Perinatal Education Programme (PEP) - Maternal Care Manual - Maternal Care Manual: Introduction

Maternal Care Manual 2006

Contents

Editor-in-chief: Prof D L Woods

Editor of the Newborn Care Manual: Prof G B Theron

Members of the Editorial Board: Dr D H Greenfield, Ms H H Louw, Prof G B Theron, Prof H A van Coeverden de Groot, Prof D L Woods

Unit 1: Antenatal care  
Diagnosing pregnancy Section 1-2
The first antenatal visit Section 1-5
Determining the duration of pregnancy Section 1-23
Side room and special investigations Section 1-28
The second antenatal visit Section 1-35
Assessing the results of the special investigations Section 1-36
Grading the risk Section 1-45
Subsequent visits Section 1-46
The visit at 28 weeks Section 1-48
The visit at 34 weeks Section 1-51
The visit at 42 weeks Section 1-54
Unit 2: Assessment of fetal growth and condition during pregnancy  
Introduction Section 2-1
Fetal growth Section 2-2
Fetal movements Section 2-15
Antenatal fetal heart rate monitoring Section 2-27
Unit 3: The hypertensive disorders of pregnancy  
The classification of hypertension during pregnancy Section 3-4
Pre-eclampsia Section 3-10
Patients at increased risk of pre-eclampsia Section 3-19
The management of pre-eclampsia Section 3-23
The emergency management of severe pre-eclampsia and imminent eclampsia Section 3-29
The management of eclampsia Section 3-35
The further management of severe pre-eclampsia and imminent eclampsia at the referral hospital Section 3-37
Gestational hypertension Section 3-39
Chronic hypertension Section 3-42
Unit 4: Antepartum haemorrhage  
The initial emergency management of antepartum haemorrhage Section 4-5
Diagnosing the cause of the bleeding Section 4-8
Antepartum bleeding caused by abruptio placentae Section 4-13
Antepartum bleeding caused by placenta praevia Section 4-24
Antepartum bleeding of unknown cause Section 4-38
Referral of a patient with an antepartum haemorrhage Section 4-43
A blood stained vaginal discharge Section 4-45
Unit 5: Preterm labour and preterm rupture of the membranes  
Diagnosis of preterm labour and preterm prelabour rupture of the membranes Section 5-15
Management of preterm labour Section 5-21
Management of preterm prelabour rupture of the membranes Section 5-31
Prelabour rupture of the membranes at term Section 5-42
Unit 6: The first stage of labour: the condition of the mother  
General condition of the patient Section 6-8
Temperature Section 6-18
Pulse rate Section 6-24
Blood pressure Section 6-29
Urine Section 6-38
Maternal exhaustion Section 6-47
Unit 7: The first stage of labour: the condition of the fetus  
Fetal heart rate patterns Section 7-10
The liquor Section 7-33
Unit 8: The first stage of labour: monitoring and management  
The diagnosis of labour Section 8-1
The two phases of the first stage of labour Section 8-2
Monitoring the first stage of labour Section 8-4
Management of a patient in the latent phase of the first stage of labour Section 8-12
Management of a patient in the active phase of the first stage of labour Section 8-15
Poor progress in the active phase of the first stage of labour Section 8-22
Cephalopelvic disproportion Section 8-31
Inadequate uterine action Section 8-35
The referral of patients with poor progress during the active phase of the first stage of labour Section 8-39
Prolapse of the umbilical cord Section 8-40
Unit 9: The second stage of labour  
The place of an episiotomy in modern midwifery Section 9-16
The management of a prolonged second stage of labour Section 9-20
Impacted shoulders Section 9-24
Unit 10: Pain relief in labour  
Methods of analgesia Section 10-8
The use of pethidine during labour Section 10-12
The use of naloxone in the newborn infant Section 10-19
Inhalational analgesia (Entonox) Section 10-23
Local anaesthesia Section 10-26
Epidural anaesthesia Section 10-30
General anaesthesia Section 10-32
Unit 11: The third stage of labour  
The normal third stage of labour Section 11-1
