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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

Newborn care principles

When a baby is born to a mother being treated for complications, the management of the newborn will depend on:

  • whether the baby has a condition or problem requiring rapid treatment;
  • whether the mother’s condition permits her to care for her newborn completely, partially or not at all.


- gasping or not breathing;

- breathing with difficulty (less than 30 or more than 60 breaths per minute, indrawing of the chest or grunting)

- central cyanosis (blueness);

- pretern or very low birth weight (less than 1 500 g);

- lethargy;

- hypothermia/cold stress (axillary temperature less than 36.5�C);

- convulsions.

  • The following conditions require early treatment:

- low birth weight (1500 g - 2500 g)

- possible bacterial infection in an apparently normal newborn whose mother had prelabour or prolonged rupture of membranes or amnionitis;

- possible congenital syphilis (mother has positive serologic test or is symptomatic).

• If the newborn has a malformation or other problem that does not require urgent (labour ward) care:

- Provide routine initial newborn care;

- Transfer the baby to the appropriate service to care for sick newborns as quickly as possible.



- Wrap the baby in a soft, dry cloth, cover with a blanket and ensure the head is covered to prevent heat loss;

- Observe frequently.

  • If the mother’s condition requires prolonged separation from the baby, transfer the baby to the appropriate service to care for newborns (see below).


Explain the baby’s problem to the mother.

  • Keep the baby warm. Wrap the baby in a soft, dry cloth, cover with a blanket and ensure the head is covered to prevent heat loss.
  • Transfer the baby in the arms of a health care provider if possible. If the baby requires special treatment such as oxygen, transfer in an incubator or bassinet.
  • Initiate breastfeeding as soon as the baby is ready to suckle or as soon as the mother’s condition permits.
  • f breastfeeding has to be delayed due to maternal or newborn problems, teach the mother to express breastmilk as soon as possible and ensure that this milk is given to the newborn.
  • Ensure that the service caring for the newborn receives the record of the labour and delivery and of any treatments given to the newborn.

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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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