Managing Complications in Pregnancy and Childbirth: - IAWG

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SALPINGECTOMY FOR ECTOPIC PREGNANCY P-109• Review for indications.• Review operative care principles (page C-47) and start an IVinfusion (page C-21).• Give a single dose of prophylactic antibiotics (page C-35):- ampicillin 2 g IV;- OR cefazolin 1 g IV.• Open the abdomen:- Make a midline vertical incision below the umbilicus to thepubic hair, through the skin and to the level of the fascia;- Make a 2–3 cm vertical incision in the fascia;- Hold the fascial edge with forceps and lengthen the incisionup and down using scissors;- Use fingers or scissors to separate the rectus muscles(abdominal wall muscles);- Use fingers to make an opening in the peritoneum near theumbilicus. Use scissors to lengthen the incision up and downin order to see the entire uterus. Carefully, to prevent bladderinjury, use scissors to separate layers and open the lower partof the peritoneum;- Place a bladder retractor over the pubic bone and place selfretainingabdominal retractors.• Identify and bring to view the fallopian tube with the ectopicgestation and its ovary.• Apply traction forceps (e.g. Babcock) to increase exposure andclamp the mesosalpinx to stop haemorrhage.• Aspirate blood from the lower abdomen and remove blood clots.• Apply gauze moistened with warm saline to pack off the bowel andomentum from the operative field.• Divide the mesosalpinx using a series of clamps (Fig P-58 A–C,page P-110). Apply each clamp close to the tubes to preserveovarian vasculature.• Transfix and tie the divided mesosalpinx with 2-0 chromic catgut (orpolyglycolic) suture before releasing the clamps.
P-110 Salpingectomy for ectopic pregnancy• Place a proximal suture around the tube at its isthmic end andexcise the tube.FIGURE P-58Clamping, dividing and cutting the mesosalpinx• Close the abdomen:- Ensure that there is no bleeding. Remove clots using asponge;- In all cases, check for injury to the bladder. If a bladder injuryis identified, repair the injury (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.
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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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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
Page 347 and 348: P-66 Manual vacuum aspiration• Di
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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
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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 and 388: UTERINE AND UTERO-OVARIAN ARTERY P-
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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: Postpartum hysterectomyP-109POSTOPE
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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