Contents:

Rapid initial assessment

Emotional and psychological support

General care principles C17

Clinical use of blood blood products and replacement fluids C23

Antibiotic therapy C35

Operative care principles C47

Normal labour and childbirth C57

Newborn care principles C77

Abdominal pain in later pregnancy and after childbirth Sl 19

Loss of fetal movements S131

Prelabour rupture of membranes S135

Immediate newborn conditions or problems S141

Paracervical block

Local anaesthesia for caesarean section

Ketamine P13

Vacuum extraction P27

Shock

Vaginal bleeding in early pregnancy

Vaginal bleeding in later pregnancy and labour Sl7

Vaginal bleeding after childbirth S25

Elevated blood pressure headache blurred vision convulsions

Unsatisfactory progress of labour S57

Malpositions and malpresentations S69

Shoulder dystocia S83

Labour with a scarred uterus S93

Fever during pregnancy and labour S99

Fever after childbirth S107

Abdominal pain in early pregnancy Sl 15

Forceps delivery P33

Caesarean section P43

Symphysiotomy P53

Dilatation and curettage P61

Culdocentesis and colpotomy P69

Manual removal of placenta P77

Repair of vaginal and perineal tears P83

Correcting uterine inversion P91

Uterine and uteroovarian artery ligation P99

Salpingectomy for ectopic pregnancy P109

Essential drugs for managing complications in pregnancy

This manual is written for midwives and doctors at the district hospital who are responsible for the care of women with complications of pregnancy, childbirth or the immediate postpartum period including immediate problems of the newborn. The emphasis of the manual is on rapid assessment and decision-making. The clinical action steps are based on clinical assessment with limited reliance on laboratory or other tests and most are possible in a variety of clinical settings (e.g. district hospital or health centre).

Section 1 outlines the clinical principles of managing complications in pregnancy and childbirth and begins with a table that the health care worker can use to rapidly assess the woman's condition and initiate appropriate treatment. This section includes the general principles of emergency, general and operative care, including: infection prevention, the use of blood and replacement fluids, antibiotics and anaesthesia and analgesia. Guidance on the initial care of the normal newborn is also provided.

Section 2 describes the symptoms by which women with complications of pregnancy and childbirth present. The symptoms reflect the major causes of mortality and morbidity. For each symptom there is a statement of general, initial management. Diagnosis tables then lead to identifying the diagnosis, which is causing the symptom. Simplified management protocols for these specific diagnoses then follow.

Section 3 describes the procedures that may be necessary in the management of the condition. Clear guidance is provided on drugs and dosages, a wide variety of anaesthesia options (e.g. safe caesarean section under local anaesthesia) and safe, effective and lower cost techniques (e.g. single layer closure of the uterus).

Section 4 contains a list of essential drugs and an index.