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Department of Reproductive Health and Research (RHR), World Health Organization

Managing Complications in Pregnancy and Childbirth

A guide for midwives and doctors 

Index         C (Clinical principles)   -   S (Symptoms)   -   P (Procedures)

Clinical principles

Rapid initial assessment

Talking with women and their families

Emotional and psychological support

Emergencies

General care principles

Clinical use of blood, blood products and replacement fluids

Antibiotic therapy

Anaesthesia and analgesia

Operative care principles

Normal Labour and childbirth

Newborn care principles

Provider and community linkages

Symptoms

Shock

Vaginal bleeding in early pregnancy

Vaginal bleeding in later pregnancy and labour

Vaginal bleeding after childbirth

Headache, blurred vision, convulsions or loss of consciousness, elevated blood pressure

Unsatisfactory progress of Labour

Malpositions and malpresentations

Shoulder dystocia

Labour with an overdistended uterus

Labour with a scarred uterus

Fetal distress in Labour

Prolapsed cord

Fever during pregnancy and labour

Fever after childbirth

Abdominal pain in early pregnancy

Abdominal pain in later pregnancy and after childbirth

Difficulty in breathing

Loss of fetal movements

Prelabour rupture of membranes

Immediate newborn conditions or problems

Procedures

Paracervical block

Pudendal block

Local anaesthesia for caesaran section

Spinal (subarachnoid) anaesthesia

Ketamine

External version

Induction and augmentation of labour

Vacuum extraction

Forceps delivery

Caesarean section

Symphysontomy

Craniotomy and craniocentesis

Dilatation and curettage

Manual vacuum aspiration

Culdocentesis and colpotomy

Episiotomy

Manual removal of placenta

Repair of cervical tears

Repair of vaginal and perinetal tears

Correcting uterine inversion

Repair of ruptured uterus

Uterine and utero-ovarian artery ligation

Postpartum hysterectomy

Salpingectomy for ectopic pregnancuy

Appendix

 

Abdominal distension
diagnosis of
early pregnancy, S-9, S-14

late pregnancy, S-18

Abdominal pain
diagnosis of 
early pregnancy, S-116

late pregnancy and postpartum, S-120 
general management, S-115, S-119

Abdominal palpation
assessment of descent by, C-61

Abdominal wounds, S-113

Abnormalities of fetus
assessment, S-147
emotional considerations, C-12

Abortion
see also Manual vacuum aspiration; Dilatation and curettage
diagnosis, S-8
management
complete, S-12
incomplete, S-11
inevitable, S-11
threatened, S-10
complications of, S-9
family planning after, S-13
follow-up treatment,
S-12
tetanus, unsafe abortions and,
S-51
types of abortion,
S-10

Abruptio placentae
diagnosis, S-18
management, S-18
prelabour rupture of membranes and, S-136

Abscess
diagnosis, S-108
management
breast, S-113
pelvic, S-110
wound, S-113

Acetone
presence in urine, C-71

Active management
third stage of labour, C-73, P-42
fetal death, S-133

Acute pyelonephritis
diagnosis, S-100
management, S-102
appendicitis, confusion with, S-115

AIDS
see Infection prevention

Allergies
lignocaine, C-41

Amnionitis
diagnosis, S-136
management, S-139
prelabour rupture of membranes and, S-136

Amniotic fluid
see also Prelabour rupture of membranes;
testing for, S-137

Amniotomy
see Artificial rupture of membranes

Anaemia
diagnosis, S-126
management
malaria and, S-56
postpartum, S-26
severe, S-127
haemoglobin or haematocrit determinations, S-26
heart failure and, S-127
malaria and, S-56, S-103
spinal anaesthesia, avoidance of, P-11

Anaesthesia and analgesia
see also Pain management
general principles, C-43
administration, timing of, C-21, C-38
caesarean section, options for,P-7, P-43
emotional support and, C-43
injection techniques, C-41, P-1
ketamine, P-13
local anaesthesia
general discussion
, C-38

adrenaline and, C-39
allergic reactions, C-41
caesarean section, use during, P-7
cardiac arrest, C-43
respiratory arrest, C-42
toxicity, C-41, C-42, C-43
vomiting, C-41, C-46

narcotics

during labour, C-59
postoperative, C-46
respiratory depression in newborn and, C-38

options, C-45
paracervical block, P-1
postoperative, C-46
premedication, C-21, C-38
pudendal block, P-3
spinal, P-11

