By Anne-Sophie Coutin et al
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Extra resources for Obstetrics in Remote Settings: Practical Guide for Non-specialized Health Care Professionals
It is essential to treat the fever and monitor for maternal and foetal complications. Shigellosis ceftriaxone IM: 1 g once daily for 3 to 5 days 2 The diluent used to prepare ceftriaxone for IM injection contains lidocaine. Do not administer ceftriaxone reconstituted with this diluent intravenously. For IV administration, use water for injection only. 60 Gonorrhoea 3. Pregnancy-related pathologies and pathological pregnancy Gonorrhoea can cause premature rupture of membranes, preterm delivery, and neonatal conjunctivitis, which can be fulminant.
Check the integrity of the bladder. 43 Bleeding during the second half of pregnancy Causes of bleeding during the 2nd half of pregnancy (summary) History Clinical signs Bleeding Haemorrhagic shock Uterus Vaginal exam Foetal heartbeat 44 Placenta praevia – Twin pregnancy – Caesarean section – Bleeding during a previous pregnancy Abruptio placentae – Pre-eclampsia – Primipara Uterine rupture – – – – – – Long labour Primipara Dystocia Grand multipara (>6) Caesarean section Overuse of oxytocin – Bright red blood – Bleeding without warning Variable – Painless bleeding, sign spontaneous or after – Light flow of blackish vaginal exam or sexual blood, or sudden bright red intercourse bleeding – Bleeding accompanied by severe, constant uterine and lower back pain – Blood loss visible – Shock proportional to amount of bleeding – Blood loss not always visible – Shock out of proportion to the amount of visible bleeding (intra-abdominal bleeding) – Diffuse haemorrhage – Soft uterus – Painful, continuous – Contractions, if present, contraction (“woody” are intermittent uterus) – Foetus high and – Foetal position hard to mobile determine (hard uterus and haematoma) Soft, spongy placenta Do only one, very cautious, vaginal exam Normal in the absence of maternal shock Cervix often closed Vaginal exam not helpful in diagnosis of abruptio placentae Absent or weak – Blood loss not always visible – Shock out of proportion to the amount of visible bleeding (intraabdominal bleeding) Foetus sometimes expelled into the abdominal cavity: uterus is retracted into a ball, the foetus felt under the skin Absent or weak CHAPTER 3 3 Pregnancy-related pathologies and pathological pregnancy 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 preterm delivery 57 Intrauterine foetal death 59 Bacterial infections 60 Parasitic infections 63 Viral infections 66 3.
When administering, monitor the mother's BP and pulse and the foetal heart rate. 9% sodium chloride or Ringer Lactate to obtain a 200 µg/ml solution. • The initial dose is 200 to 300 µg/minute; the maintenance dose is 50 to 150 µg/minute • Administer by increasing the rate up to 20 drops/minute (maximum 30 drops/minute), monitoring the BP every 5 minutes. • As soon as the hypertension is controlled, gradually reduce the rate (15 drops/minute, then 10, then 5) until stopping infusion. Stopping abruptly can trigger a hypertensive crisis.