Managing Complications in Pregnancy and Childbirth: - IAWG

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S-44 Headache, blurred vision, convulsions or loss of consciousness, elevated blood pressure- If the signs remain unchanged, keep the woman in thehospital. Continue the same management and monitor fetalgrowth by symphysis-fundal height;- If there are signs of growth restriction, consider earlydelivery. If not, continue hospitalization until term.• If urinary protein level increases, manage as severe pre-eclampsia(see below).Note: Symptoms and signs of pre-eclampsia do not completelydisappear until after pregnancy ends.GESTATION MORE THAN 37 COMPLETE WEEKSIf there are signs of fetal compromise, assess the cervix (page P-18) andexpedite delivery:• If the cervix is favourable (soft, thin, partly dilated), rupture themembranes with an amniotic hook or a Kocher clamp and inducelabour using oxytocin or prostaglandins (page P-17).• If the cervix is unfavourable (firm, thick, closed), ripen the cervixusing prostaglandins or a Foley catheter (page P-24) or deliver bycaesarean section (page P-43).SEVERE PRE-ECLAMPSIA AND ECLAMPSIASevere pre-eclampsia and eclampsia are managed similarly with theexception that delivery must occur within 12 hours of onset ofconvulsions in eclampsia. ALL cases of severe pre-eclampsia should bemanaged actively. Symptoms and signs of “impending eclampsia”(blurred vision, hyperreflexia) are unreliable and expectant managementis not recommended.MANAGEMENT DURING A CONVULSION• Give anticonvulsive drugs (page S-44).• Gather equipment (airway, suction, mask and bag, oxygen) andgive oxygen at 4–6 L per minute.• Protect the woman from injury but do not actively restrain her.• Place the woman on her left side to reduce risk of aspiration ofsecretions, vomit and blood.
Headache, blurred vision, convulsions or loss of consciousness, elevated blood pressureS-45• After the convulsion, aspirate the mouth and throat as necessary.
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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
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ANAESTHESIA AND ANALGESIA C-37Pain
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Anaesthesia and analgesiaC-39• Gi
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Anaesthesia and analgesiaC-41TABLE
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Anaesthesia and analgesiaC-43MANAGE
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Anaesthesia and analgesiaC-45- Give
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Anaesthesia and analgesiaC-47Proced
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OPERATIVE CARE PRINCIPLES C-47The w
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Operative care principlesC-49• Ho
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Operative care principlesC-51HAEMOS
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Operative care principlesC-53- Plac
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Operative care principlesC-55A urin
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NORMAL LABOUR AND CHILDBIRTH C-57NO
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Normal labour and childbirthC-59- E
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Normal labour and childbirthC-61•
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Normal labour and childbirthC-69FIG
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Normal labour and childbirthC-71FIG
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Normal labour and childbirthC-75Not
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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 and 110: SHOCK S-1Shock is characterized by
Page 111 and 112: ShockS-3BEDSIDE CLOTTING TEST• As
Page 113 and 114: ShockS-5• If trauma is suspected
Page 115 and 116: VAGINAL BLEEDING IN EARLY PREGNANCY
Page 117 and 118: Vaginal bleeding in early pregnancy
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
Page 147 and 148: Headache, blurred vision, convulsio
Page 153: Headache, blurred vision, convulsio
Page 171 and 172: UNSATISFACTORY PROGRESS OF LABOUR S
Page 173 and 174: Unsatisfactory progress of labourS-
Page 183 and 184: MALPOSITIONS AND MALPRESENTATIONS S
Page 185 and 186: Malpositions and malpresentationsS-
Page 199 and 200: S-84 Shoulder dystociaFIGURE S-26As
Page 201 and 202: S-86 Shoulder dystocia
Page 203 and 204: S-88 Labour with an overdistended u
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S-90 Labour with an overdistended u
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S-92 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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