Managing Complications in Pregnancy and Childbirth: - IAWG

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PUDENDAL BLOCK P-3TABLE P-2Indications and precautions for pudendal blockIndications• Instrumental or breech delivery• Episiotomy and repair of perinealtears• Craniotomy or craniocentesis• Manual removal of placentaPrecautions• Make sure there are no knownallergies to lignocaine or relateddrugs• Do not inject into a vessel• Review general care principles (page C-17).• Prepare 40 mL 0.5% lignocaine solution without adrenaline (page C-39).Note: It is best to limit the pudendal block to 30 mL of solution sothat a maximum of 10 mL of additional solution may be injected intothe perineum during repair of tears, if needed.• Use a 15 cm, 22-gauge needle to inject the lignocaine.The target is the pudendal nerve as it passes through the lesser sciaticnotch. There are two approaches:• through the perineum;• through the vagina.The perineal approach requires no special instrument. For the vaginalapproach, a special needle guide (“trumpet”), if available, providesprotection for the provider’s fingers.PERINEAL APPROACH• Infiltrate the perineal skin on both sides of the vagina using 10 mLof lignocaine solution.Note: Aspirate (pull back on the plunger) to be sure that no vesselhas been penetrated. If blood is returned in the syringe withaspiration, remove the needle. Recheck the position carefully andtry again. Never inject if blood is aspirated. The woman can sufferconvulsions and death if IV injection of lignocaine occurs.• Wearing high-level disinfected gloves, place two fingers in thevagina and guide the needle through the perineal tissue to the tipof the woman’s left ischial spine (Fig P-2, page P-4).
P-4 Pudendal blockFIGURE P-2Perineal approach• Inject 10 mL of lignocaine solution in the angle between the ischialspine and the ischial tuberosity.• Pass the needle through the sacrospinous ligament and injectanother 10 mL of lignocaine solution.• Repeat the procedure on the opposite side.• If an episiotomy is to be performed, infiltrate the episiotomy site inthe usual manner at this time (page P-71).• At the conclusion of the set of injections, wait 2 minutes and thenpinch the area with forceps. If the woman can feel the pinch, wait 2more minutes and then retest.Anaesthetize early to provide sufficient time for effect.
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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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S-84 Shoulder dystociaFIGURE S-26As
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S-86 Shoulder dystocia
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S-88 Labour with an overdistended u
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S-94 Labour with a scarred uterus-
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S-96 Fetal distress in labour- If t
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S-98 Prolapsed cord- If breech pres
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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
Page 229 and 230: Fever after childbirthS-113• If t
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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
Page 277 and 278: SECTION 3PROCEDURES
Page 279: P-2 Paracervical blocktry again. Ne
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
Page 297 and 298: Induction and augmentation of labou
Page 305 and 306: VACUUM EXTRACTION P-27Figure P-6 sh
Page 307 and 308: Vacuum extractionP-29• With the p
Page 309 and 310: Vacuum extractionP-31FAILURE• Vac
Page 311 and 312: FORCEPS DELIVERY P-33• Review for
Page 313 and 314: Forceps deliveryP-35- fetal heart r
Page 315 and 316: BREECH DELIVERY P-37• Review for
Page 317 and 318: Breech deliveryP-39• Hold the bab
Page 319 and 320: Breech deliveryP-41Note: Ask an ass
Page 321 and 322: Breech deliveryP-43extended at hip
Page 323 and 324: CAESAREAN SECTION P-43• Review fo
Page 325 and 326: Caesarean sectionP-45• Use two fi
Page 327 and 328: Caesarean sectionP-47• Hand the b
Page 329 and 330: 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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