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Managing Complications in Pregnancy and Childbirth: a Guide for Midwives and Doctors Integrated Management Of Pregnancy And Childbirth Managing Complications in Pregnancy and Childbirth: A guide for midwives and doctors Second Edition Integrated Management Of Pregnancy And Childbirth Managing Complications in Pregnancy and Childbirth: A guide for midwives and doctors Second Edition Managing complications in pregnancy and childbirth: a guide for midwives and doctors – 2nd ed. ISBN 978-92-4-156549-3 © World Health Organization 2017 Some rights reserved. This work is available under the Creative Commons Attribution- NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/ licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. Managing complications in pregnancy and childbirth: a guide for midwives and doctors – 2nd ed. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/ about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Printed in Malta ACKNOWLEDGEMENTS Managing Complications in Pregnancy and Childbirth represents a common understanding between WHO, UNFPA, and UNICEF of key elements of an approach to reducing maternal and perinatal mortality and morbidity. These agencies co-operate closely in efforts to reduce maternal and perinatal mortality and morbidity. The principles and policies of each agency are governed by the relevant decisions of each agency’s governing body and each agency implements the interventions described in this document in accordance with these principles and policies and within the scope of its mandate. Both editions of the guide have been reviewed and endorsed by the International Confederation of Midwives and the International Federation of Gynecology and Obstetrics. WHO gratefully acknowledges the technical and editorial assistance provided by the USAID-funded Maternal and Child Survival Program (MCSP) and Jhpiego for the second edition of this guide. This edition is made possible by Jhpiego and the generous support of the American people through the United States Agency for International Development (USAID) under the terms of the Cooperative Agreement AID-OAA-A-14-00028. Financial support for the first edition was provided by USAID’s Bureau for Global Health through the Nutrition and Maternal Health Division, Office of Health and Nutrition, under the terms of Award No. HRN-A-00-98-00043-00, and through the Service Delivery Improvement Division, Office of Population and Reproductive Health, under the terms of Award No. HRN-A-00-98-00041-00. Financial support towards the preparation and production of the first edition of this manual was provided by the Governments of Australia, the Netherlands, Sweden, the United Kingdom of Great Britain and Northern Ireland, and the United States of America. Technical and editorial assistance was provided by staff of Jhpiego’s Maternal and Neonatal Health Program and Training in Reproductive Health Project. Image sources Figure S-6. Intrauterine balloon tamponade: Chin, E. 2016. Uterine Balloon Tamponade to Treat Postpartum Hemorrhage. Jhpiego: Baltimore, MD. Box S-3. Non-pneumatic anti-shock garment: Pathfinder International, Wall Chart: Applying the Non-pneumatic Anti Shock Garment (NASG), part of the Clinical and Community Action to Address Postpartum Hemorrhage Toolkit, 2010; and Pathfinder International, Wall Chart: Removing the Non-pneumatic Anti Shock Garment (NASG), part of the Clinical and Community Action to Address Postpartum Hemorrhage Toolkit, 2010. Figure P-8. Locating the flexion point (F): A. Vacca, the flexion point (F). vaccaresearch.com. © 2015 Vacca Research Pty Ltd. Reprinted by permission of Vacca Research Pty Ltd. Figure P-9. Locating the flexion point (F), 3 cm anterior to the posterior fontanelle, and calculating cup insertion distance: A. Vacca, direct occipito-anterior position and low OT, no asynclitism—digital distance 6–7 cm. vaccaresearch.com. © 2015 Vacca Research Pty Ltd. Reprinted by permission of Vacca Research Pty Ltd. Figure P-10. Applying the cup: A. Vacca, (A) holding the cup, retracting the perineum; (B) inserting the cup through introitus; and (C) attaching the cup over the flexion point. vaccaresearch.com. © 2015 Vacca Research Pty Ltd. Reprinted by permission of Vacca Research Pty Ltd. Figure P-11. Applying traction and delivering the head: A. Vacca, (A) finger- thumb traction position, (B) applying axis traction, (C) upward traction with crowning. vaccaresearch.com. © 2015 Vacca Research Pty Ltd. Reprinted by permission of Vacca Research Pty Ltd. Contributions to the Second Edition Major contributors: Matthews Mathai Susheela Engelbrecht Contributors: Mercedes Bonet Maurice Bucagu Metin Gülmezoglu Mega Gupta Christina Heym Kathleen Hill Eva Lathrop Olufemi Oladapo Nathalie Roos Jeffrey M. Smith Editing: Sandra Crump Gill Gyte Editing Assistance: Deborah Stein Project Management: Young Kim Susan Moffson Artists: Kim Battista Erica Chin Cover design: Máire Ní Mhearáin Layout: Trudy Conley Renata Kepner Bekah Walsh Courtney Weber Reviewers: Yusuf Ahmed Tina Lavender Suzanne Stalls Wame Baravilala Goldy Mazia Will Stone Luc de Bernis Shalini Ninan Kusum Thapa Sheena Currie Lisa Noguchi Niranjan Thomas Blami Dao Lennart Nordström Nynke Van Den Sylvia Deganus Pius Okong Broek Ravichandran V P Paily John Varallo Jeganathan Dhammica Rowel Peter Von Dadelszen Rajshree Jha Arulkumaran Sabaratnam Charlotte Warren Contributions to the First Edition Major contributors: Matthews Mathai Harshad Sanghvi Richard J. Guidotti Contributors: Fredrik Broekhuizen Beverley Chalmers Robert Johnson Anne Foster-Rosales Jeffrey M. Smith Jelka Zupan Editing: Melissa McCormick Editing Assistance: Ann Blouse David Bramley Kathleen Hines Georgeanna Murgatroyd Elizabeth Oliveras Artist: Mary Jane Orley Cover design: Máire Ní Mhearáin Layout: Deborah Brigade The special contribution of George Povey, whose original work inspired the idea for this manual, is gratefully acknowledged. Reviewers: Sabaratnam Arulkumaran Barbara Kinzie Zahida Qureshi Allan Rosenfield Ann Davenport Jerker Liljestrand Abdul Bari Saifuddin Michael Dobson André Lalonde Willibrord Shasha Jean Emmanuel Enriquito Lu Betty Sweet Susheela Engelbrecht Florence Mirembe Paul Van Look Miguel Espinoza Glen Mola Patrice White Petra ten Hoope-Bender Monir Islam TABLE OF CONTENTS v Preface ix Introduction xi How to use this manual xiii Abbreviations xv List of diagnoses xvii SECTION 1: CLINICAL PRINCIPLES Rapid initial assessment C-1 Talking with women and their families C-5 Emotional and psychological support in obstetric and newborn emergencies C-9 Obstetric emergencies C-21 General care principles C-25 Clinical use of blood, blood products and replacement fluids C-37 Antibiotic therapy C-49 Anaesthesia and analgesia C-55 Operative care principles C-65 Normal labour and childbirth C-77 Newborn care principles C-111 Provider and community linkages C-115 SECTION
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