Managing Complications in Pregnancy and Childbirth: - IAWG

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Abdominal pain in later pregnancy and after childbirthS-125If preterm labour continues despite use of tocolytic drugs,arrange for the baby to receive care at the most appropriateservice with neonatal facilities.TABLE S-17Tocolytic drugs a to stop uterine contractionsDrugInitialDoseSubsequent DoseSide Effects andPrecautionsSalbutamolIndomethacin10 mg in 1 LIV fluids.Start IVinfusion at10 dropsper minute.100 mgloading doseby mouth orrectumIf contractionspersist, increaseinfusion rate by 10drops per minuteevery 30 minutesuntil contractionsstop or maternalpulse rate exceeds120 per minute.If contractions stop,maintain the sameinfusion rate for atleast 12 hours afterthe last contraction.25 mg every 6 hoursfor 48 hoursa Alternative drugs include terbutaline, nifedipine and ritodrine.ALLOWING LABOUR TO PROGRESS• Allow labour to progress if:- gestation is more than 37 weeks;- the cervix is more than 3 cm dilated;- there is active bleeding;If maternal heartrate increases (morethan 120 per minute),reduce infusion rate; Ifthe woman isanaemic, use withcaution.If steroids andsalbutamol are used,maternal pulmonaryoedema may occur.Restrict fluids,maintain fluid balanceand stop drug.If gestation is morethan 32 weeks, avoiduse to preventpremature closure offetal ductus arteriosus.Do not use for morethan 48 hours.
S-126 Abdominal pain in later pregnancy and after childbirth- the fetus is distressed, dead or has an anomaly incompatiblewith survival;- there is amnionitis or pre-eclampsia.• Monitor progress of labour using the partograph (page C-65).Note: Avoid delivery by vacuum extraction as the risks ofintracranial haemorrhage in the preterm baby are high.• Prepare for management of preterm or low birth weight baby andanticipate the need for resuscitation (page S-141).
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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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UNSATISFACTORY PROGRESS OF LABOUR S
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Unsatisfactory progress of labourS-
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MALPOSITIONS AND MALPRESENTATIONS S
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Malpositions and malpresentationsS-
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Page 195 and 196: Malpositions and malpresentationsS-
Page 197 and 198: 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 223 and 224: FEVER AFTER CHILDBIRTH S-107PROBLEM
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 243 and 244: S-122 Abdominal pain in later pregn
Page 245: S-124 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
Page 277 and 278: SECTION 3PROCEDURES
Page 279 and 280: P-2 Paracervical blocktry again. Ne
Page 281 and 282: P-4 Pudendal blockFIGURE P-2Perinea
Page 283 and 284: P-6 Pudendal block• Inject 10 mL
Page 285 and 286: P-8 Local anaesthesia for caesarean
Page 287 and 288: P-10 Local anaesthesia for caesarea
Page 289 and 290: P-12 Spinal anaesthesia• If the n
Page 291 and 292: KETAMINE P-13TABLE P-5Indications a
Page 293 and 294: EXTERNAL VERSION P-15• Review for
Page 295 and 296: 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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