Anal sphincter tears
see Vaginal or perineal tears

Analgesia
see Anaesthesia and analgesia

Antibiotics, C-35

Antidepressants
breast feeding and, C-13

Antiseptics
chlorhexidine, C-22, C-49
iodophors, C-22, C-49

Anxiety
dealing with, C-5
shock and anxiousness, S-1

Appendicitis
diagnosis, S-116
management, S-117
diagnostic confusion, S-115, S-119
gravid uterus and, S-119

Artificial rupture of membranes
see also Rupture of membranes
procedure, P-17

Asthma
see Bronchial asthma

Atelectasis
diagnosis, S-109

Atonic uterus
diagnosis, S-27
management, S-28

Augmentation of labour
see Induction and augmentation of labour

Birth control
see Family planning

Birth defects
emotional considerations, C-12
epilepsy, treatment and, S-51
malformations, S-147

Bladder
catheterization, C-48
infection, S-101
postoperative care, C-54
repair of injury, P-97

Bleeding
see also Haemorrhage; Coagulopathy
diagnosis of

early pregnancy, S-8
labour, S-17, S-18
later pregnancy, S-17, S-18
postpartum, S-27

general management

early pregnancy, S-7
labour, S-17
later pregnancy, S-17
postpartum, S-26

antepartum, S-7, S-17
aorta, compression of, S-30
caesarean section, control during, P-48
light or heavy, S-8
loss measurement, S-25
packing uterus, S-30
postpartum, S-25
shock causation, S-4
uterus, bimanual compression of, S-29

Blood and blood products
see also Transfusion
general principles, C-23
coagulopathy, managment, S-19
compatibility tests, C-25
infection prevention, C-24
plasma transfusions, C-24
prescribing, C-27
screening for infectious agents, C-25
septic shock, C-29
unnecessary use, C-23
whole blood or red cell transfusions, C-24

Blood pressure
see also Hypertension 
diastolic, measuring of, S-36
proteinuria, pre-eclampsia and,S-37, S-39
shock and low blood pressure, S-1

Blurred vision
diagnosis of, C-41, S-38

Breast abscess
diagnosis, S-108
management, S-113
breastfeeding, S-113

Breast engorgement
diagnosis, S-108
management, S-111

Breast infections
see Breast abscess; Mastitis

Breastfeeding
antidepressant drugs and, C-13
complications

breast abscess, S-113
breast engorgement, S-111
mastitis, S-112

delay in initial feeding, C-78
initiating, C-76, C-78

Breathing
techniques during labour, C-58 

Breathing difficulty
see also
Cyanosis; Respiratory arrest

diagnosis of, S-126
general management, S-125
newborns, S-141

resuscitation planning, C-73
oxygen administration, S-146, S-147

preterm babies, S-147
shock and rapid breathing, S-1

Breech presentation and delivery
see also Malpresentation or malposition
diagnosis, S-74
management, S-79
delivery procedure, P-37
anaesthesia options, C-45, P-3
caesarean section and, S-80, P-49
complete breech, S-74, S-79, P-37
complications, S-80
craniotomy and, P-58
external version, correction by, S-79, P-15
extraction, P-42
footling breech, P-41
frank breech, S-74, S-79, P-37
head, entrapped, P-41
Lovset's manoeuvre, P-38
Mauriceau Smellie Veit
manoeuvre, P-40

meconium-staining and, S-96
multiple pregnancy and, S-90
post-delivery care, P-42

Bronchial asthma
diagnosis, S-126
management, S-129

Bronchitis, S-129

Bronchospasm
bronchial asthma and, S-129
transfusion caused, C-28

Brow presentation
diagnosis, S-73
management, S-76

Caesarean section
procedure, P-43
anaesthesia options, C-45, P-7, P-11, P-43
antibiotics, C-35
bleeding control, P-48

postoperative, P-50

breech presentation and, P-49
classical incision, P-50
closing abdomen, P-48
closing uterus, P-47
heart failure and, P-43, S-128
high-vertical incision, P-50
hysterectomy after, P-103
oxytocin use in subsequent pregnancy, P-21
placenta praevia and, P-49
placenta, delivery of, P-45
postoperative care, P-50, S-97
transverse lie and, P-49
tubal ligation after, P-51

