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The Department of Obstetrics and Gynaecology
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Guidelines -Confirm reports of Hb, blood group, VDRL/ HIV, and urinalysis are ready and normal. If not, get them done. -Send blood for spot test for HIV if not done earlier to emergency lab and check the report. -Check if she has received tetanus immunization (at least 2 doses, if the last dose prior to pregnancy was given > 5 years ago, and 1 dose if the last dose prior to pregnancy was given < 5 years ago). -IV access through # 18 cannula -Collect and send blood for blood grouping and cross matching and check availability. -Do clot observation test (COT), platelet count, DIC profile -BUN, serum electrolytes, LFT -Put in a CVP line using a cava fix if possible -Catheterize the bladder with 14/16 F Foley catheter. - Do urine albumin -Send a call to the ophthalmology resident for a fundoscopy examination -Inform lecturer
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Treatment Orders -Nil by mouth -IV fluids -Shave/ clip and prepare private parts -Simple enema stat (not to eclamptic) -Lateral position -TPR, FHS, 1/2 hourly -BP 1 hourly -I/O chart -M/C urine 2 hourly -Consider induction/augmentation after stabilization -Pritchard’s regime -Antihypertensive -Keep ready suction, oxygen, resuscitation kit, mouth gag, 10 ml 10% Ca-gluconate, -No Methyl ergometrine Inform if *,
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Guidelines -IV access through # 18 cannula – collect blood for blood grouping and cross matching and confirm availability, COT, Hb, BUN, serum electrolytes. -Insert CVP catheter/ cava fix, Foley catheter. -Inform Lecturer -Confirm reports of Hb, blood group, VDRL/ HIV, and urinalysis are ready and normal. If not, get them done. -Send blood for spot test for HIV if not done earlier to emergency lab and check the report. -Check if she has received tetanus immunization (at least 2 doses, if the last dose prior to pregnancy was given > 5 years ago, and 1 dose if the last dose prior to pregnancy was given < 5 years ago). -If FHS are present, consider emergency LSCS according to gestational age- follow guidelines “For LSCS” -Confirm availability of FFP and platelets -Fundoscopy if required.
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Treatment Orders -Nil by mouth -IV fluids (initiate with Ringer lactate) -Shave/ clip and prepare private parts -Simple enema stat -Lateral position -Nasal oxygen -TPR, FHS, FH, AG 1/2 hourly -I/O chart -M/C urine 2 hourly -Artificial low rupture of membranes -Oxytocin for induction/ augmentation if LSCS is not planned.
Inform if
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Guidelines -Check the cause and follow specific protocol -H/o bleeding disorders -PIH -Abruptio placenta -Retained dead fetus -Septic abortion, septicaemia, chorioamnionitis -Amniotic fluid embolism -Placenta previa -Massive haemorrhagic shock, PPH, ruptured ectopic pregnancy -Large volume replacements with crystalloids -IV access with 18 no cannula. Do not do a venesection. -Send blood for grouping cross match. -Perform coagulation profile tests Platelet count, PT, aPTT, plasma fibrinogen levels, fibrinogen- fibrin degradation products -*See Appendix for normal laboratory ranges -Perform bed side coagulation tests -Bleeding time -Clot observation test
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Treatment Orders -Identify cause and follow appropriate protocol -Check and ask for appropriate factors: -Whole blood -FFP -Platelet packs -Semi packed cells -Cryoprecipitate -Consult haematologist.
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Guidelines -IV access through # 18 cannula- collect and send blood for grouping cross matching, and check availability. Do Hb -Inform lecturer -Don’t do a vaginal, rectal or speculum examination till confirmation of diagnosis. -Do ultrasonography for confirmation if diagnosis is doubtful, and patient is stable. -Consider blood transfusion. -Check- gestational age (GA), FHS -Confirm reports of Hb, blood group, VDRL/ HIV, and urinalysis are ready and normal. If not, get them done. -Send blood for spot test for HIV if not done earlier to emergency lab and check the report. -Check if she has received tetanus immunization (at least 2 doses, if the last dose prior to pregnancy was given > 5 years ago, and 1 dose if the last dose prior to pregnancy was given < 5 years ago).
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Treatment Orders -Nil by mouth -IV fluids -Shave/ clip hair and prepare private parts -Lateral position -TPR, FHS 1/2 hourly -I/O chart -M/C urine -Sterile vulval pad -Save all pads -Watch for vaginal bleeding -Antibiotic (see antibiotic policy) -If GA< 34wks, and pregnancy is conserved, -Give Inj Betamethasone 12 mg IM stat and repeat after 24 hours. -Consent for LSCS -If patient is for LSCS (follow guidelines “For LSCS”) Inform if *
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Guidelines -Confirm reports of Hb, blood group, VDRL/ HIV, and urinalysis are ready and normal. If not, get them done. -Check if she has received tetanus immunization (at least 2 doses, if the last dose prior to pregnancy was given > 5 years ago, and 1 dose if the last dose prior to pregnancy was given < 5 years ago). -Send blood for spot test for HIV if not done earlier to emergency lab and check the report. -IV access through # 18 cannula- collect and send blood for grouping and cross matching. -Inform lecturer -1st vertex: After delivery of 1 st twin reconfirm presentation of 2nd twin. If 2 nd twin in longitudinal lie, start oxytocin drip. If no bleeding/ and FHS normal after delivery of 1st twin, await delivery. -For 1st non-vertex presentation: see appropriate orders for malpresentations. - Use 1 clamp-for 1st and 2 clamps for 2nd baby (for identification of the placenta). -Check placenta and membranes for chorionicity. |
Treatment Orders -Shave/ clip hair and prepare private parts -Simple enema stat -Lateral position -TPR,FHS 1/2 hourly -Inform if * -Cord prolapse. -Inform on rupture of membranes -No Methyl ergometrine with delivery of first twin. -Clamp cord early -IV 500 ml RL + 5 units Oxytocin after delivery of first twin . -Consent for ECV/IPV/LSCS of second twin. -Collect cord blood of both babies after birth of second twin -Postpartum hemorrhage prophylaxis. |
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Guidelines -Confirm reports of Hb, blood group, VDRL/ HIV, and urinalysis are ready and normal. If not, get them done. -Send blood for spot test for HIV if not done earlier to emergency lab and check the report. -Check if she has received tetanus immunization (at least 2 doses, if the last dose prior to pregnancy was given > 5 years ago, and 1 dose if the last dose prior to pregnancy was given < 5 years ago). -Exclude contraindications for control of preterm labor. If none, consider tocolysis. -Collect and send a high vaginal swab (HVS) for microbiologic study. Do an ultrasonography after stabilization –for gestational age.
