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Skilled Birth Attendant Classes - Janani

1) Vaginal bleeding during pregnancy or delivery can have various causes and requires different management depending on the stage and severity of bleeding. 2) Hypertension during pregnancy needs to be monitored and may indicate pre-eclampsia, a serious condition requiring specialist care and potentially early delivery. 3) Convulsions during pregnancy or delivery are assumed to be eclampsia and require immediate first aid, anti-convulsant medication, and transfer to a facility for further management and delivery.

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145 views27 pages

Skilled Birth Attendant Classes - Janani

1) Vaginal bleeding during pregnancy or delivery can have various causes and requires different management depending on the stage and severity of bleeding. 2) Hypertension during pregnancy needs to be monitored and may indicate pre-eclampsia, a serious condition requiring specialist care and potentially early delivery. 3) Convulsions during pregnancy or delivery are assumed to be eclampsia and require immediate first aid, anti-convulsant medication, and transfer to a facility for further management and delivery.

Uploaded by

athirai
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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o n ,

S o lom C.
e ta . N .
Re gy,S. H
s .
y : Mr c o lo ,
d b n a e i . R
u i de & G y
J an an r,
G i cs rs. Y ea
te tr M I
O bs d T o: rs i ng .N.C.
o f u id e , N u S.H
. D G c.
H.O M.S
A) VAGINAL BLEEDING.
During pregnancy:
a) Early pregnancy.
b) Late pregnancy.
During & after delivery:
a) Immediate.
b) Delayed.
During pregnancy: Early
pregnancy.
P/V bleeding before 20 weeks of gestation.
Could be threatened / spontaneous abortion,
ectopic pregnancy (or) hydatidiform mole.
If sure of pregnancy, do a P/V & remove the
products of conception with a finger.
Ensure asepsis.
In case of heavy bleeding or shock:
i. Observe for 4-6 hrs.
ii.Complete bed rest.
iii. Start I.V. line & I.V. fluids.
iv. Transport to a 24hr PHC.

 Seeking medical help after an abortion:


i. Increased bleeding / for 2 days.
ii. Foul smelling vaginal discharge.
iii. Abdominal pain.
iv. Fever / unwell.
v. Weakness/dizziness/ fainting.
Advice on selfcare after abortion:
i. Rest.
ii.Change cloth / pad every 4-6 hrs.
iii.Perineal wash with soap & water.
iv.Avoidance of intercourse until bleeding
stops.
v.Advice on family planning methods.
vi.If delay in menstruation for 6 wks or more,
seek medical help.
During pregnancy: Late
pregnancy:
P/V bleeding > 20 weeks of pregnancy:
i. Called as APH.
ii.May be placenta praevia, abruptio
placenta (or) ruptured uterus.
iii.DONOT do a P/V.
iv.Refer to FRU with blood transfusion
facilities.
v.Start an I.V. access & start RL / NS
solution.
vi.If in shock, rapid infusion.
During & after delivery:
Loss of blood > 500ml during (or) after
delivery.
Difficult to measure, so, if bleeding > 10
mins. after delivery name as PPH.
i.e., increased P/V bleeding in first 24
hrs after delivery.
Immediate PPH:
Atonic uterus.
Tears in vagina, cervix (or) perineum.
Retained placenta / fragments.
Inverted / ruptured uterus.
Atleast differentiate which case could be
managed at the grassroot level & which
can’t be.
Steps to be taken before shifting to a FRU:
a. Assess vitals.
b. Try to find the cause.
c. Give Inj.OXYTOCIN, 10U,IM stat.
d. Massage uterus to expel clots.
e. I.V. access & RL / NS.
f. Add Inj.Oxytocin10U to the drips.
g. If bleeding profusely (or) in shock, flow rate to be @ 60
drops/min.
h. If I.V. line can’t be arranged, ensure that she has adequate
oral intake. [NOT in case of unconsciousness].
i. Provide TRENDLENBURG’S position – head low.
j. Cover with blanket for warmth.
k. Assess vitals every 15mins.
l. Advice to empty bladder to facilitate uterine contraction.
m. Transport to a FRU with blood transfusion facilities.
n. While transportation, continue I.V.
fluids @ 30 drops/min.
o. Accompany her, prepare donors & try to
estimate the blood loss. (by counting
the no. of pads soiled)
ONSET OF DEATH IN CASE OF PPH
CAN BE AS LITTLE AS 2hrs.
Delayed / Secondary:
PPH > 24 after delivery.
Either-
lasting for > 24 hrs (or)
occuring after 24 hrs of delivery.
May be due to-
 Infection.
Retained clots / placental fragments.
If infection,
 Fever.
 Foul – smelling vaginal discharge.
LABEL AS “ PUERPERAL SEPSIS “
Manage as;
Inj. OXYTOCIN, 10U, IM.
Start I.V. access with 10U
Oxytocin in the drip.
Assess for signs of pallor.
Refer to a FRU - estimate Hb%,
blood transfusion.
B) HYPERTENSION & PRE-
ECLAMPSIA:
INTRO-
Women with past h/o HT in previous
pregnancies have a greater chance of having
raised BP in present pregnancy.
Measure BP at every AN / PN visits.
If BP > 140 / 90 mmHg, check after 1 hr.
Do urinalysis – for PROTEINURIA.
If BP < 160 / 110 mm Hg & no proteinuria,
can be managed at home.
Home management:
 Monitor BP daily / on alternate days.
 Check urine.
 Adequate bed rest – to get up only for
toiletting, bathing & dining.
 Provide LLP.
 If BP increases, refer to PHC for ANTI-
HYPERTENSIVES.
 Educate her & family about danger signs.
If BP > 160 / 110 mm Hg without proteinuria,
refer to PHC for anti-hypertensives.
PRE- ECLAMPSIA.
o Refer to FRU for admission & management.
DANGER SIGNS:
 Very high BP (> 160 / 110 mm Hg )
 Severe headache
 Visual disturbances
 Pain in upper abdomen
 Oliguria
 Sudden / severe oedema [ face, vulva,
sacrum / lower back ].
A women with pre-eclampsia must be
advised to deliver in FRU.
If presents in first stage of labor, refer
immediately to FRU.
If presents in late first stage / in second
stage & if no time to transport-
 Carry out delivery
 Monitor BP hourly
 Refer to FRU as soon as possible
 Ensure her stability before transport
 Women who develop eclampsia should be
managed as with convulsions.
C) CONVULSIONS:
Convulsions during pregnancy, delivery
(or) in the postnatal period to be assumed
as ECLAMPSIA.
 If convulsing, offer supportive care-
 don’t leave her alone
 protect from fall / injury
 ensure a clear airway & breathing =
head tilt,

chin lift, removal of obstruction


 if fits over, transport in LLP
 keep mouth gag in between the jaws
(given in the kit).
Check vitals & record.
Give the FIRST DOSE of Inj. MAGNESIUM
SULPHATE.
 In the kit as 50% solution.
 Give deep IM of it 10ml in each buttock.
 22 gauge needle & 10 cc syringe are in
the kit.
 During the injection she may feel warm &
after it may feel flushy, thirsty,
headache, nausea (or) vomiting.
 DO NOT repeat the dose without medical
supervision.
I.V. access & fluids @ 30 drops/min.
Transport to FRU – with facilities for
MTP.
Ensure that she reaches within 2 hrs
after the first dose.
If in labor & delivery is imminent,
conduct delivery then immediately
transport to FRU with first dose of Inj.
Magsulph.

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