Managing Complications in Pregnancy and Childbirth: - IAWG

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S-58 Unsatisfactory progress of labour• Presentation other than vertex with occiputanteriorCervix fully dilated and woman has urge to push, butthere is no descent• Malpresentation ormalposition, page S-69Prolonged expulsivephase, page S-67Figure S-6, page S-59 is a sample partograph for prolonged activephase of labour:• The woman was admitted in active labour at 10 AM:- fetal head 5/5 palpable;- cervix dilated 4 cm;- inadequate contractions (two in 10 minutes, each lasting lessthan 20 seconds).• At 2 PM:- fetal head still 5/5 palpable;- cervix dilated 4 cm and to the right of the alert line;- membranes ruptured spontaneously and amniotic fluid is clear;- inadequate uterine contractions (one in 10 minutes, lastingless than 20 seconds).• At 6 PM:- fetal head still 5/5 palpable;- cervix dilated 6 cm;- contractions still inadequate (two in 10 minutes, each lastingless than 20 seconds).• At 9 PM:- fetal heart rate 80 per minute;- amniotic fluid stained with meconium;- no further progress in labour.• Caesarean section was performed at 9:20 PM due to fetal distress.• Note that the partograph was not adequately filled out. Thediagnosis of prolonged labour was evident at 2 PM and labourshould have been augmented with oxytocin at that time.
Unsatisfactory progress of labourS-59FIGURE S-6 Partograph showing prolonged active phase of labour
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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
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NEWBORN CARE PRINCIPLES C-77When a
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PROVIDER AND COMMUNITY LINKAGES C-7
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Provider and community linkagesC-81
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SHOCK S-1Shock is characterized by
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ShockS-3BEDSIDE CLOTTING TEST• As
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ShockS-5• If trauma is suspected
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VAGINAL BLEEDING IN EARLY PREGNANCY
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Vaginal bleeding in early pregnancy
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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
Page 147 and 148: Headache, blurred vision, convulsio
Page 171: UNSATISFACTORY PROGRESS OF LABOUR S
Page 175 and 176: 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
Page 209 and 210: S-94 Labour with a scarred uterus-
Page 211 and 212: S-96 Fetal distress in labour- If t
Page 213 and 214: S-98 Prolapsed cord- If breech pres
Page 215 and 216: 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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