Managing Complications in Pregnancy and Childbirth: - IAWG

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P-50 Caesarean sectionBABY IS BREECH• If the baby is breech, grasp a foot and deliver it through theincision.• Complete the delivery as in a vaginal breech delivery (page P-37):- Deliver the legs and the body up to the shoulders, then deliverthe arms;- Flex (bend) the head using the Mauriceau Smellie Veitmanoeuvre (page P-40).BABY IS TRANSVERSETHE BABY’S BACK IS UP• If the back is up (near the top of the uterus), reach into the uterusand find the baby’s ankles.• Grasp the ankles and pull gently through the incision to deliver thelegs and complete the delivery as for a breech baby (page P-38).THE BABY’S BACK IS DOWN• If the back is down, a high vertical uterine incision is the preferredincision (page P-50).• After the incision is made, reach into the uterus and find the feet.Pull them through the incision and complete the delivery as for abreech baby (page P-38).• To repair the vertical incision, you will need several layers ofsuture (page P-50).PLACENTA PRAEVIA• If a low anterior placenta is encountered, incise through it anddeliver the fetus.• After delivery of the baby, if the placenta cannot be detachedmanually, the diagnosis is placenta accreta, a common finding atthe site of a previous caesarean scar. Perform a hysterectomy (pageP-103).
Caesarean sectionP-51• Women with placenta praevia are at high risk of postpartumhaemorrhage. If there is bleeding at the placental site, under-runthe bleeding sites with chromic catgut (or polyglycolic) sutures.• Watch for bleeding in the immediate postpartum period and takeappropriate action (page S-25).POST-PROCEDURE CARE• Review postoperative care principles (page C-52).• If bleeding occurs:- Massage the uterus to expel blood and blood clots. Presenceof blood clots will inhibit effective uterine contractions;- Give oxytocin 20 units in 1 L IV fluids (normal saline orRinger’s lactate) at 60 drops per minute and ergometrine 0.2 mgIM and prostaglandins (Table S-8, page S-28). These drugscan be given together or sequentially.• If there are signs of infection or the woman currently has fever,give a combination of antibiotics until she is fever-free for 48 hours(page C-35):- ampicillin 2 g IV every 6 hours;- PLUS gentamicin 5 mg/kg body weight IV every 24 hours;- PLUS metronidazole 500 mg IV every 8 hours.• Give appropriate analgesic drugs (page C-37).HIGH VERTICAL (“CLASSICAL”) INCISION• Open the abdomen through a midline incision skirting theumbilicus. Approximately one-third of the incision should be abovethe umbilicus and two-thirds below.• Use a scalpel to make the incision:- Check the position of the round ligaments and ensure that theincision is in the midline (the uterus may have twisted to oneside);- Make the uterine incision in the midline over the fundus of theuterus;
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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
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S-126 Difficulty in breathingDIAGNO
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S-128 Difficulty in breathing- Give
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S-130 Difficulty in breathing
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LOSS OF FETAL MOVEMENTS S-131PROBLE
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Loss of fetal movementsS-133• Alt
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PRELABOUR RUPTURE OF MEMBRANES S-13
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Prelabour rupture of membranesS-137
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Prelabour rupture of membranesS-139
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IMMEDIATE NEWBORN CONDITIONS OR S-1
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Immediate newborn conditions or pro
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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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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: Caesarean sectionP-49CLOSING THE AB
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
Page 345 and 346: P-64 Dilatation and curettage- feve
Page 347 and 348: P-66 Manual vacuum aspiration• Di
Page 349 and 350: P-68 Manual vacuum aspiration• Qu
Page 351 and 352: CULDOCENTESIS AND COLPOTOMY P-69CUL
Page 353 and 354: Culdocentesis and colpotomyP-71•
Page 355 and 356: P-72 EpisiotomyFIGURE P-39Infiltrat
Page 357 and 358: P-74 Episiotomy- At the opening of
Page 359 and 360: P-76 Episiotomy
Page 361 and 362: P-78 Manual removal of placenta•
Page 363 and 364: P-80 Manual removal of placenta•
Page 365 and 366: P-2 Repair of cervical tears
Page 367 and 368: REPAIR OF VAGINAL AND PERINEAL TEAR
Page 369 and 370: P-84 Repair of vaginal and perineal
Page 377 and 378: CORRECTING UTERINE INVERSION P-91
Page 379 and 380: 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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