Obstetrics in Remote Settings

222 Pages·2007·3.51 MB·English

by  Practical Guide

Obstetrics
in remote settings
Practical guide
for non-specialized health care professionals
2007 – FIRST EDITION
© Médecins Sans Frontières – March 2007
All rights reserved for all countries. No reproduction, translation and adaptation may be done
without the prior permission of the Copyright owner.
ISBN 2-906498-67-X
Obstetrics
in remote settings
First Edition Editorial Commitee:
Anne-Sophie Coutin (O), Véronique Grouzard (N),
Myriam Henkens (MD), Tonia Marquardt (MD)
Contributors:
Béatrice Guyard-Boileau (O), Christine Lebrun (MW), Jean Rigal (MD), Myrto Schaefer (MD),
Elisabeth Szumilin (MD), Françoise Weiss (Ph)
(O) Obstetrician, (MD) Medical Doctor, (N) Nurse, (MW) Midwife, (Ph) Pharmacist
Translated from French by N. Friedman, V. Grouzard and T. Marquardt
Illustrations: Germain Péronne
Design and layout: Evelyne Laissu
Foreword
This manual is intended for non-obstetricians working in remote settings where
medical resources are lacking. The goal is to overcome the fundamental threat of
pathology—that is, save the mother, protect her from any functional sequelae of the
pregnancy, and deliver the child in the best possible conditions.
The manual is not meant to teach diagnosis and management to those unfamiliar with
them; that requires several years of specialized study based mainly on practical
experience. Rather, it presents the concepts most likely to help those practicing in
difficult conditions.
We thought it necessary to discuss certain techniques, like symphysiotomy, which are
now considered outdated. Conversely, some things, like X-ray pelvimetry, were
deliberately omitted—not for the sake of leaving things out, but because they were not
considered applicable.
Despite all efforts, it is possible that errors may have been overlooked in this manual.
Please inform the authors of any errors detected. It is important to remember that, if in
doubt, it is the responsibility of the prescribing medical professional to ensure that the
doses indicated in this manual conform to the manufacturer's specifications.
The authors would be grateful for any comments or criticisms to ensure that this
manual continues to evolve and remains adapted to the reality of the field.
Comments should be addressed to:
Médecins Sans Frontières - Medical Department
8 rue St-Sabin - 75544 Paris Cedex 11 - France
Tel.: [phone]
Fax: [phone]
e.mail:
How to use this manual
Organisation
There are two easy ways to find information in this manual:
– The table of contents at the beginning of the manual with the number and title of
each chapter, their subsections and page numbers.
– An alphabetical index at the end of the manual.
Names of drugs
The International Non-proprietary Name (INN) of drugs is used in this manual.
Abbreviations used
Units
kg = kilogram
g = gram
mg = milligram
µg = microgram
UI = international unit
M = million
ml = millilitre
dl = decilitre
Administration route
PO = per os - oral
IM = intramuscular
IV = intravenous
SC = subcutaneous
Drugs
AQ = amodiaquine
AS = artesunate
MQ = mefloquine
SP = sulfadoxine + pyrimethamine
5
Table of contents
1 The diagnosis and monitoring of a normal pregnancy page 9
Diagnosing pregnancy (11) Antenatal visits (14)
2 Bleeding during pregnancy page 25
First half of the pregnancy:
Abortion (27) Ectopic pregnancy (29) Molar pregnancy (33) Cervicitis (34)
Functional bleeding (34)
Second half of the pregnancy:
Placenta praevia (35) Abruptio placentae (37) Uterine rupture (40) Table
summarizing the causes of bleeding during the 2nd half of pregnancy (44)
3 Pregnancy-related pathologies and pathological pregnancy page 45
Iron deficiency anaemia (47) Pregnancy-induced hypertension and
pre-eclampsia (48) Eclampsia (52) Abnormally large uterus (53)
Polyhydramnios (54) Premature rupture of membranes (55)
Threatened dpreterm delivery (57) Intrauterine foetal death (59)
Bacterial infections (60) Parasitic infections (63) Viral infections (66)
4 Normal delivery and usual procedures for various problems page 71
Normal delivery (73) Artificial rupture of the membranes
(amniotomy) (83) Prolapsed cord (85) Nuchal cord (87) Vacuum
extraction (88) Symphysiotomy (91) Episiotomy (95) Perineal repair
(96) Deinfibulation (100)
5 Special deliveries page 101
Breech presentation (103) Twin pregnancy (110) Total breech
extraction (112)
6
Malpresentations and labour dystocia page 115
6
Obstructed labour (117) Prolonged obstructed labour (120) Induction of
labour (122) The use of oxytocin during labour (124) Shoulder dystocia (127)
Transverse lie and shoulder presentation (128) External version (131)
Internal version (133) Face presentation (135) Brow presentation (138)
Third stage of labour page 141
7
Normal third stage of labour (143) Postpartum haemorrhage (146) Uterine
inversion (150) Cervical or vaginal tears (153)
Intrauterine procedures page 155
8
Precautions common to all intrauterine procedures (157) Manual
removal of the placenta (158) Uterine exploration (159) Digital
curettage (160) Manual vaccum aspiration (161) Instrumental
curettage (165) Destructive delivery (169)
Infant care page 175
9
Initial care or the newborn (177) Resuscitation of the newborn (180)
Low birth weight infant (183)
Postpartum care page 185
10
Normal postpartum events (187) Postnatal visits (188) Postpartum
complications (190) Contraception (192)
Appendices page 195
Main drugs used in obstetrics (196) Main references (216)
Index page 217
7
1
CHAPTER 1
The diagnosis and
monitoring of
a normal pregnancy
Diagnosing pregnancy 11
Antenatal visits 14