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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 


Section 1 - Clinical Principles


Emergencies can happen suddenly, as with a convulsion, or they can develop as a result of a complication that is not properly managed or monitored. 


Preventing emergencies

Most emergencies can be prevented by:

  • careful planning; 

  • following clinical guidelines; 

  • close monitoring of the woman.

Responding to an emergency

Responding to an emergency promptly and effectively requires that members of the clinical team know their roles and how the team should function to respond most effectively to emergencies. Team members should also know:

  • clinical situations and their diagnoses and treatments;

  • drugs and their use, administration and side effects; 

  • emergency equipment and how it functions.

The ability of a facility to deal with emergencies should be assessed and reinforced by frequent practice emergency drills


Initial management

In managing an emergency:

  • Stay calm. Think logically and focus on the needs of the woman.

  • Do not leave the woman unattended.

  • Take charge. Avoid confusion by having one person in charge.

  • SHOUT FOR HELP. Have one person go for help and have another person gather emergency equipment and supplies (e.g. oxygen cylinder, emergency kit).

  • If the woman is unconscious, assess the airway, breathing and circulation.

  • If shock is suspected, immediately begin treatment. Even if signs of shock are not present, keep shock in mind as you evaluate the woman further because her status may worsen rapidly. If shock develops, it is important to begin treatment immediately. 

  • Position the woman lying down on her left side with her feet elevated. Loosen tight clothing.

  • Talk to the woman and help her to stay calm. Ask what happened and what symptoms she is experiencing.Perform a quick examination including vital signs (blood pressure, pulse, respiration, temperature) and skin colour. Estimate the amount of blood lost and assess symptoms and signs.

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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



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