Cannula
infusion, insertion for, C-21
venous cutdown, insertion by, S-3

Cardiac arrest
anaesthesia reactions, C-43

Catheterization
see Bladder

Cellulitis
wound cellulitis, S-114

Cephalohaematoma
vacuum extraction and, P-30

Cephalopelvic disproportion
diagnosis, S-57
management, S-65

Cerebral haemorrhage
hypertension and, S-48

Cervical dilatation
labour, diagnosis and confirmation of, C-60

Cervical tears
repair, P-81
anaesthesia options, C-45
bleeding caused by, S-31
forceps delivery and, P-35
vacuum extraction and, P-31

Cervicitis
diagnosis, S-136
Foley catheter, dangers of use of, P-25

Cervix
see also Tears
induction of labour, assessment of cervix prior to, P-18
paracervical block, P-1
ripening, P-24
ruptured uterus involving, repair, P-96

Clotting disorders
see Coagulopathy

Coagulopathy
diagnosis
bedside clotting test, S-2
management, S-19
eclampsia, caesarean delivery and, S-47
spinal anaesthesia, avoidance of, P-11

Colloid solutions
replacement fluids, use as, C-31

Colpotomy
procedure, P-70
anaesthesia options, C-45

Coma
diagnosis of, S-38

Communication techniques
general principles, C-6
labour and childbirth, C-57

Community linkages, C-79

Companion, support
see Family members

Compound presentation
diagnosis, S-74
management, S-78

Confusion
shock and, S-1

Congenital syphilis
management in newborns,
S-150

Consciousness
see Loss of consciousness

Contractions
false labour and cessation of, S-64
inadequate and prolonged labour, S-63, S-66
partograph, recording of, C-66

Convulsions
diagnosis of, S-38
lignocaine toxicity and, C-42
newborn, S-141, S-149

Cord
see also Prolapsed cord delivery, checking during, C-72
traction, placental delivery by, C-74, S-31
pulsations and prolapsed cord, S-97

Cough
diagnosis of, S-126

Craniocentesis
procedure

breech presentation, P-60
caesarean section and, P-60
closed cervix, P-59
dilated cervix, P-59

emotional considerations, C-11
post-procedure care, P-60

Craniotomy
procedure

breech presentation, P-58
cephalic presentation, P-57

anaesthesia options, C-45, P-3
emotional considerations, C-11
post-procedure care, P-60

Culdocentesis
procedure, P-69
anaesthesia options, C-45

Curettage
see Dilatation and curettage

Cyanosis
see also Breathing and breathing difficulty
diagnosis of, S-126
Cyanosis (cont.)
newborns, S-141, S-146

Cystitis
diagnosis, S-100
management, S-101

Deep vein thrombosis, S-109

Delivery
see Labour and childbirth

Depression
antidepressant drugs, breast feeding and, C-13
postpartum, emotional considerations, C-13

Descent
assessment of, C-61

Dextran
shock and danger of administration, S-2

Dextrose solutions
acetone in urine, used for, C-71
maintenance fluids, use as, C-31
replacement fluids, use as, C-30
subcutaneous, danger of administration, C-33

Dilatation
see Cervical dilatation

Dilatation and curettage
procedure, P-61
see also Vacuum aspiration anaesthesia options, C-45, P-1, P-11
complications, P-63
post-procedure care, P-63

Diuretics
mild pre-eclampsia and danger of administration of, S-42

Drainage
surgical procedures and, C-51

Dressing
surgical procedures and, C-54

Dyspareunia
diagnosis of, S-136

Dysuria
diagnosis of, S-100, S-136

Eclampsia and pre-eclampsia
diagnosis, S-37
general management, S-35, S-39
anticonvulsive drugs, S-44
antihypertensive drugs, S-46
convulsions, S-40, S-43
degrees of pre-eclampsia, S-38
delivery mandates, S-47
mild pre-eclampsia, S-42
oedema and pre-eclampsia, S-39, S-126
proteinuria and pre-eclampsia, S-37, S-39
pulmonary oedema and pre-eclampsia, S-126
severe pre-eclampsia and eclampsia, S-43
spinal anaesthesia, avoidance of, P-11

Ectopic pregnancy
diagnosis, S-8 , S-13
culdocentesis, P-69
management, S-14
appendicitis, confusion with,S-115
salpingectomy or salpingostomy, P-109
vaginal bleeding in early pregnancy and, S-7

