Managing Complications in Pregnancy and Childbirth: - IAWG

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P-70 Culdocentesis and colpotomyectopic pregnancy and further observations and tests may beneeded (page S-13).• If no fluid is obtained, remove the needle, re-insert it and aspirateagain. If no fluid is obtained, the woman may have an unrupturedectopic pregnancy (page S-13).• If pus is obtained, keep the needle in place and proceed tocolpotomy (see below).COLPOTOMYIf pus is obtained on culdocentesis, keep the needle in place and make astab incision at the site of the puncture:• Remove the needle and insert blunt forceps or a finger through theincision to break loculi in the abscess cavity (Fig P-38);FIGURE P-38Colpotomy for pelvic abscess• Allow the pus to drain;• Insert a high-level disinfected soft rubber corrugated drain throughthe incision;Note: A drain can be prepared by cutting off the fingertips of ahigh-level disinfected rubber glove.• If required, use a stitch through the drain to anchor it in the vagina;• Remove the drain when there is no more drainage of pus.
Culdocentesis and colpotomyP-71• If no pus is obtained, the abscess may be higher than the pouch ofDouglas. A laparotomy will be required for peritoneal lavage(wash-out).
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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
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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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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
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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
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Page 323 and 324: CAESAREAN SECTION P-43• Review fo
Page 325 and 326: Caesarean sectionP-45• Use two fi
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Page 329 and 330: Caesarean sectionP-49CLOSING THE AB
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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: CULDOCENTESIS AND COLPOTOMY P-69CUL
Page 355 and 356: P-72 EpisiotomyFIGURE P-39Infiltrat
Page 357 and 358: P-74 Episiotomy- At the opening of
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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
Page 381 and 382: P-94 Correcting uterine inversion-
Page 383 and 384: P-96 Repair of ruptured uterus• S
Page 385 and 386: P-98 Repair of ruptured uterus• I
Page 387 and 388: UTERINE AND UTERO-OVARIAN ARTERY P-
Page 389 and 390: Uterine and utero-ovarian artery li
Page 391 and 392: POSTPARTUM HYSTERECTOMY P-103Postpa
Page 393 and 394: Postpartum hysterectomyP-105FIGURE
Page 395 and 396: Postpartum hysterectomyP-107• Clo
Page 397 and 398: Postpartum hysterectomyP-109POSTOPE
Page 399 and 400: P-110 Salpingectomy for ectopic pre
Page 401 and 402: 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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