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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


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



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


Paracervical block

Pudendal block

Local anaesthesia for caesaran section

Spinal (subarachnoid) anaesthesia


External version

Induction and augmentation of labour

Vacuum extraction

Forceps delivery

Caesarean section


Craniotomy and craniocentesis

Dilatation and curettage

Manual vacuum aspiration

Culdocentesis and colpotomy


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



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

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

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

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

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

see Infection prevention

lignocaine, C-41

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

see Artificial rupture of membranes

diagnosis, S-126
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


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

see Anaesthesia and analgesia

Antibiotics, C-35

breast feeding and, C-13

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

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

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

see Bronchial asthma

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

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

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

antidepressant drugs and, C-13

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

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

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

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

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

Cardiac arrest
anaesthesia reactions, C-43

see Bladder

wound cellulitis, S-114

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

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

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

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

procedure, P-70
anaesthesia options, C-45

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

shock and, S-1

Congenital syphilis
management in newborns,

see Loss of consciousness

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

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

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

diagnosis of, S-126


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


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

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

procedure, P-69
anaesthesia options, C-45

see Dilatation and curettage

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

diagnosis, S-100
management, S-101

Deep vein thrombosis, S-109

see Labour and childbirth

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

assessment of, C-61

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

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

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

surgical procedures and, C-51

surgical procedures and, C-54

diagnosis of, S-136

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

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

diagnosis, S-39

labour, avoidance of use during, C-58

diagnosis, S-39
management, S-51

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

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

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

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

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

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

anaemia and, S-26

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

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

see also Bleeding

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

inverted uterus, correction of, P-92

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

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

diagnosis, S-101
see also Infection prevention

High blood pressure
see Blood pressure

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

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

threatened abortion and, S-10

Hyaline membrane disease in newborns, S-147

see also Blood pressure
diagnosis of, S-36

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

newborn, S-148

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

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

tetanus, S-50

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

assessment of, P-18
ripening, P-24

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

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

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


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

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

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


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

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

see Tears

anaesthesia options, C-45

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

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

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

diagnosis, S-108
management, S-112

Mauriceau Smellie Veit
manoeuvre, P-40

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

see also Rupture of membranes
artificial rupture, P-17

diagnosis, S-39

diagnosis, S-108
management, S-110

diagnosis, S-39

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

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

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

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

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

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

newborn, difficulty breathing and, S-146

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

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

Paracervical block
procedure, P-1

general use, C-65

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

inadequate, determination of, S-65

Perineal tears
see Vaginal or perineal tears

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

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

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

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

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 

see also Malpresentation or malposition
normal presentation, C-62

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

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

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

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

Provider linkages, C-79

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

shock and weak pulse rate, S-1

see Acute pyelonephritis

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

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

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

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

emotional considerations, C-10

Supine hypotension syndrome, C-48

Support companion
see Family members

see Operations

removal, C-55
selection, C-52

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

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

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

diagnosis, S-38
management, S-50

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

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

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

shock management, S-4

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

pneumonia and, S-129

diagnosis, S-109

confirmation of diagnosis

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

see Cord; Prolapsed cord

see Loss of consciousness

Unsatisfactory progress of labour
see Prolonged labour

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

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

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

magnesium sulfate administration and, S-45

malaria and, S-55

shock and, S-1


proteinuria, S-37

urinary tract infection, S-101

Uterine and utero-ovarian artery
procedure, P-99

Uterine atony
see Atonic uterus

Uterine inversion
see Inverted 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

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

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

newborns, S-143

see Blurred vision

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

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





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