Edema
see Oedema

Elevated blood pressure
see Blood pressure

Emergency response procedures
planning for, C-15
rapid initial assessment, C-3

Emotional support
general principles, C-7
labour, anxiety during, C-58
pain management and, C-43

Encephalitis
diagnosis, S-39

Enemas
labour, avoidance of use during, C-58

Epilepsy
diagnosis, S-39
management, S-51

Episiotomy
procedure, P-71
anaesthesia options, C-45, P-3
complications

haematoma, P-74
infections, P-74

repair of, P-73

External version
procedure, P-15
fetal heart rate and, P-15

Face presentation
diagnosis, S-73
management, S-77

False labour
diagnosis, S-57
management, S-64

Family members
emotional reactions of, C-7
labour and childbirth, support during, C-57
mortality, dealing with, C-9
talking with, C-5

Family planning
abortion and, S-12, S-13
methods, S-13
molar pregnancy and, S-15
ruptured uterus, post-repair counselling, P-98
tubal ligation during caesarean section, P-51
salpingostomy, post-procedure counselling, P-111

Fasciitis
necrotizing fasciitis, S-114

Femoral pulse
palpation, S-30

Fetal health and fetal distress
death of fetus, S-132
heart rate

fetal distress and, S-95
abruptio placentae and, S-18
artificial rupture of membranes and, P-17
external version, monitoring
requirements, P-15
normal labour and, C-57
not heard, S-131
prolonged labour and, S-57
sedative administration and, S-131

loss of movement, S-131
malpresentation or malposition, S-69
meconium-staining, S-96

Fetal skull landmarks, C-62

Fever
diagnosis of 
pregnancy and labour, S-100
postpartum, S-108
general management, S-99, S-107
postoperative, C-55

Fluids
see also Infusion
enema, administration by, C-32
malaria and fluid managment, S-55
subcutaneous, administration by, C-33

Foley catheter
induction of labour, P-25

Forceps delivery
procedure, P-33
anaesthesia options, C-45, P-3
breech presentation with entrapped head, P-41
brow presentation, avoidance of use in, S-76
complications

rupture of uterus, P-35
tears, P-35

episiotomy to aid, P-35
failure, P-35
Piper forceps, P-41

Gastrointestinal function
postoperative, C-53

Glove and gown requirements, C-18

Glucose solutions
replacement fluids, use as, C-30

Grieving, C-10

Haematocrit
anaemia and, S-26

Haematoma
broad ligament, S-20, P-96
cephalohaematoma, P-30
episiotomy and, P-74
ruptured uterus involving, repair,P-96
vaginal or perineal tears and, P-89
wound, S-113

Haemoglobin
anaemia and, S-26
transfusion determinations, C-26

Haemorrhage
see also Bleeding
diagnosis

antepartum, S-17
postpartum, S-25

general management

antepartum, S-17
postpartum, S-26

cerebral, pregnancy-induced

hypertension and, S-48

coagulopathy and, S-19
definition of, S-25
delayed postpartum, S-33
immediate postpartum, S-25
IV infusions and, C-30
postpartum, prevention of, S-25, C-73
replacement fluids, C-30
secondary postpartum, S-33
spinal anaesthesia, avoidance of, P-11

Haemostasis, C-51

Halothane
inverted uterus, correction of, P-92

Handwashing
general procedures, C-17
surgical preparation, C-48

Headache
diagnosis of, S-38

Heart attack
see Cardiac arrest

Heart disease
heart failure and, S-128
ketamine, dangers of use of, P-13

Heart failure
diagnosis, S-126
management, S-127
anaemia and, S-127
caesarean section, S-128, P-43
heart disease and, S-128
labour, management during, S-128
spinal anaesthesia, avoidance of, P-11

Hepatitis
diagnosis, S-101
see also Infection prevention

High blood pressure
see Blood pressure

HIV
see Infection prevention
rupture of membranes and danger of perinatal
transmission, P-17

Hookworm
bleeding and, S-26
heart failure management, S-127

Hormones
threatened abortion and, S-10

Hyaline membrane disease in newborns, S-147

Hypertension
see also Blood pressure
diagnosis of, S-36
management

chronic hypertension, S-49
eclampsia, S-43
pre-eclampsia, S-42
pregnancy-induced hypertension, S-41

antihypertensive drugs, S-46
complications, S-48
diuretics, danger of use in, S-42

