6 курс / Неонатология / Интегрированное_Ведение_Беременности_и_Родов_Уход_во_время_беременности
.pdfАнтенатальныйуход |
C18 |
АНТЕНАТАЛЬНЫЙУХОД
РОДЫНАДОМУБЕЗУЧАСТИЯКВАЛИФИЦИРОВАННОГОМЕДРАБОТНИКА
Вновьподчеркнитеважностьприсутствияприродахквалифицированногомедработника
Инструктируйтематьисемьюпопроведению чистыхибезопасныхродовнадому
Еслиженщинарешиларожатьвдомашнихусловияхбезучастияквалифицированного медработника,совместносженщиной ичленамиеесемьиобсудитеэтипростейшиеинструкции
Выдайтеженщинеодноразовыйнабордляприемародови объясните,какимпользоваться.
Настоятельнопопроситеее/их:
Подготовитьчистуюкомнатуилиместо,гдебудутпроходитьроды.
Удостоверитьсявтом,чтопомощницадоипослекаждогоконтактасженщинойи/или новорожденныммоетрукисмыломподпроточнойводой.Помощницатакжедолжнакоротко подстричьногти.
Сразупослерождениявыложитьребенканагрудьматери,обеспечивконтакткожа–к–коже; протеретьглазаребенка,используяотдельные длякаждогоглазакускичистойматерии.
Укрытьматьиноворожденного.
Использоватьдляперерезкиилигированияпуповинылезвиеиспециальныенити,имеющиесяв одноразовомнаборе.Пуповинаперерезаетсясразупослепрекращениявнейпульсации.
Послеперерезкипуповиныобсушитьребенка.Вытеретьчистойматериейилиполотенцем,ноне купатьвтечение6часовпослерождения.
Подождать,покаплацентародитсясамостоятельно.
Начатькормлениегрудью,когдаребенокпроявитпризнакиготовности,втечениепервогочаса послеродов.
НЕоставлятьродильницуоднупоменьшеймеревтечение24часовпослеродов.
Согреватьматьиноворожденного.Одетьилизапеленатьребенка,наегоголовуодетьшапочку.
Уничтожитьпоследбезопаснымиправильнымспособом(путемсжиганияилизахоронения).
Рекомендуйтеизбегатьприносящихвреддействий
НАПРИМЕР:
НЕиспользоватьместныенародныесредствадляускоренияначалародов.
НЕ ждатьпрекращенияотхожденияоколоплодныхводдотого,какобратитьсявмедучреждение. НЕ вводитьникакиевеществаипредметывовлагалищевовремяродовивпослеродовом
периоде.
НЕ надавливатьнаживотроженице вовремяродов. НЕ потягивать запуповинусцельюрожденияплаценты.
НЕ накладыватьнакультюпуповинызолу,коровийнавозиличто-либо.
Поощряйтеиспользованиеместныхнародныхспособов,имеющихблаготворноевлияние
____________________________________________________________________
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Расскажитеобопасныхпризнаках
Расскажитеобопасныхпризнаках
Если уженщиныи/илиноворожденногообнаружен любойизэтихпризнаков,она/они БЕЗОТЛАГАТЕЛЬНО,влюбоевремядолжнынаправиться вмедицинскийцентр.
Женщина
Водыотошли,носпустя6часовродоваядеятельностьнеразвилась.
Родовыеболи/схваткипродолжаютсяболее12часов.
Профузноекровотечениевпослеродовомпериоде(прокладка/материяпропитываетсяменее чемза5минут)
Усиливающеесякровотечение
Плацентанеродиласьболеечемчерез1часпослерожденияребенка.
