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




ABORTION

Tell a woman who has had a spontaneous abortion that spontaneous abortion is common and occurs in at least 15% (one in every seven) of clinically recognized pregnancies. Also reassure the woman that the chances for a subsequent successful pregnancy are good unless there has been sepsis or a cause of the abortion is identified that may have an adverse effect on future pregnancies (this is rare).

Some women may want to become pregnant soon after having an incomplete abortion. The woman should be encouraged to delay the next pregnancy
until she is completely recovered.

It is important to counsel women who have had an unsafe abortion. If pregnancy is not desired, certain methods of family planning can be started
immediately (within 7 days) provided there are no severe complications requiring further treatment.

Also identify any other reproductive health services that a woman may need.

For example, some women may need:

:: Tetanus prophylaxis or tetanus booster
:: Treatment for sexually transmitted diseases (STDs)
:: Cervical cancer screening.


ECTOPIC PREGNANCY

1 Prior to discharge, provide counselling and advice on prognosis for fertility. Given the increased risk of future ectopic pregnancy, family planning counselling and provision of a family planning method, if desired, is especially important.
2 Correct anaemia with oral iron.
3 Schedule a follow-up visit at 4 weeks.


MOLAR PREGNANCY
Recommend a hormonal family planning method for at least 1 year to prevent pregnancy. Voluntary tubal ligation may be offered if the woman has completed her family.

Follow up every 8 weeks for at least 1 year with urine pregnancy tests because of the risk of persistent trophoblastic disease or choriocarcinoma. If the urine pregnancy test is not negative after 8 weeks or becomes positive again within the first year, refer the woman to a tertiary care centre for further follow-up and management

BLEEDING IN LATE PREGNANCY AND LABOUR AND POSTPARTUM HAEMORRHAGE

1 Monitor blood loss, vital signs and urine output and treat appropriately. Remember bleeding can recur.
2 After bleeding is controlled (24 hours after bleeding stops), determine haemoglobin or haematocrit to check for anaemia and treat appropriately.
3 Record details or problems and procedures carried out.
  Inform the woman about these and provide her with a written summary. Provide counselling and advise on prognosis for fertility and childbirth.
4 Schedule a follow-up visit at 4 weeks.



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