Hypodermic needles
sharps handling procedures, C-20

Hypothermia
newborn, S-148

Hypovolaemia
see also Shock
spinal anaesthesia, avoidance of use in, P-11
replacement fluids and, C-32

Hysterectomy
procedure, P-103
postoperative care, P-108
subtotal, P-104
total, P-107

Immunizations
tetanus, S-50

Induction and augmentation of labour
procedure, P-17
artificial rupture of membranes, P-17
augmentation, P-25
cervix

assessment of, P-18
ripening, P-24

Foley catheter, P-25
uterine rupture, oxytocin and, P-19

Infection
breast, S-112
newborn sepsis, S-139
sepsis after abortion, S-9
urinary tract, S-101
uterus, S-110, S-139
wound, S-113

 

 

Infection prevention
general discussion, C-17
antibiotic prophylaxis, C-35

blood and blood products, C-24
HIV transmission, perinatal, P-17
hypertension complications, S-48
labour, cleanliness during, C-58
surgical procedures generally, C-47

Informational rights, C-5

Informed consent, C-47

Infusion
procedure, C-21
blood transfusions compared, C-23
cannula insertion, C-21, S-3
fluid balance, S-55
heart failure and, S-128
maintenance fluid therapy, C-31
phenytoin, S-52
replacement fluids, C-30

colloid solutions, C-31
crystalloid solutions, C-30
dextrose solutions, C-30
glucose solutions, C-30
Ringer's lactate, C-21
saline, normal, C-21, C-30

shock

management of, C-30, S-2
plasma substitutes, danger of, C-21

subcutaneous administration of replacement fluids, C-33
transfusion, alternatives to, C-30
venous cutdown, cannula
insertion, S-3


Initial assessment, C-1

Injection
injection techniques, C-41, P-1
tetanus, S-50

Instruments
surgery counts, C-51

Inverted uterus
diagnosis, S-27
management, S-33
procedure, correction of, P-91

anaesthesia options, C-45
hydrostatic, P-92
manual, P-91
surgical, P-92
complications, P-94
post-procedure care, P-94


Ketamine
procedure, P-13

Labour and childbirth
see also Prolonged labour; Malpresentation or malposition
diagnosis, C-59
general management, C-57
acetone in urine, C-71
active management, third stage, C-73
augmentation of labour, P-25
bleeding during, S-17
blood pressure during, C-71
caesarean, prior

oxytocin use after, P-21
vaginal delivery after, S-93

cervix

dilatation, C-60
effacement, C-59, C-60

childbirth positions, C-71
cord, checking, C-72
descent, assessment of, C-61
eclampsia, delivery mandates, S-47
head, delivery of, C-72
heart failure during, S-128
induction of labour, P-17
labour positions, C-59
maternal condition during, C-71
multiple pregnancy, S-89
newborn care, initial, C-75
partograph

assessment by, C-65
samples of, C-69, S-59, S-61, S-63

phases of, C-60
placenta, C-73
placenta praevia, delivery mandates, S-23
presentation and position, C-62
previous caesarean

oxytocin use after, P-21
vaginal delivery after, S-93

progress, assessment of, C-64
pulse during, C-37
pushing, S-67
shoulder, delivery of, C-72
show, S-17
stages of, C-60, C-70
third stage, C-60, C-73
umbilical cord, checking, C-72
unsatisfactory progress, S-57

Lacerations
see Tears

Laparotomy
anaesthesia options, C-45

Lethargy
diagnosis of, S-126
newborns, S-141, S-148

Lithotomy position, C-22

Local anaesthesia
see Anaesthesia and analgesia

Loss of consciousness
diagnosis of, S-38
general management, S-35
shock and, S-1

Lovset's manoeuvre, P-38

Maintenance fluid therapy, C-31

Malaria
diagnosis, S-39, S-103
general discussion, S-52, S-103
anaemia and, S-56, S-127
convulsions, S-54
fluid balance, S-55
hypoglycaemia, S-55
drug resistant, S-104, S-105
severe/complicated, S-52
uncomplicated, S-103

