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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. Send blood for grouping and cross matching -Check ultrasonography report to rule out congenital malformations -Confirm pelvic adequacy- qualified obstetrician to confirm, if trial of vaginal delivery is planned. -Check if transient brow- monitors progress of labor. -If persistent brow 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 antiseptic like Cetrimide for vulval/vaginal swabbing and vaginal examination. -IV 500 ml RL
Inform if
Meconium in amniotic fluid |
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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). -No amniotomy. -Take universal precautions. -Contact HIV officer in office hours or lecturer on call in emergency hours for Nevirapine
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Treatment Orders -Shave/ clip hair and prepare private parts -Simple enema stat -Left lateral position -Liquids orally -TPR, FHS 1/2 hourly -Tablet Nevirapine: 200 mg stat at onset of labor
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 -Send blood sugar/check GTT report if available -Do ultrasonography- for anomalies and lie if no previous scan available or clinically lie/ presentation cannot be made out |
Treatment Orders -Shave/ clip hair and prepare private parts -Simple enema stat -TPR, FHS 1/2 hourly -Left lateral position -Controlled amniotomy if cephalic presentation -If malpresentation follow protocol for the same
Inform if
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Guidelines -Confirm reports of Hb, blood group, VDRL, HIV, urinalysis are ready and normal -If abnormal see appropriate protocol -Check if she has received tetanus toxoid (at least 2 doses) -Confirm IUFD on ultrasound -Send fresh Hb, CBC, coagulation profile If in labour- -IV access through 18 # cannula -Send blood for grouping/cross matching -Check cause of death, check for abruption and see appropriate protocol -Check coagulation profile. Refer DIC protocol if abnormal. -Inform lecturer on call -If there are good uterine contractions observe -Augmentation of labour by oxytocin drip if required. If not in labour- -Induction of labour/ await spontaneous onset of labour |
Treatment Orders Shave/ clip hair and prepare private parts -Simple enema stat -Lateral position -Liquids orally -TPR 1/2 hourly -I/O chart -Measure and chart urine output 2 hourly. -Check and follow relevant labour protocol as per the cause of the IUFD. -IV antibiotics (see antibiotic policy)
Inform if
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Guidelines -Gain IV access through # 18 cannula- collect and send blood for grouping cross matching. Do ward Hb. -Check vital parameters. -Inform lecturer -Do colpopuncture. If it is positive, don't send patient for ultrasonography. Prepare her for exploratory laparotomy. -If colpopuncture is negative, then perform urine pregnancy test
Suspected ectopic: -Take lecturer’s opinion- ultrasonography to be done if patient is stable. - B eta HCG test depending on unit policy. -Insert Foley catheter. -Consent for blood and blood products if transfusion is required
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Treatment Orders -IV 500 ml RL as required Ruptured ectopic -Treatment of shock, nasal moist oxygen -Nil by mouth - Shave/ clip hair and prepare abdomen, back (if hairy), and private parts -Prepare for laparotomy -Consent for laparotomy / blood /blood products as required Unruptured ectopic -Nil by mouth -Shave/ clip hair and prepare abdomen, back (if hairy), and private parts -TPR ½ hourly -Consent for laparotomy/ laparoscopy followed by laparotomy/operative laparoscopy. -I/O chart -Get fresh Hb level -Inform if
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Guidelines -Gain IV access through # 18 cannula- collect and send blood for Hb, grouping, VDRL, serum electrolytes. -Check LFT, BUN at least in severe and intractable cases. -Send urine for routine examination, and for the presence of ketones. -Do ultrasonography- for detection of multiple/molar pregnancy.
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Treatment Orders -Nil by mouth -TPR 4 hourly -I/O chart -M/C urine -IV infusions -500 ml 10% Dextrose -500 ml 10% Dextrose + 10 ml KCl -500 ml 10% Dextrose -500 ml DNS + 10 ml KCl -500 ml 10% D + 1 amp MVI -Inj Metoclopramide 10 mg/ Ondansetron 2 mg IM Inj Pyridoxine 10 mg IM Inj Rantidine.50 mg IM Inj 50 ml 50% Dextrose IV 6 hourly if severe; in antecubital vein 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). -Examine and exclude cord prolapse, uterine hyperactivity. -Check for meconium staining of the amniotic fluid. -Inform lecturer on duty. -Do cardiotocography if available -If no response to therapy, consider delivery- LSCS/ forceps (refer to respective guidelines). -Obtain consent for blood and blood products transfusion. |
Treatment Orders -Nil by mouth -Discontinue Oxytocin infusion if already receiving -IV 500 ml RL fast -Left lateral position/ nasal moist O 2. -Shave/ clip hair and prepare private parts -TPR, FHS 15 mins -Consent for LSCS/ forceps/vacuum as appropriate. -If hyper stimulation / hypertonus: tocolysis may be considered if immediate delivery is not possible. |
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Guidelines -Access 2 IV lines #18 - cannula/CVP- cava fix. --Send blood group and cross match. Don’t wait for cross match report. Speak to BBO and ask if blood of respective blood group of patient is available in the blood bank. If blood group is not known ask if blood of all types are available. If blood of all blood groups are not available, -Ask BBO to check patient’s blood group and ask about availability of O+ve and O-ve blood. -Inform lecturer -Obtain consent for blood and blood products transfusion.
