Managing Complications in Pregnancy and Childbirth: - IAWG

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P-16 External version- Reassess the fetal heart rate every 5 minutes;- If the fetal heart rate does not stabilize within the next 30minutes, deliver by caesarean section (page P-43).FIGURE P-5External version of a breech presentation.
INDUCTION AND AUGMENTATION OF LABOUR P-17Induction of labour and augmentation of labour are performed fordifferent indications but the methods are the same.• Induction of labour: stimulating the uterus to begin labour.• Augmentation of labour: stimulating the uterus during labour toincrease the frequency, duration and strength of contractions.A good labour pattern is established when there are three contractionsin 10 minutes, each lasting more than 40 seconds.If the membranes are intact, it is recommended practice in bothinduction and augmentation of labour to first perform artificial ruptureof membranes (ARM). In some cases, this is all that is needed to inducelabour. Membrane rupture, whether spontaneous or artificial, often setsoff the following chain of events:- Amniotic fluid is expelled;- Uterine volume is decreased;- Prostaglandins are produced, stimulating labour;- Uterine contractions begin (if the woman is not in labour) orbecome stronger (if she is already in labour).ARTIFICIAL RUPTURE OF MEMBRANES• Review for indications.Note: In areas of high HIV prevalence it is prudent to leave themembranes intact for as long as possible to reduce perinataltransmission of HIV.• Listen to and note the fetal heart rate.• Ask the woman to lie on her back with her legs bent, feet togetherand knees apart.• Wearing high-level disinfected gloves, use one hand to examinethe cervix and note the consistency, position, effacement anddilatation.• Use the other hand to insert an amniotic hook or a Kocher clampinto the vagina.• Guide the clamp or hook towards the membranes along the fingersin the vagina.
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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
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Fever after childbirthS-113• If t
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Fever after childbirthS-115- apply
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Fever after childbirthS-117• Remo
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ABDOMINAL PAIN IN EARLY PREGNANCY S
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Abdominal pain in early pregnancyS-
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Abdominal pain in early pregnancyS-
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S-120 Abdominal pain in later pregn
Page 243 and 244: S-122 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: EXTERNAL VERSION P-15• Review for
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
Page 331 and 332: Caesarean sectionP-51• Women with
Page 333 and 334: Caesarean sectionP-53• Grasp the
Page 335 and 336: P-54 SymphysiotomyAbduction of the
Page 337 and 338: P-56 Symphysiotomy• After separat
Page 339 and 340: P-58 Craniotomy and craniocentesis
Page 341 and 342: P-60 Craniotomy and craniocentesisA
Page 343 and 344: 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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