Новорожденный
Явномалыеразмеры
Затрудненноедыхание
Припадки
Лихорадка
Холодныйнаощупь
Кровотечение
Отказываетсяотгруди
Роды:периодраскрытия,изгнанияираннийпослеродовыйпериод
РОДЫ:ПЕРИОДРАСКРЫТИЯ,ИЗГНАНИЯИРАННИЙПОСЛЕРОДОВЫЙПЕРИОД
РОДЫ:ПЕРИОДРАСКРЫТИЯ,ИЗГНАНИЯИРАННИЙПОСЛЕРОДОВЫЙПЕРИОД
CHILDBIRTH: LABOUR,DELIVERYAND IMMEDIATE POSTPARTUM CARE
Examinethewomaninlabourorwithruptured membranes
EXAMINE THE WOMAN IN LABOUR OR WITH RUPTURED MEMBRANES
First do Rapid assessment and management |
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ASK,CHECK RECORD |
LOOK,LISTEN,FEEL |
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Historyofthislabour: |
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Observethewoman’sresponseto |
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Whendidcontractionsbegin? |
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contractions: |
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Howfrequentarecontractions? |
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Õ Isshecopingwellorisshe |
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Howstrong? |
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distressed? |
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Haveyourwatersbroken?Ifyes, |
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Õ Isshepushingorgrunting? |
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when? Weretheyclearorgreen? |
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Check abdomenfor: |
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Haveyouhadanybleeding? |
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Õ caesareansectionscar. |
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Ifyes,when? How much? |
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Õ horizontalridgeacrosslower |
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Isthebabymoving? |
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abdomen(ifpresent,emptybladder |
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Doyouhaveanyconcern? |
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andobserveagain). |
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Checkrecord,orifnorecord: |
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Feelabdomenfor: |
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Askwhenthedeliveryisexpected. |
Õ contractionsfrequency,duration, |
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Determineifpreterm |
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anycontinuouscontractions? |
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(lessthan8monthspregnant). |
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Õ fetallie—longitudinalortransverse? |
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Reviewthebirthplan. |
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Õ fetalpresentation—head,breech, |
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Ifpriorpregnancies: |
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other? |
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Numberofprior |
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Õ morethanonefetus? |
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pregnancies/deliveries. |
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Õ fetalmovement. |
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Anypriorcaesareansection,forceps, |
Listentothefetalheartbeat: |
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orvacuum,orothercomplication |
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Õ Countnumberofbeatsin1minute. |
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suchaspostpartum haemorhage? |
Õ Iflessthan100beatsperminute, |
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Anypriorthirddegreetear? |
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ormorethan180,turnwoman on |
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Currentpregnancy: |
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herleftsideandcountagain. |
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RPRstatus |
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Measurebloodpressure. |
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Hbresults |
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Measuretemperature. |
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Tetanusimmunizationstatus |
Lookforpallor. |
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HIVstatus |
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Lookforsunkeneyes,drymouth. |
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Infantfeedingplan |
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Pinchtheskinoftheforearm:doesit |
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gobackquickly? |
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NEXT:Performvaginalexaminationanddecidestageoflabour
D2 D2 ОСМОТРЖЕНЩИНЫВРОДАХ,ИЛИС РАЗРЫВОМПЛОДНЫХОБОЛОЧЕК.
