Managing Complications in Pregnancy and Childbirth: - IAWG

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Fever during pregnancy and labourS-107manage as a mixed infection (see below). Treatment options forconfirmed chloroquine-resistant vivax malaria include:• quinine salt (dihydrochloride or sulfate) 10 mg/kg body weight bymouth twice daily for 7 days;Note: The dose of quinine is less than that used for falciparummalaria; diagnosis of species is essential.• OR mefloquine 15 mg/kg body weight by mouth as a single dose;• OR sulfadoxine/pyrimethamine 3 tablets by mouth as a single dose;Note: Sulfadoxine/pyrimethamine is not generally recommendedbecause it acts slowly to clear vivax parasites.• OR artesunate 4 mg/kg body weight by mouth in a divided loadingdose on day 1 followed by 2 mg/kg body weight daily for 6 days.TREATMENT OF LIVER STAGES OF VIVAX MALARIAVivax malaria may remain dormant in the liver. From time to time, thesedormant stages are released into the blood to cause a new, symptomaticvivax infection. Primaquine can be used to clear the liver stages but itsuse is not acceptable during pregnancy. Primaquine should be usedafter delivery. Dose regimes vary by geographic region; use the doserecommended in the national guidelines.AREAS OF MIXED FALCIPARUM-VIVAX MALARIAIn areas of mixed transmission, the proportions of malaria species andtheir drug sensitivity patterns vary. Referral to the national treatmentguidelines is essential. If microscopic diagnosis is available, specifictreatment can be prescribed. Where unavailable, options include:• assume the infection is due to P. falciparum and treat accordingly(follow national guidelines);• in areas of chloroquine-resistant but sulfadoxine/pyrimethaminesensitive P. falciparum and chloroquine sensitive P. vivax, treatwith standard dose chloroquine and standard dose sulfadoxine/pyrimethamine.
FEVER AFTER CHILDBIRTH S-107PROBLEM• A woman has a fever (temperature 38°C or more) occurring morethan 24 hours after delivery.GENERAL MANAGEMENT• Encourage bed rest.• Ensure adequate hydration by mouth or IV.• Use a fan or tepid sponge to help decrease temperature.• If shock is suspected, immediately begin treatment (page S-1).Even if signs of shock are not present, keep shock in mind as youevaluate the woman further because her status may worsen rapidly.If shock develops, it is important to begin treatment immediately.
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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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S-18 Vaginal bleeding in later preg
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S-26 Vaginal bleeding after childbi
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HEADACHE, BLURRED VISION, CONVULSIO
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Headache, blurred vision, convulsio
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Page 171 and 172: UNSATISFACTORY PROGRESS OF LABOUR S
Page 173 and 174: 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
Page 221: S-106 Fever during pregnancy and la
Page 225 and 226: Fever after childbirthS-109Presenti
Page 227 and 228: Fever after childbirthS-111aGive he
Page 229 and 230: Fever after childbirthS-113• If t
Page 231 and 232: Fever after childbirthS-115- apply
Page 233 and 234: Fever after childbirthS-117• Remo
Page 235 and 236: ABDOMINAL PAIN IN EARLY PREGNANCY S
Page 237 and 238: Abdominal pain in early pregnancyS-
Page 239 and 240: Abdominal pain in early pregnancyS-
Page 241 and 242: S-120 Abdominal pain in later pregn
Page 249 and 250: S-126 Difficulty in breathingDIAGNO
Page 251 and 252: S-128 Difficulty in breathing- Give
Page 253 and 254: S-130 Difficulty in breathing
Page 255 and 256: LOSS OF FETAL MOVEMENTS S-131PROBLE
Page 257 and 258: Loss of fetal movementsS-133• Alt
Page 259 and 260: PRELABOUR RUPTURE OF MEMBRANES S-13
Page 261 and 262: Prelabour rupture of membranesS-137
Page 263 and 264: Prelabour rupture of membranesS-139
Page 265 and 266: IMMEDIATE NEWBORN CONDITIONS OR S-1
Page 267 and 268: Immediate newborn conditions or pro
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Immediate newborn conditions or pro
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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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