Malformations
emotional considerations, C-12
general, S-147

Malpresentation or malposition
see also Breech presentation and delivery
diagnosis, S-72, S-73, S-74, S-75
general management, S-69
breech presentation, S-74, S-79
brow presentation, S-73, S-76
caesarean section and, P-49
chin-anterior position, S-77
chin-posterior position, S-77
compound presentation, S-74, S-78
external version, correction by, P-15
face presentation, S-73, S-77
multiple pregnancy and, S-90
occiput positions, S-70, S-72, S-75
shoulder presentation, S-75, S-81
transverse lie, S-75, S-81

Manual vacuum aspiration
procedure, P-65
anaesthesia options, C-45
complications, P-68
dilatation and curettage compared, P-61
post-procedure care, P-68

Mastitis
diagnosis, S-108
management, S-112

Mauriceau Smellie Veit
manoeuvre, P-40

Meconium
aspiration, prevention of, S-143
breech presentation and, S-96
fetal distress and, S-96
thickness of, C-57, S-96

Membranes
see also Rupture of membranes
artificial rupture, P-17

Meningitis
diagnosis, S-39

Metritis
diagnosis, S-108
management, S-110

Migraine
diagnosis, S-39

Miscarriage
see Abortion

Molar pregnancy
diagnosis, S-8
management, S-15
family planning after, S-16

Monitoring labour and childbirth
see Partograph monitoring

Morbidity, dealing with
maternal, C-9
neonatal, C-10

Multiple pregnancy
diagnosis, S-87
Multiple pregnancy (cont.)
management, S-89

Necrotizing fasciitis, S-114

Newborns
general care principles, C-77
asphyxia, S-147
bacterial infections, S-147
breastfeeding, C-76, C-78
breathing check, C-73
breathing difficulty, S-141
breech delivery, care after, P-42
congenital syphilis, management, S-150
convulsions, S-149
cyanosis, S-146
hyaline membrane disease, S-147
hypothermia, S-148
initial care, C-75
lethargy, S-148
low birth weight, S-147, S-149
malformations, S-147
oxygen administration, S-146
premature

preparation for, S-123
breathing difficulties, S-147

preterm rupture of membranes,

management after delivery,S-149

prolonged rupture of membranes,

management after delivery, S-149

resuscitation, S-142
separation from mother, C-76, C-78
sepsis, newborn, S-139
syphilis, management, S-150
transferring, C-78
ventilation, S-143

Not breathing
see Respiratory arrest

Nutrition
acetone in urine, C-71
dextrose, C-71
labour, administration during, C-58

Obstructed labour
diagnosis, S-57
management, S-66
partograph, S-61

Occiput positions
diagnosis, S-70
management, occiput posterior, S-75

Oedema
see also Pulmonary oedema
diagnosis of, S-126
diuretics, danger of administration of, S-42
pre-eclampsia and, S-37, S-39

Operations
general principles, C-47
see also Postoperative care
intra-operative care, C-48
pre-operative care, C-47

Ovarian cysts
diagnosis, S-116, 
management, S-117
appendicitis, confusion with, S-115
ultrasound and, S-14

Overdistended uterus
diagnosis, S-87
excess amniotic fluid, S-88
large fetus, S-88
multiple pregnancy, S-89

Oxygen
newborn, difficulty breathing and, S-146

Pain
see Abdominal pain

Pain management
see also Anaesthesia and analgesia
emotional support and pain management, C-43
healing, pain relief and, C-46
labour, C-58
postoperative, C-46
surgical procedures, C-50

Pallor
shock and, S-1
anaemia and, S-126

Paracervical block
procedure, P-1

Partograph
general use, C-65
samples

breech presentation, S-79
contractions, inadequate, S-63
normal labour and childbirth, C-65
obstructed labour, S-61
prolonged labour, S-59


Pelvic abscess
diagnosis, S-108
management, S-110
colpotomy, P-70
culdocentesis, P-69

Pelvic inflammatory disease
ectopic pregnancy, confusion with, S-7

Pelvis
inadequate, determination of, S-65

Perineal tears
see Vaginal or perineal tears

Peritonitis
diagnosis, S-108
management, S-111
appendicitis and, S-117

Placenta
see also Retained placenta accreta, S-32
controlled cord traction delivery, C-74
delivery, C-74
examination of, C-75
fragments, retained, S-32
manual removal

procedure, P-77
anaesthesia options, C-45, P-3, P-11
complications, P-79
inverted uterus and, P-91
post-procedure care, P-79

membrane tears, C-75
removal at caesarean section, P-45
retained, S-27, S-31

Placenta praevia
diagnosis, S-18
managment, S-21
caesarean section and, P-49

Plasma transfusions
coagulopathy and, S-20
infection risks, C-24
replacement fluid use, C-30