Firststageoflabour(1): whenthewomanisnotinactivelabour
CARE |
FIRSTSTAGE OF LABOUR: NOTIN ACTIVE LABOUR |
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UsethischartforcareofthewomanwhenNOTIN ACTIVE LABOUR,when cervixdilated0-3cmandcontractionsareweak,lessthan2in10minutes. |
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POSTPARTUM |
MONITOR EVERY HOUR: |
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MONITOR EVERY 4 HOURS: |
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Foremergencysigns,usingrapidassessment(RAM) |
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Bloodpressure . |
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Cervicaldilatation |
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Frequency,intensityanddurationofcontractions. |
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Unlessindicated,DO NOTdovaginalexaminationmorefrequentlythanevery4hours. |
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Fetalheartrate . |
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Temperature. |
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IMMEDIATEAND |
Mood and behaviour(distressed,anxious) . |
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Pulse . |
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ASSESS PROGRESS OF LABOUR |
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TREATAND ADVISE,IF REQUIRED |
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RecordfindingsregularlyinLabourrecordandPartograph |
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Recordtimeofruptureofmembranesandcolourofamnioticfluid. |
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GiveSupportivecare |
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Neverleavethewomanalone. |
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LABOUR,DELIVERYCHILDBIRTH: |
After8hoursif: |
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Refer the woman urgentlytohospital . |
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Õ Contractionsstrongerandmorefrequentbut |
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Õ Noprogressincervicaldilatationwithorwithoutmembranesruptured. |
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After8hoursif: |
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Dischargethewoman and advisehertoreturnif: |
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Õ noincreaseincontractions,and |
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Õ pain/discomfortincreases |
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Õ membranesarenotruptured,and |
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Õ vaginalbleeding |
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Õ noprogressincervicaldilatation. |
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Õ membranes rupture. |
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Cervicaldilatation4cmorgreater. |
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Beginplottingthepartograph and managethewomanasin Activelabour . |
D8 D8 ПЕРВЫЙПЕРИОДРОДОВ(1):КОГДА ЖЕНЩИНАНЕНАХОДИТСЯВАКТИВНОЙ ФАЗЕРОДОВ
CHILDBIRTH: LABOUR,DELIVERYAND IMMEDIATE POSTPARTUM CARE
CHILDBIRTH: LABOUR,DELIVERYAND IMMEDIATE POSTPARTUM CARE
DECIDE STAGE OF LABOUR |
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D3 |
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ASK,CHECK RECORD |
LOOK,LISTEN,FEEL |
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SIGNS |
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CLASSIFY |
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MANAGE |
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Explaintothewomanthat |
Lookat vulvafor: |
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Bulgingthinperineum,vagina |
IMMINENT DELIVERY |
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Seesecondstageoflabour |
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youwillgiveheravaginal |
Õ bulgingperineum |
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gapingandheadvisible,ful |
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Recordinpartograph . |
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examinationandaskforher |
Õ anyvisiblefetalparts |
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cervicaldilatation. |
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consent. |
Õ vaginalbleeding |
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Cervicaldilatation: |
LATEACTIVE LABOUR |
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Seefirststageoflabour–activelabour . |
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Õ leakingamnioticfluid;ifyes,isitmeconium |
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stained,foul-smelling? |
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Õ multigravida ≥5 cm |
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Startplottingpartograph . |
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Õ warts,keloidtissueorscarsthatmayinterfere |
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Õ primigravida ≥6 cm |
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Recordinlabourrecord . |
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withdelivery. |
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Cervicaldilatation ≥4cm. |
EARLYACTIVE LABOUR |
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Performvaginalexamination |
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Cervicaldilatation:0-3cm; |
NOTYETIN ACTIVE |
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Seefirststageoflabour—notactivelabour . |
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DO NOTshavetheperinealarea. |
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Prepare: |
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contractionsweakand |
LABOUR |
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Recordinlabourrecord . |
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Õ cleangloves |
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<2in10minutes. |
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Õ swabs,pads. |
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Washhandswithsoapbeforeandaftereach |
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examination. |
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Washvulvaandperinealareas. |
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Putongloves. |
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Positionthewomanwithlegsflexedandapart. |
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DO NOTperformvaginalexaminationifbleeding |
