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
Diagnosis and Initial Management

1 Make a rapid evaluation of the general condition of the woman including vital signs (pulse, blood pressure, respiration, temperature).
2 If you suspect shock, immediately begin treatment. Even if signs of shock are not present, keep shock in mind as you evaluate the woman further because her status may worsen rapidly. If shock develops, it is important to begin treatment immediately.
3 Shout for help if the woman is in shock, or is bleeding excessively.
4 Start a rapid IV infusion.
5 Find out if the woman is currently pregnant or has been recently delivered:
If she is currently pregnant, find out the approximate period of gestation
If she is currently pregnant and less than 22 weeks, consider abortion and ectopic pregnancy
– The risk of ectopic pregnancy is greater in any woman with anaemia, pelvic inflammatory disease (PID), threatened abortion or unusual complaints about abdominal pain; if you suspect an ectopic
pregnancy, perform bimanual examination gently because an early
ectopic pregnancy is easily ruptured
– Consider abortion in any woman of reproductive age who has a missed period (delayed menstrual bleeding with more than a month having passed since her last menstrual period) and has one or more
of the following: bleeding, cramping, partial expulsion of products of conception, dilated cervix or smaller uterus than expected. If abortion is a possible diagnosis, identify and treat any complications immediately.
If she is currently pregnant and more than 22 weeks, consider placenta previa, abruptio placentae and uterine rupture; do not do a vaginal examination at this stage
If she has been recently delivered, consider postpartum haemorrhage
due to atonicity of the uterus first
– Massage the uterus to expel blood and blood clots; blood clots trapped in the uterus will inhibit effective uterine contractions
– Give oxytocin 10 units IM
– Start an IV infusion and infuse IV fluids with 20 units oxytocin in the bag
– Catheterize the bladder.

6 Check to see if the placenta has been expelled and examine the placenta to be certain it is complete.
– Examine the cervix, vagina and perineum for tears.

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  Kep Points  
Active management of the third stage of labour includes:

Giving an oxytocic to the mother as soon as the baby is born

Delivery of the placenta by
controlled cord traction

Uterine massage to ensure that the uterus is contracted.