Managing Complications in Pregnancy and Childbirth: - IAWG

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P-100 Uterine and utero-ovarian artery ligation• Ligate the utero-ovarian artery just below the point where theovarian suspensory ligament joins the uterus (Fig P-53).• Repeat on the other side.• Observe for continued bleeding or formation of haematoma.FIGURE P-53Sites for ligating uterine and utero-ovarian arteries• Close the abdomen:- Ensure that there is no bleeding. Remove clots using asponge.- Examine carefully for injuries to the bladder and repair anyfound (page P-97).- Close the fascia with continuous 0 chromic catgut (orpolyglycolic) suture.Note: There is no need to close the bladder peritoneum or theabdominal peritoneum.- If there are signs of infection, pack the subcutaneous tissuewith gauze and place loose 0 catgut (or polyglycolic) sutures.Close the skin with a delayed closure after the infection hascleared.- If there are no signs of infection, close the skin with verticalmattress sutures of 3-0 nylon (or silk) and apply a steriledressing.POST-PROCEDURE CARE• Review postoperative care principles (page C-52).
Uterine and utero-ovarian artery ligationP-101• 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).• If there are no signs of infection, remove the abdominal drain after48 hours.• Offer other health services, if possible (page S-13).
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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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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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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
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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
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Page 383 and 384: P-96 Repair of ruptured uterus• S
Page 385 and 386: P-98 Repair of ruptured uterus• I
Page 387: UTERINE AND UTERO-OVARIAN ARTERY P-
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
Page 405 and 406: INDEX A-3Abdominal distensiondiagno
Page 407 and 408: IndexA-5Atonic uterusdiagnosis, S-2
Page 409 and 410: IndexS-97transverse lie and, P-49tu
Page 411 and 412: IndexDescentassessment of, C-61Dext
Page 413 and 414: IndexFetal skull landmarks, C-62Fev
Page 415 and 416: Indexpostoperative care, P-108subto
Page 417 and 418: IndexA-15Maintenance fluid therapy,
Page 419 and 420: IndexA-17syphilis, management, S-15
Page 421 and 422: Indexgeneral management, S-25Pre-ec
Page 423 and 424: IndexA-21Stillbirthemotional consid
Page 425 and 426: IndexA-23anaesthesia options, C-45b
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Managing Complications in Pregnancy and Childbirth: - IAWG

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