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noworatanytimeafter7monthsofpregnancy. |
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Performgentlevaginalexamination(donotstart |
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duringacontraction): |
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Õ Determinecervicaldilatationincentimetres. |
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Õ Feelforpresentingpart.Isithard,roundand |
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smooth(thehead)?Ifnot,identifythe |
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presentingpart. |
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Õ Feelformembranes–aretheyintact? |
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Õ Feelforcord–isitfelt?Isitpulsating?Ifso, |
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actimmediatelyason . |
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NEXT:Respondtoobstetricalproblemsonadmission. |
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Decidestageoflabour |
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D3 |
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Respondtoobstetricalproblemsonadmission |
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D4 |
D4 |
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RESPOND TO OBSTETRICAL PROBLEMS ON ADMISSION |
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Usethischartifabnormalfindingsonassessingpregnancyandfetalstatus |
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SIGNS |
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CLASSIFY |
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TREATAND ADVISE |
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Transverselie. |
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OBSTRUCTED LABOUR |
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Ifdistressed,insertanIVlineandgivefluids . |
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Continuouscontractions. |
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Ifinlabour>24hours,giveappropriateIM/IV |
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Constantpainbetweencontractions. |
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antibiotics . |
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Sudden and severeabdominalpain. |
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Referurgentlytohospital . |
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Horizontalridgeacrosslower |
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abdomen. |
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Labour>24hours. |
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FOR ALLSITUATIONSINREDBELOW,REFER URGENTLYTO HOSPITALIFINEARLYLABOUR,MANAGE ONLYIFINLATELABOUR |
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Ruptureofmembranesandanyof: |
UTERINE AND |
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GiveappropriateIM/IVantibiotics . |
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Õ Fever >38˚C |
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FETAL INFECTION |
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Iflatelabour,deliverandrefertohospital |
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Õ Foul-smellingvaginaldischarge. |
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afterdelivery . |
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Plantotreatnewborn . |
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Ruptureofmembranesat |
RISK OF UTERINE AND |
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GiveappropriateIM/IVantibiotics . |
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<8 monthsofpregnancy. |
FETAL INFECTION |
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Iflatelabour,deliver |
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Discontinueantibioticformotherafterdeliveryifno |
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signsofinfection. |
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Plantotreatnewborn . |
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Diastolicbloodpressure>90mmHg. |
PRE-ECLAMPSIA |
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Assessfurtherandmanageason . |
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Severepalmarandconjunctival |
SEVERE ANAEMIA |
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Manageason . |
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pallorand/orhaemoglobin<7g/dl. |
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Breechorothermalpresentation . |
OBSTETRICAL |
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Followspecificinstructions |
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Multiplepregnancy . |
COMPLICATION |
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(seepagenumbersinleftcolumn). |
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Fetaldistress . |
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Prolapsedcord . |
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ОПРЕДЕЛИТЕСТАДИЮРОДОВ
РЕАГИРУЙТЕНАВОЗНИКНОВЕНИЕ АКУШЕРСКИХОСЛОЖНЕНИЙВМОМЕНТ ПОСТУПЛЕНИЯ(1)
CHILDBIRTH: LABOUR,DELIVERYAND IMMEDIATE POSTPARTUM CARE
CHILDBIRTH: LABOUR,DELIVERYAND IMMEDIATE POSTPARTUM CARE
MONITOR EVERY 30 MINUTES: |
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MONITOR EVERY 4 HOURS: |
D9 |
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Foremergencysigns,usingrapidassessment(RAM) |
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Cervicaldilatation |
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Frequency,intensityanddurationofcontractions. |
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Unlessindicated,donot dovaginalexaminationmorefrequentlythanevery4hours. |
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Fetalheartrate . |
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Temperature. |
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Mood and behaviour(distressed,anxious) . |
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Pulse . |
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Bloodpressure . |
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RecordfindingsregularlyinLabourrecordandPartograph |
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Recordtimeofruptureofmembranesandcolourofamnioticfluid. |
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GiveSupportivecare |
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Neverleavethewomanalone. |
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FIRSTSTAGE OF LABOUR:IN ACTIVE LABOUR
UsethischartwhenthewomanisIN ACTIVE LABOUR,whencervixdilated4cmormore.
