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

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.