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Hospital Care for Mothers GUIDELINES for MANAGEMENT of COMMON MATERNAL CONDITIONS Pocket Book of Hospital Care for Mothers ISBN 978-92-9022-498-3

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Hospital Care for Mothers GUIDELINES for MANAGEMENT of COMMON MATERNAL CONDITIONS Pocket Book of Hospital Care for Mothers ISBN 978-92-9022-498-3 POCKET BOOK OF Hospital care for mothers GUIDELINES FOR MANAGEMENT OF COMMON MATERNAL CONDITIONS Pocket book of hospital care for mothers ISBN 978-92-9022-498-3 © 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 specifi c 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. Pocket book of hospital care for mothers, Guidelines for management of common maternal conditions. New Delhi: World Health Organization, Regional Offi ce for South-East Asia; 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, fi gures 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 specifi c 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. Foreword There has been a signifi cant decline in maternal mortality in Member States of the WHO South-East Asia Region over the past two decades. In comparison with 1990, there were 149,000 fewer maternal deaths in 2015 – an unprecedented feat in maternal survival in the history of the Region. Despite this sharp reduction by 69 per cent, maternal mortality continues to be high in many Member States. To accelerate further reductions in maternal mortality, ‘Ending preventable maternal, newborn and child deaths with focus on neonatal deaths’ in 2014 was declared one of the eight Flagship Priorities for the WHO South-East Asia Region. The Pocket Book of Hospital Care for Mothers: Guidelines for Management of Common Maternal Conditions, brought out by the World Health Organization’s Regional Offi ce for South-East Asia, is a fi rst-of-its-kind compilation of updated WHO guidelines for the treatment recommendations, management of pregnancy and common pregnancy-related or associated complications and diseases at the fi rst referral-level hospitals. It presents relevant, up-to-date, evidence-based clinical guidelines that can be used by clinicians in their daily work in hospitals. An expert group at the regional level was convened to review available updated WHO guidelines on maternal and newborn health for compilation of this Pocket Book. The guidelines focus on outpatient and inpatient management of normal pregnancy, labour and the postpartum period along with maternal morbidities associated with or aggravated during pregnancy such as gestational diabetes, hypertension, anaemia, heart disease and mal-presentations as well as emergency conditions. Most of these conditions are responsible for maternal and neonatal morbidity and mortality. The book also covers information on essential medicines that can be used in hospitals along with essential newborn care, and appropriate supportive care of common neonatal problems. This Pocket Book is an eff ort to provide information in our Region for optimizing the quality of care during pregnancy, delivery and the postnatal period. It is presented in a user-friendly format as a ready reckoner for use by doctors, nurses and midwives for ease of consultation on a daily basis. The commitment of our providers goes a long way in achieving the target of maternal and newborn mortality reduction that is envisaged in the Sustainable Development Goals and the Global Strategy for Women’s, Children’s and Adolescents’ Health for 2016–2030. I am sure that Member States will fi nd thisPocket Book on Hospital Care for Mothers: Guidelines for Management of Common Maternal Conditions useful for application in their own settings. Dr. Poonam Khetrapal Singh Regional Director WHO South-East Asia Region Acknowledgements The Pocket Book of Hospital Care for Mothers: Guidelines for Management of Common Maternal Conditions is the product of the contribution of several individuals. The draft was reviewed by a regional expert group comprising representatives of technical partners and Member States. The development of the Pocket Book was coordinated by the WHO Collaborating Centre for Human Reproduction at the Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, India, under the leadership of Professor Alka Kriplani, along with team members Professor Vatsla Dadhwal, Dr K. Aparna Sharma, Dr Rohini Sehgal and Dr Garima Kachcawa. WHO would like to thank the coordination team and the experts who contributed to the development of this publication, ensured that it conformed to WHO guidelines and adapted it for use across various countries. Regional Expert Group Bangladesh: Professor Saria Tasnim, Institute of Child and Mother Health (ICMH), Dhaka. India: Dr Vinita Das, King George Medical University, Lucknow; Dr Pratima Mittal, Safdarjung Hospital, New Delhi; Dr Manju Vatsa; Dr A. K. Deorari and Dr Neeta Singh, All India Institute of Medical Sciences, New Delhi; Dr Lakhbir Dhaliwal, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh; Dr Poonam Shivkumar, Mahatma Gandhi Institute of Medical Sciences, Wardha; Dr Himanshu Bhushan, Ministry of Health and Family Welfare, New Delhi; Dr Sunita Dhamija, Johns Hopkins Program for International Education in Gynaecology and Obstetrics (Jhpiego), India. Indonesia: Dr Dwiana Ocviyanti, University of Indonesia, Jakarta. Nepal: Dr Kiran Regmi, Family Health Bureau, Kathmandu; Dr Nuzhat Rafi que, United Nations Children's Fund, Regional Offi ce for South Asia (ROSA), Kathmandu. Sri Lanka: Dr Hemantha Senanayake, Sri Lanka College of Obstetrics and Gynaecology, Colombo. Thailand: Dr Surasith Chaithongwongwatthana, Faculty of Medicine, Chulalangkom University; Dr Streerut Thadakant, Ramathibodi School of Nursing, Faculty of Medicine, Mahidol University, Bangkok. Dr Susanne Carai, freelance consultant, Berlin, Germany. Technical support in the fi nalization of this Pocket Book was provided by Dr Neena Raina, Dr Rajesh Mehta, Dr Arvind Mathur, Dr Martin Weber, Dr Anoma Jayathilaka and Dr Priya Karna of the WHO Regional Offi ce for South-East Asia, New Delhi, India; Dr Matthews Mathai, WHO Headquarters, Geneva; and Dr Rustini Floranita, WHO Country Offi ce, Jakarta, Indonesia. Contents CHAPTER 1: EMERGENCY CONDITIONS IN PREGNANCY AND LABOUR 1 1.1 Rapid Assessment and Management 2 1.1.1 Triage and rapid initial assessment 2 1.2 Management of Maternal Emergency Conditions 5 1.2.1 Airway and breathing 5 1.2.2 Circulation 8 1.2.3 Vaginal bleeding 13 1.2.4 Convulsions 49 1.2.5 Diffi culty in breathing 53 1.3 Fetal Distress 58 CHAPTER 2: NORMAL PREGNANCY, LABOUR AND PUERPERIUM 61 2.1 Antenatal Care 63 2.1.1 Medical history 67 2.1.2 General physical examination 69 2.1.3 Obstetric physical examination 69 2.1.4 Supporting tests 71 2.1.5 Nutritional interventions 72 2.1.6 Preventive measures 73 2.1.7 Information and counselling 73 2.1.8 Identifi cation of complications and referral 77 2.2 Normal Labour and Childbirth 82 2.2.1 Initial evaluation of a woman in labour 82 2.2.2 Diagnosis 83 2.2.3 Using the partogram 89 2.2.4 The fi rst stage 91 2.2.5 The second stage 96 2.2.6 The third stage 100 2.3 The
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