Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors

World Health Organization, 2003 - Childbirth - 379 pages

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.

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Contents

• Rapid initial assessment: C-1
• Emotional and psychological support: C-7
• General care principles C17: C-17
• Clinical use of blood blood products and replacement fluids C23: C-24
• Antibiotic therapy C35: C-35
• Operative care principles C47: C-47
• Normal labour and childbirth C57: C-57
• Newborn care principles C77: C-77
• Shock: S-1
• Vaginal bleeding in early pregnancy: S-7
• Vaginal bleeding in later pregnancy and labour Sl7: S-19
• Vaginal bleeding after childbirth S25: S-25
• Elevated blood pressure headache blurred vision convulsions: S-35
• Unsatisfactory progress of labour S57: S-57
• Malpositions and malpresentations S69: S-69
• Shoulder dystocia S83: S-83
• Labour with a scarred uterus S93: S-93
• Fever during pregnancy and labour S99: S-99
• Fever after childbirth S107: 7
• Abdominal pain in early pregnancy Sl 15: 15
• Abdominal pain in later pregnancy and after childbirth Sl 19: 21
• Loss of fetal movements S131: 31
• Prelabour rupture of membranes S135: 35
• Immediate newborn conditions or problems S141: 43
• Paracervical block: P-1
• Local anaesthesia for caesarean section: P-7
• Ketamine P13: P-13
• Vacuum extraction P27: P-27
• Forceps delivery P33: P-33
• Caesarean section P43: P-43
• Symphysiotomy P53: P-53
• Dilatation and curettage P61: P-61
• Culdocentesis and colpotomy P69: P-69
• Manual removal of placenta P77: P-77
• Repair of vaginal and perineal tears P83: P-83
• Correcting uterine inversion P91: P-91
• Uterine and uteroovarian artery ligation P99: P-99
• Salpingectomy for ectopic pregnancy P109: P-109
• Essential drugs for managing complications in pregnancy: A-2

Bibliographic information

• Title: Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors; Integrated management of pregnancy and childbirth; Nonserial Publication
• Contributor: World Health Organization. Reproductive Health and Research
• Edition: illustrated, reprint
• Publisher: World Health Organization, 2003
• ISBN: 9241545879, 9789241545877
• Length: 379 pages