Managing Complications in Pregnancy and Childbirth: - IAWG

Labour with an overdistended uterusS-89MULTIPLE PREGNANCYFIRST BABY• Start an IV infusion and slowly infuse IV fluids (page C-21).• Monitor fetuses by intermittent auscultation of the fetal heart rates.If there are fetal heart rate abnormalities (less than 100 or morethan 180 beats per minute), suspect fetal distress (page S-95).• Check presentation:- If a vertex presentation, allow labour to progress as for asingle vertex presentation (page C-57) and monitor progress inlabour using a partograph (page C-65);- If a breech presentation, apply the same guidelines as for asingleton breech presentation (page S-79) and monitorprogress in labour using a partograph (page C-65);- If a transverse lie, deliver by caesarean section (page P-43).Leave a clamp on the maternal end of the umbilical cord and donot attempt to deliver the placenta until the last baby is delivered.SECOND OR ADDITIONAL BABY(S)• Immediately after the first baby is delivered:- Palpate the abdomen to determine lie of additional baby;- Correct to longitudinal lie by external version (page P-15);- Check fetal heart rate(s).• Perform a vaginal examination to determine if:- the cord has prolapsed (page S-97);- the membranes are intact or ruptured.VERTEX PRESENTATION• If the head is not engaged, manoeuvre the head into the pelvismanually (hands on abdomen), if possible.• If the membranes are intact, rupture the membranes with anamniotic hook or a Kocher clamp.