The active management of the normal third stage of labour Section 11-6
Oxytocic drugs used during the third stage of labour Section 11-7
The use of the passive method in managing the third stage of labour Section 11-11
The examination of the placenta Section 11-18
The abnormal third stage of labour Section 11-22
The management of a postpartum haemorrhage Section 11-28
Methods of reducing the risk of postpartum haemorrhage Section 11-34
Inversion of the uterus Section 11-39
Unit 12: The puerperium  
Management of the puerperium Section 12-5
The 6 week postnatal visit Section 12-18
Puerperal pyrexia Section 12-20
Puerperal psychiatric disorders Section 12-36
Secondary postpartum haemorrhage Section 12-38
Self-monitoring Section 12-44
Unit 13: Medical problems during pregnancy, labour and the puerperium  
Urinary tract infection during pregnancy Section 13-1
Anaemia during pregnancy Section 13-15
Heart valve disease in pregnancy and the puerperium Section 13-23
Diabetes mellitus in pregnancy Section 13-31
Unit 14: Family planning after pregnancy  
Giving contraceptive advice after pregnancy Section 14-5
Contraceptive methods available after pregnancy Section 14-6
Contra-indications to the various contraceptive methods Section 14-9
Major side-effects of contraceptives Section 14-10
Unit 15: Regionalized perinatal care  
The perinatal care clinic Section 15-9
Transferring patients safely to hospital Section 15-18
Maternal deaths Section 15-23
Skills workshop 1-1: The general examination at the first clinic visit  
History taking Section 1-1A
Examination of the patient Section 1-1E
Testing the patient's urine Section 1-1J
Doing a pregnancy test Section 1-1K
Skills workshop 1-2: Examination of the abdomen in pregnancy  
General examination of the abdomen Section 1-2A
Examination of the uterus and the fetus Section 1-2D
Skills workshop 1-3: Vaginal examination in pregnancy  
Skills workshop 1-4: Screening tests for syphilis  
Skills workshop 1-5: Screening tests for HIV  
Skills workshop 2: Routine use of the antenatal card  
Skills workshop 3: Measuring blood pressure and proteinuria  
Measuring the blood pressure Section 3-A
Measuring proteinuria Section 3-H
Skills workshop 8-1: Examination of the abdomen in labour  
Abdominal examination Section 8-1A
Examination of the fetus Section 8-1E
Descent of the fetal head Section 8-1I
Examination of the uterus Section 8-1J
Assessing contractions Section 8-1K
Skills workshop 8-2: Vaginal examination in labour  
Preparation for a vaginal examination in labour Section 8-2A
Procedure of examination Section 8-2C
The vulva and vagina Section 8-2D
The cervix Section 8-2E
The membranes and liquor Section 8-2G
The presenting part Section 8-2H
Moulding Section 8-2K
Assessing the pelvis Section 8-2M
Skills workshop 8-3: Recording observations on the partogram  
Recording the condition of the mother Section 8-3A
Recording the condition of the fetus Section 8-3C
Recording the progress of labour Section 8-3F
Exercises on the correct use of the partogram Section 8-3P
Skills workshop 9: Performing and repairing an episiotomy  
Performing an episiotomy Section 9-A
Repairing an episiotomy Section 9-F
Appendix 1: Guidelines for the management of patients with risk factors and medical problems during pregnancy, labour and the puerperium  

COPYRIGHT

All rights reserved. No part of this Perinatal Education Programme may be altered in any way without the written permission of the editorial board of the Perinatal Education Trust. To facilitate the improvement of perinatal care in Southern Africa, however, parts of the Programme may be reproduced for teaching purposes provided due acknowledgement is given and the material is not sold for financial profit. While the advice and information in the Programme are believed to be accurate, the editorial board cannot accept responsibility or liability for any errors or omissions that may have been made.

ISBN 0 7992 1362 4

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Edited by Aldo Campana,