Managing Complications in Pregnancy and Childbirth: - IAWG

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C-42 Anaesthesia and analgesiaAllergy Mild Toxicity Severe Toxicity Life-ThreateningToxicity (veryrare)• Shock• Redness ofskin• Skin rash/hives• Bronchospasm• Vomiting• Serum sickness• Numbness oflips and tongue• Metallic tastein mouth• Dizziness/lightheadedness• Ringing in ears• Difficulty infocusing eyes• Sleepiness• Disorientation• Muscletwitching andshivering• Slurred speech• Tonic-clonicconvulsions• Respiratorydepression orarrest• Cardiacdepression orarrest
Anaesthesia and analgesiaC-43MANAGEMENT OF LIGNOCAINE ALLERGY• Give adrenaline 1:1 000, 0.5 mL IM, repeated every 10 minutes ifnecessary.• In acute situations, give hydrocortisone 100 mg IV every hour.• To prevent recurrence, give diphenhydramine 50 mg IM or IVslowly, then 50 mg by mouth every 6 hours.• Treat bronchospasm with aminophylline 250 mg in normal saline 10mL IV slowly.• Laryngeal oedema may require immediate tracheostomy.• For shock, begin standard shock management (page S-1).• Severe or recurrent signs may require corticosteroids (e.g.hydrocortisone IV 2 mg/kg body weight every 4 hours untilcondition improves). In chronic situations give prednisone 5 mg orprednisolone 10 mg by mouth every 6 hours until conditionimproves.MANAGEMENT OF LIGNOCAINE TOXICITYSymptoms and signs of toxicity (Table C-5, page C-41) should alert thepractitioner to immediately stop injecting and prepare to treat severeand life-threatening side effects. If symptoms and signs of mild toxicityare observed, wait a few minutes to see if the symptoms subside, checkvital signs, talk to the woman and then continue the procedure, ifpossible.CONVULSIONS• Turn the woman to her left side, insert an airway and aspiratesecretions.• Give oxygen at 6–8 L per minute by mask or nasal cannulae.• Give diazepam 1–5 mg IV in 1 mg increments. Repeat if convulsionsrecur.Note: The use of diazepam to treat convulsions may causerespiratory depression.RESPIRATORY ARREST• If the woman is not breathing, assist ventilation using an Ambubag and mask or via endotracheal tube; Give oxygen at 4–6 L perminute.
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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,
Page 14 and 15: xAbbreviations
Page 16 and 17: xiiList of diagnoses
Page 18 and 19: RAPID INITIAL ASSESSMENT C-1When a
Page 20 and 21: Rapid initial assessmentC-3Abdomina
Page 22 and 23: TALKING WITH WOMEN AND THEIR FAMILI
Page 24 and 25: EMOTIONAL AND PSYCHOLOGICAL SUPPORT
Page 26 and 27: Emotional and psychological support
Page 33 and 34: C-16 Emotional and psychological su
Page 35 and 36: C-16 Emergencies• If the woman is
Page 37 and 38: C-18 General care principles- after
Page 39 and 40: C-20 General care principlesaGloves
Page 41 and 42: C-22 General care principles- weari
Page 43 and 44: C-24 General care principles• Nev
Page 45 and 46: C-24 Clinical use of blood, blood p
Page 57 and 58: ANTIBIOTIC THERAPY C-35Infection du
Page 59 and 60: ANAESTHESIA AND ANALGESIA C-37Pain
Page 61 and 62: Anaesthesia and analgesiaC-39• Gi
Page 63: Anaesthesia and analgesiaC-41TABLE
Page 67 and 68: Anaesthesia and analgesiaC-45- Give
Page 69 and 70: Anaesthesia and analgesiaC-47Proced
Page 71 and 72: OPERATIVE CARE PRINCIPLES C-47The w
Page 73 and 74: Operative care principlesC-49• Ho
Page 75 and 76: Operative care principlesC-51HAEMOS
Page 77 and 78: Operative care principlesC-53- Plac
Page 79 and 80: Operative care principlesC-55A urin
Page 81 and 82: NORMAL LABOUR AND CHILDBIRTH C-57NO
Page 83 and 84: Normal labour and childbirthC-59- E
Page 85 and 86: Normal labour and childbirthC-61•
Page 93 and 94: Normal labour and childbirthC-69FIG
Page 95 and 96: Normal labour and childbirthC-71FIG
Page 99 and 100: Normal labour and childbirthC-75Not
Page 101 and 102: Normal labour and childbirthC-77Nev
Page 103 and 104: NEWBORN CARE PRINCIPLES C-77When a
Page 105 and 106: PROVIDER AND COMMUNITY LINKAGES C-7
Page 107 and 108: Provider and community linkagesC-81
Page 109 and 110: SHOCK S-1Shock is characterized by
Page 111 and 112: ShockS-3BEDSIDE CLOTTING TEST• As
Page 113 and 114: 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
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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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