Pneumonia
diagnosis, S-126
Pneumonia (cont.)
management, S-129

Position
see Malpresentation or malposition

Postoperative care
bladder, C-54
bleeding, internal, monitoring for, C-52
fever, C-55
gastrointestinal function, C-53
initial, C-52
pain relief and healing, C-46
suture removal, C-55
wound, C-54

Postpartum care
bleeding, S-25
breast engorgement, S-111
breast infections, S-112
caesarean section, postoperative care, P-50
depression, C-12
fever, S-107
haemorrhage, S-25
psychosis, C-14
symphysiotomy, care after, P-56

Postpartum haemorrhage
see also Bleeding; Haemorrhage
general management, S-25

Pre-eclampsia
see Eclampsia and pre-eclampsia

Prelabour rupture of membranes
diagnosis, S-136
managment, S-136
newborn care and, S-149

Premature labour and childbirth
see Preterm labour 

Presentation
see also Malpresentation or malposition
normal presentation, C-62

Preterm labour
diagnosis, S-120
management, S-122
newborn

preterm, care of, S-147, S-149
bacterial infections in, S-147
hyaline membrane disease, S-147
low birth weight, S-147, S-149

rupture of membranes, preterm, S-135

Privacy rights, C-5

Prolapsed cord
management, S-97
breech presentation and, S-80
compound presentation and, S-78
delivery, checking during, C-72
overdistended uterus and, S-88

Prolonged labour
see also Induction and augmentation of labour
diagnosis, S-57
management

latent phase, S-64
active phase, S-65
expulsive phase, S-67

cephalopelvic disproportion, S-65
obstruction, S-66
partograph, samples of S-59S-61, S-63
uterine activity, inadequate, S-66

Proteinuria
diagnosis of, S-37
measurement of, S-37
pre-eclampsia and, S-37, S-39

Provider linkages, C-79

Psychosis
ketamine, dangers of use of, P-13
postpartum, emotional considerations, C-14

Pubic hair
shaving, C-48

Pudendal block
procedure, P-3

Pulmonary oedema
diagnosis, S-38
pre-eclampsia and, S-44

Pulse
shock and weak pulse rate, S-1

Pyelonephritis
see Acute pyelonephritis

Rales
diagnosis of, S-126
pulmonary oedema, pre-eclampsia and, S-44

Rapid initial assessment, C-1

Referral patterns, C-80

Respiratory arrest
see also Breathing and breathing difficulty
anaesthesia reactions, C-42

Resuscitation
newborn, S-142

Retained placenta
diagnosis, S-27
management, S-31
cord traction delivery, S-31
ergometrine, danger of use of, S-31
fragments, retained, S-32

Rights of women, C-5

Rupture of membranes
artificial rupture, P-17
HIV prevalence and, P-17
normal labour, C-57
prelabour, S-135

Ruptured uterus
diagnosis, S-18
management, S-20
repair, P-95
caesarean section after, S-94
forceps delivery, P-35
impending rupture, S-94
induction of labour and danger of, P-19
oxytocin administration and danger of, P-19
pregnancy risks after, P-98
scars causing, S-93
shoulder dystocia and, S-84
symphysiotomy to avoid, P-53
vaginal delivery after, S-93

Salpingectomy or salpingostomy
procedure, P-109
family planning counselling after, P-111
pregnancy risks after, P-111

Sharps
handling, C-20, C-51
needle-stick injury, pudendal block and, P-5
surgery counts, C-51

Shock
diagnosis, S-1
management, S-1
anaphylactic shock, C-28
causation, S-4
emergency response, C-16
IV infusions, C-21, C-30
replacement fluids, C-30
septic, blood transfusion and,C-29
transfusion caused, C-28
transfusion requirements, C-23

Shoulder dystocia
diagnosis, S-83
managment, S-83
brachial plexus injury and, S-84

