correct anaemia with ferrous sulfate or ferrous fumerate 60 mg bymouth daily for 6 months.• Schedule a follow-up visit at 4 weeks.MOLAR PREGNANCYMolar pregnancy is characterized by an abnormal proliferation ofchorionic villi.IMMEDIATE MANAGEMENT• If the diagnosis of molar pregnancy is certain, evacuate theuterus:- If cervical dilatation is needed, use a paracervical block (pageP-1);