Managing Complications in Pregnancy and Childbirth: - IAWG

S-52 Headache, blurred vision, convulsions or loss of consciousness, elevated blood pressure• Monitor fetal growth and condition.• If there are no complications, deliver at term.• If pre-eclampsia develops, manage as mild pre-eclampsia (page S-42) or severe pre-eclampsia (page S-43).• If there are fetal heart rate abnormalities (less than 100 or morethan 180 beats per minute), suspect fetal distress (page S-95).• If fetal growth restriction is severe and pregnancy dating isaccurate, assess the cervix (page P-18) and consider delivery:Note: Assessment of gestation by ultrasound in late pregnancy isnot accurate.- If the cervix is favourable (soft, thin, partly dilated), rupturethe membranes with an amniotic hook or a Kocher clamp andinduce labour using oxytocin or prostaglandins (page P-17);- If the cervix is unfavourable (firm, thick, closed), ripen thecervix using prostaglandins or a Foley catheter (page P-24).• Observe for complications including abruptio placentae (page S-18) and superimposed pre-eclampsia (see Mild pre-eclampsia, pageS-42).TETANUSClostridium tetani may enter the uterine cavity on unclean instrumentsor hands, particularly during non-professional abortions or noninstitutionaldeliveries. The newborn is usually infected from uncleaninstruments used in cutting the cord or from contaminated substancesapplied as traditional cord dressings.Treatment should begin as soon as possible.• Control spasms with diazepam 10 mg IV slowly over 2 minutes. Ifspasms are severe, the woman may have to be paralyzed and puton a ventilator. This may be possible only at a tertiary care centre.• Provide general care:- Nurse in a quiet room but monitor closely;- Avoid unnecessary stimuli;- Maintain hydration and nutrition;