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Treatment Orders General -Head low -Nil by mouth -Nasal moist oxygen -TPR, BP, CVP 1/2 hourly -I/O chart -RL -M/C urine 1 hourly -Blood/FFP transfusion as required -If bleeding stops, monitor -Inform if
Hemorrhagic -Follow specific guidelines as per diagnosis Septic -Antibiotics -Low dose Hydrocortisone -Consider Dopamine drip if required Anaphylactic -Adrenaline -Hydrocortisone 100 mg IV |
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Guidelines -Access 2 IV lines #-18 cannula/CVP- cava fix -Send blood for Hb, blood group and cross match -Check bleeding time, perform clot observation test -Inform lecturer -Examine the placenta and confirm that placenta and membranes have been completely expelled out. -Check if the uterus is well contracted. -Evacuate the bladder with Foley catheter if full. -If the placenta is retained, remove it manually. -Examine for genital tract trauma. -If uterus is atonic then perform bimanual massage and elevation. -Obtain consent for blood and blood products transfusion.
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Treatment Orders -Nil by mouth -TPR 1/2 hourly -I/O chart -M/C urine 1 hourly -IV 500 ml RL+20 units Oxytocin -Blood/FFP -Inj. Methyl ergometrine 0.1 mg IV, 0.1 mg IM or -Inj. PGF 2 a 250µg IM -If bleeding stops, monitor
Inform if
-Continue Oxytocin infusion. -Transfusion as required. -Repair genital tract trauma if present |
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Guidelines -Access 2 IV lines #-18 no cannula /CVP- cava fix. -Send blood for Hb, Blood group and cross matching. -Check Hb. -Inform Lecturer on duty. -Insert central venous line -Insert Foley catheter. -Check if placenta and membranes have separated, uterus has contracted, and bladder is full. -Check if there is a mass outside introitus/ in vagina -Check if the placenta is attached to the mass. -Obtain consent for blood and blood products transfusion.
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Treatment Orders -Immediate reposition by a qualified person. -Inform lecturer at the earliest. -If successful then -Nil by mouth -Fundal height/ TPR 1/2 hourly -I/O chart -M/C urine 1 hourly -IV 500 ml RL+20 units Oxytocin -Blood/FFP -Inj. Methyl ergometrine 0.1 mg. IM -Inj. PGF 2 a 250µg IM -If placenta is retained-MRP after reposition of uterus. -Check for genital tract trauma- repair -If uterus is atonic-do bimanual massage. -Follow PPH guidelines |
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Corridor, Receiving Room, Etc.)
Delivery In An Outside Hospital /Nursing Home
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Guidelines -Check delivery of placenta- deliver if not delivered, collect cord blood. -Check for genital trauma. -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). -Admit in wwd and not inside lwd -Confinement number is not to be given if baby is delivered outside the hospital. -Manage the specific condition for which referred as per respective guidelines |
Treatment Orders -Inj. TT 0.5 cc IM + ATS 250 IU IM/SC if not immunised -Give Antibiotics -Repair genital trauma, if present.
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Guidelines -Send blood for Hb, blood group Rh typing, VDRL/HIV -Get urinalysis done. -Get ultrasonography done. -If patient is Rh –ve, get partner’s blood group and Rh typing done. If partner is Rh +ve, do Indirect Coombs’ test (ICT). If ICT –ve, consider Anti D administration.
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Treatment Orders -Shave/ clip hair and prepare private parts -Complete bed rest -Sterile vulval pad -Watch for vaginal bleeding / passage of products of conception -Inj TT 0.5 ml IM -Inj 17 alpha hydroxyprogesterone caproate/acetate depot 250 mg deep IM /other progestational support (Tab Micronised progesterone 100 mg bid vaginally, if progesterone support is desired). -Folic acid 5 mg/d PO
Inform if **
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