Managing complications in pregnancy and childbirth: a guide for midwives and doctors

This manual, and a similar one on the management of preterm and sick newborns, is written for midwives and doctors working in district hospitals. It complements and is consistent with the Essential Care Practice Guide for Pregnancy and Childbirth which is prepared mainly for the primary health care level. Together these manuals will provide guidance for health workers who are responsible for the care of pregnant women and newborns at all levels of care.

The manual contains the following information, section by section:

• clinical principles of managing complications in pregnancy and childbirth: offers a table that the health care worker can use to rapidly assess the woman’s condition and initiate appropriate treatment. General principle of emergency, general and operative care, including infection prevention, the use of blood and replacement fluids, antibiotics and anaesthesia and analgesia are then presented. A description of normal labour and childbirth, including use of the partograph and active management of the third stage, is included in order to provide the health care worker the information needed to differentiate between the normal process and a complication. Guidance on the initial care of the normal newborn is also provided, as is information on providing emotional support to the woman and her family and outlines the linkage between the providers and their community
• symptoms by which women with complications of pregnancy and childbirth present: 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. Where there are several choices of therapy, the most effective and inexpensive is chosen. Also in this section is information on management for immediate conditions or problems of the newborn
• procedures that may be necessary in the management of the condition: these procedures are not intended to be detailed “how-to” instructions but rather a summary of the main steps associated with each procedure. 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)
• a list of essential drugs and an index: the index is organised so that it can be used in an emergency situation to find relevant material quickly. The most critical information including diagnosis, management and steps for a procedure are listed first in bold. Other relevant entries follow in alphabetical order. Only the pages containing critical or relevant information are included, rather than listing every page that contains the word or phrase