Shoulder presentation
diagnosis, S-75
management, S-81

Spinal anaesthesia
procedure, P-11

Stillbirth
emotional considerations, C-10

Supine hypotension syndrome, C-48

Support companion
see Family members

Surgery
see Operations

Suture
removal, C-55
selection, C-52

Symphysiotomy
procedure, P-53
anaesthesia options, C-45
brow presentation, avoidance of symphysiotomy in, S-76
complications, P-56
post-procedure care, P-56
risks, P-53
ruptured uterus, avoidance of, P-53
vacuum extraction and, P-30, P-53

Syphilis
congenital, S-141
death of fetus, S-132
management in newborns, S-150

Tears
see also Cervical tears; Vaginal or perineal tears
bladder, P-97
bleeding caused by, S-31
placenta, examination for, C-75

Tetanus
diagnosis, S-38
management, S-50

Thrombosis
see Deep vein thrombosis

Tocolysis and tocolytic agents
conditions of use, S-122
precautions for use, S-123
threatened abortion and, S-11

Training, C-80

Transfusion
see also Blood and blood products
general principles, C-25
autotransfusion, C-26, S-14
coagulopathy management, S-19
haemoglobin value and, C-26
infection risks, C-24
monitoring, C-27
reactions

anaphylactic shock, C-28
bronchospasm, C-28
monitoring for, C-27

replacement fluid alternatives, C-30

Transverse lie
diagnosis, S-75
management, S-81
caesarean section and, P-49
external version, P-15
internal podalic version, S-90

Trauma
shock management, S-4

Tubal ligation
caesarean section and, P-51
ruptured uterus repair and, P-96

Tuberculosis
pneumonia and, S-129

Typhoid
diagnosis, S-109

Ultrasound
confirmation of diagnosis

ectopic pregnancy, S-14
fetal death, S-132
ovarian cyst, S-14
overdistended uterus, S-87
placenta praevia, S-22


Umbilical
see Cord; Prolapsed cord

Unconsciousness
see Loss of consciousness

Unsatisfactory progress of labour
see Prolonged labour

Ureter
protection during surgical procedures, P-96, P-99, P-104

Urinary tract infections
diagnosis of, S-100
management
acute pyelonephritis, S-102
cystitis, S-101 
false labour and, S-65

Urine
proteinuria and pre-eclampsia, S-37, S-39
scanty output

magnesium sulfate administration and, S-45

malaria and, S-55

shock and, S-1

testing

proteinuria, S-37

urinary tract infection, S-101


Uterine and utero-ovarian artery
ligation
procedure, P-99

Uterine atony
see Atonic uterus

Uterine inversion
see Inverted uterus

Uterus
see also Atonic uterus; Inverted uterus; Ruptured uterus
appendicitis and gravid uterus, S-119
artery ligation, P-99
bimanual compression of, S-29
caesarean section, closing, P-47
dilatation and curettage, P-61
inadequate uterine activity and prolonged labour, S-66
manual vacuum aspiration, P-65
massage after placenta delivery, C-75
overdistended, S-87
packing, S-30
scarred uterus and vaginal delivery, S-93

Vacuum aspiration
see Manual vacuum aspiration

Vacuum extraction
procedure, P-27
anaesthesia options, C-45
brow presentation, avoidance of use in, S-76
complications

cephalohaematoma, P-30
tears, P-31

episiotomy to aid, P-28
face presentation, avoidance of use in, S-78
failure, P-30
preterm labour, avoidance of use in, S-123
symphysiotomy and, P-30, P-53

Vaginal bleeding
see Bleeding

Vaginal examination
bleeding danger, C-1, S-17, S-21
descent assessment by, C-61
placenta praevia and, S-21
progress of labour, assessment of, C-64

Vaginal or perineal tears
repair, P-83
anaesthesia options, C-45, P-11
anal sphincter tears

detection, P-83
neglected cases, P-89
repair, P-86

bleeding caused by, S-31
complications, P-89
degrees of tears, P-83
forceps delivery causing, P-35
haematoma, P-89
post-procedure care, P-88
ruptured uterus involving, repair, P-96

Vaginitis
diagnosis, S-136
Foley catheter, dangers of use of, P-25

Ventilation
newborns, S-143

Vision
see Blurred vision

Vomiting
diagnosis of, S-8, S-39, S-100, S-108, S-116
anaesthesia administration and, C-46
shock management, S-2

Waste disposal, C-20

Water, breaking
see Prelabour rupture of
membranes

Wounds
infections of, S-113
surgical wound care, C-54

 

 

 

 

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