Managing Complications in Pregnancy and Childbirth: - IAWG

S-90 Labour with an overdistended uterus• Check fetal heart rate between contractions.• If contractions are inadequate after birth of first baby, augmentlabour with oxytocin using rapid escalation (Table P-8, page P-23) to produce good contractions (three contractions in 10minutes, each lasting more than 40 seconds).• If spontaneous delivery does not occur within 2 hours of goodcontractions or if there are fetal heart rate abnormalities (less than100 or more than 180 beats per minute), deliver by caesareansection (page P-43).BREECH PRESENTATION• If the baby is estimated to be no larger than the first baby, and ifthe cervix has not contracted, consider vaginal delivery (page C-71):- If there are inadequate or no contractions after birth of firstbaby, escalate oxytocin infusion at a rapid rate (Table P-8,page P-23) to produce good contractions (three contractionsin 10 minutes, each lasting more than 40 seconds);- If the membranes are intact and the breech has descended,rupture the membranes with an amniotic hook or a Kocherclamp (page P-17);- Check fetal heart rate between contractions. If there are fetalheart rate abnormalities (less than 100 or more than 180 beatsper minute), deliver by breech extraction (page P-42);• If vaginal delivery is not possible, deliver by caesarean section(page P-43).TRANSVERSE LIE• If the membranes are intact, attempt external version (page P-15);• If external version fails and the cervix is fully dilated andmembranes are still intact, attempt internal podalic version:Note: Do not attempt internal podalic version if the provider isuntrained, the membranes have ruptured and the amniotic fluid hasdrained, or if the uterus is scarred. Do not persist if the baby doesnot turn easily.- Wearing high-level disinfected gloves, insert a hand into theuterus and grasp the baby’s foot;