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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 


In support of the Safe Motherhood Initiative, the WHO Making Pregnancy Safer Strategy focuses on the Health Sector’s contribution to reducing maternal and newborn deaths.

The Integrated Management of Pregnancy and Childbirth (IMPAC) is the technical component of the aforementioned strategy and mainly addresses the following:

  • Improving the skills of health workers through locally adapted guidelines and standards for the management of pregnancy and childbirth at different levels of the health care system;

  • Interventions to improve the health care system’s response to the needs of pregnant women and their newborns, and to improve the district level management of health services, including the provision of adequate staffing, logistics, supplies and equipment;

  • Health education and promotion of activities that improve family and community attitudes and practices in relation to pregnancy and childbirth.

This manual, and a similar one on the management of preterm and sick newborns, is written for midwives and doctors working in district hospitals. This manual complements and is consistent with the Essential Care Practice Guide for Pregnancy and Childbirth which is prepared mainly for the primary health care level. Together these manuals will provide guidance for health workers who are responsible for the care of pregnant women and newborns at all levels of care.

The interventions described in these manuals are based on the latest available scientific evidence. Given that evidence-based medicine is the standard on which to base clinical practice, it is planned to update the manual as new information is acquired.

It is hoped that this manual will be used at the side of the patient, and be readily available whenever a midwife or doctor is confronted with an obstetric emergency.

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