Managing Complications in Pregnancy and Childbirth: - IAWG

S-50 Headache, blurred vision, convulsions or loss of consciousness, elevated blood pressure- If the cervix is unfavourable (firm, thick, closed), ripen thecervix using misoprostol, prostaglandins or a Foley catheter(page P-24).Note: If caesarean section is performed, ensure that:• Coagulopathy has been ruled out;• Safe general anaesthesia is available. Spinal anaesthesia isassociated with the risk of hypotension. This risk can be reduced ifadequate IV fluids (500–1 000 mL) are infused prior toadministration of the anaesthetic (page P-11).Do not use local anaesthesia or ketamine in women with preeclampsiaor eclampsia.POSTPARTUM CARE• Anticonvulsive therapy should be maintained for 24 hours afterdelivery or the last convulsion, whichever occurs last.• Continue antihypertensive therapy as long as the diastolicpressure is 110 mm Hg or more.• Continue to monitor urine output.REFERRAL FOR TERTIARY LEVEL CAREConsider referral of women who have:• oliguria that persists for 48 hours after delivery;• coagulation failure [e.g. coagulopathy (page S-19) or haemolysis,elevated liver enzymes and low platelets (HELLP) syndrome];• persistent coma lasting more than 24 hours after convulsion.COMPLICATIONS OF PREGNANCY-INDUCED HYPERTENSIONComplications may cause adverse perinatal and maternal outcomes.Because complications are often difficult to treat, efforts should bemade to prevent them by early diagnosis and proper management.Health care providers should be aware that management can also leadto complications. Manage complications as follows: