Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
Emergency Obstectric Care
Hypertension in Pregnancy
Assessment and management
Postpartum care
Chronic hypertension
Management of Slow Progress of Labour
General principles
Slow progress of labour
Progress of labour
Operative procedures
Bleeding in Pregnancy and Childbirth
Diagnosis and initial management
Specific management
Aftercare and follow-up

Delivery should take place as soon as the woman’s condition has been stabilized. Delaying delivery to increase fetal maturity will risk the lives of both the woman and the fetus. Delivery should occur regardless of the gestational age.

:: Assess the cervix
:: If the cervix is favourable (soft, thinned, partially dilated), rupture the membranes with an amniotic hook or Kocher clamp and induce labour using oxytocin or prostaglandins
:: If vaginal delivery is not anticipated within 12 hours (for eclampsia) or 24 hours (for severe pre-eclampsia), deliver by caesarean section
:: If there are fetal heart rate abnormalities (less than 100 or more than 180 beats per minute), deliver by caesarean section
:: If the cervix is unfavourable (firm, thick, closed) and the fetus is alive, deliver by caesarean section.

Spinal anaesthesia is suitable for most pre-eclamptic patients if there is no clinical evidence of abnormal bleeding (see pages 14–29 to 14–30). A general anaesthetic raises the risks of a hypertensive disaster (stroke or left ventricular failure) at intubation or airway problems from laryngeal oedema (see page 14–30).

Get skilled anaesthetic help early; this will also aid the management of hypertensive crises and fits.

If safe anaesthesia is not available for caesarean section or if the fetus is dead or too premature for survival, aim for vaginal delivery.

If the cervix is unfavourable (firm, thick, closed) and the fetus is alive, ripen the cervix using prostaglandins or Foley catheter.

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