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Treatment Orders -Shave/ clip hair and prepare private parts. -CBR, no enema, -TPR, FHS 1/2 hourly -IV 1000 ml RL fast Or 500 ml D5W + 60 mg Isoxsuprine ▪ -Inj Betamethasone 12 mg IM stat up to 35 weeks, repeat after 24 hours. -Monitor: Pulse, BP, UA, FHR, -Stop titration/omit if:
( ▪ Alternative regimens with Terbutaline, Ritodrine, or any other drug may be used instead.) |
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Guidelines -Confirm reports of Hb, blood group, VDRL/ HIV, and urinalysis are ready and normal. If not, get them done. -Send blood for spot test for HIV if not done earlier to emergency lab and check the report. -Check if she has received tetanus immunization (at least 2 doses, if the last dose prior to pregnancy was given > 5 years ago, and 1 dose if the last dose prior to pregnancy was given < 5 years ago). -Collect and send a high vaginal swab (HVS) for microbiologic examination
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Treatment Orders Inevitable labor -Shave/ clip hair and prepare private parts. -Simple enema stat. -Left lateral position. -TPR, FHS 1/2 hourly.
Inform if *
-Wide episiotomy -Late clamping of cord (as usual) -Inform neonatologist |
Guidelines -IV access through # 18 cannula. -Send blood for grouping and cross matching. -Confirm reports of Hb, blood group, VDRL/ HIV, and urinalysis are ready and normal. If not, get them done. -Check if she has received tetanus immunization (at least 2 doses, if the last dose prior to pregnancy was given > 5 years ago, and 1 dose if the last dose prior to pregnancy was given < 5 years ago). -Insert Foley catheter and do- cystodistension (300 ml saline), clamp catheter with a hemostat, or push PP-digitally -Call lecturer on call. -Consider immediate delivery- check cord pulsations/FHS/ cervical dilatation. If cervix is fully dilated- consider forceps application. -Lecturer on duty to decide mode of delivery. -Cervix not fully dilated- take gravida for LSCS immediately if FHS/cord pulsations present-LSCS to be done under GA.
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Treatment Orders -Nil by mouth -Head low 1/2 block -TPR, FHS 1/2 hourly till delivery - Shave/ clip hair and prepare abdomen, back (if hair is present), and private parts. -Consent for LSCS -IV 500 ml RL -IV tocolysis optional (see tocolysis chart)
Inform if
-LSCS stat -Check protocol for LSCS |
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Guidelines -Confirm reports of Hb, blood group, VDRL/ HIV, and urinalysis are ready and normal. If not, get them done. -Send blood for spot test for HIV if not done earlier to emergency lab and check the report. -Check if she has received tetanus immunization (at least 2 doses, if the last dose prior to pregnancy was given > 5 years ago, and 1 dose if the last dose prior to pregnancy was given < 5 years ago). -IV access through # 18 cannula. Send blood for grouping and cross matching -Check ultrasonography report to exclude congenital malformations -Check type of breech and pelvic adequacy- qualified obstetrician to confirm. If advised then do ultrasonography
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Treatment Orders -Liquids orally - Shave/ clip hair and prepare abdomen, back (if hair is present), and private parts. -Simple enema stat (if presenting part engaged) -TPR, FHS 1/2 hourly -If decision for LSCS, check -LSCS protocol -IV 500 ml RL
Inform if
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Guidelines -Confirm reports of Hb, blood group, VDRL/ HIV, and urinalysis are ready and normal. If not, get them done. -Send blood for spot test for HIV if not done earlier to emergency lab and check the report. -Check if she has received tetanus immunization (at least 2 doses, if the last dose prior to pregnancy was given > 5 years ago, and 1 dose if the last dose prior to pregnancy was given < 5 years ago). -IV access through # 18 cannula. Send blood for grouping and cross matching -Check ultrasonography report to rule out congenital malformations -Check pelvic adequacy- qualified obstetrician to confirm. -If the fetus is in persistent mentoposterior position or contracted pelvis - check LSCS protocol
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Treatment Orders -Liquids orally -Shave/ clip hair and prepare abdomen, back (if hair is present), and private parts. -Simple enema stat (if presenting part engaged) -TPR, FHS 1/2 hourly -No antiseptics like Cetrimide for vulval/vaginal swabbing or vaginal examination. -IV 500 ml RL
Inform if
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