MCPC - Anaesthesia and Analgesia - Health Education To Villages

Health Education To Villages

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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

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Anaesthesia and Analgesia - Table C- 6

Procedure	Analgesia/Anaesthesia Options
Breech delivery	• General methods of labour support • Pudendal block
Caesarean section	• Spinal anaesthesia • Local anaesthesia • Ketamine • General anaesthesia
Cervical tears (extensive)	• Pethidine and diazepam • Ketamine
Colpotomy/Culdocentesis	• Local anaesthesia
Craniotomy/Craniocentesis	• Emotional support and encouragement • Diazepam • Pudendal block
Dilatation and curettage	• Paracervical block • Pethidine
Episiotomy	• Local anaesthesia • Pudendal block
Forceps delivery	• Emotional support and encouragement • Pudendal block
Labour and childbirth	• General methods of labour support • Pethidine and promethazine
Laparotomy	• General anaesthesia • Spinal anaesthesia
Manual removal of placenta	• Pethidine and diazepam • Ketamine
Manual vacuum aspiration	• Paracervical block • Pethidine
Perineal tears (first and second degree)	• Local anaesthesia • Pudendal block
Perineal tears (third and fourth degree)	• Pudendal block • Ketamine • Local anaesthesia plus pethidine and diazepam • Spinal anaesthesia
Symphysiotomy	• Local anaesthesia
Uterine inversion (correction of)	• Pethidine and diazepam • General anaesthesia
Vacuum extraction	• Emotional support and encouragement • Pudendal block

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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

Symptoms

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

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

Procedures

Paracervical 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

Appendix

Essential drugs for managing complications in pregnancy and childbirth

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