ASSESS PROGRESS OF LABOUR |
TREATAND ADVISE,IF REQUIRED |
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Partographpassestotherightof ALERTLINE. |
Reassesswomanandconsidercriteriaforreferral. |
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Callseniorpersonifavailable.Alertemergencytransportservices. |
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Encouragewomantoemptybladder. |
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Ensureadequatehydrationbutomitsolidfoods. |
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Encourageuprightpositionandwalkingifwomanwishes. |
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Monitorintensively.Reassessin2hoursandreferifnoprogress.Ifreferraltakesalongtime,refer |
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immediately(DONOTwaittocrossactionline). |
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Partographpassestotherightof ACTIONLINE. |
Referurgentlytohospital |
unlessbirthisimminent. |
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Cervixdilated10cmorbulgingperineum. |
Manageasin Secondstageoflabour |
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Firststageoflabour(2): whenthewomanisinactivelabour |
D9 |
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Secondstageoflabour:deliverthebabyandgiveimmediatenewborncare(1) |
D10 |
D10 |
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SECOND STAGE OF LABOUR: DELIVER THE BABY AND GIVE IMMEDIATE NEWBORN CARE |
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Usethischartwhencervixdilated10cmorbulgingthinperineumandheadvisible. |
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MONITOR EVERY 5 MINUTES: |
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Foremergencysigns,usingrapidassessment(RAM) |
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Frequency,intensityanddurationofcontractions. |
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Fetalheartrate . |
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Perineumthinningandbulging. |
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Visibledescentoffetalheadorduringcontraction. |
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Mood and behaviour(distressed,anxious) . |
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RecordfindingsregularlyinLabourrecordandPartograph(pp.N4-N6). |
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GiveSupportivecare |
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Neverleavethewomanalone. |
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DELIVER THEBABY |
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TREATAND ADVISEIFREQUIRED |
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Ensurealldeliveryequipmentandsupplies,includingnewbornresuscitationequipment,are |
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available,andplaceofdeliveryiscleanandwarm (25°C) . |
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Ensurebladderisempty. |
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Ifunabletopassurineandbladderisfull,emptybladder . |
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Assistthewomanintoacomfortablepositionofherchoice,asuprightaspossible. |
DO NOTletherlieflat(horizontally)onherback. |
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Staywithherandofferheremotionalandphysicalsupport |
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Ifthewomanisdistressed,encouragepaindiscomfortrelief . |
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Allowhertopushasshewisheswithcontractions. |
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DO NOTurgehertopush. |
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If,after30minutesofspontaneousexpulsiveefforts,theperineumdoesnotbegintothinandstretch |
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withcontractions,doavaginalexaminationtoconfirmfulldilatationofcervix. |
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Ifcervixisnotfullydilated,awaitsecondstage.Placewomanonherleftsideanddiscourage |
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pushing.Encouragebreathingtechnique . |
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Waituntilheadvisibleandperineumdistending. |
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Ifsecondstagelastsfor2hoursormorewithoutvisiblesteadydescentofthehead,callforstaff |
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Washhandswithcleanwaterandsoap.Putonglovesjustbeforedelivery. |
trainedtousevacuumextractoror referurgentlytohospital . |
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SeeUniversalprecautionsduringlabouranddelivery . |
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Ifobviousobstructiontoprogress(warts/scarring/keloidtissue/previousthirddegreetear),doa |
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generousepisiotomy.DO NOTperformepisiotomyroutinely. |
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Ifbreechorothermalpresentation,manageason . |
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ПЕРВЫЙПЕРИОДРОДОВ(1): В АКТИВНОЙФАЗЕ
ВТОРОЙПЕРИОДРОДОВ:ПРИМИТЕ РОДЫИПРЕДОСТАВЬТЕНЕОТЛОЖНУЮ ПОМОЩЬНОВОРОЖДЕННОМУ(1)
CHILDBIRTH: LABOUR,DELIVERYAND IMMEDIATE POSTPARTUM CARE
CHILDBIRTH: LABOUR,DELIVERYAND IMMEDIATE POSTPARTUM CARE CHILDBIRTH: LABOUR,DELIVERYAND IMMEDIATE POSTPARTUM CARE
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SIGNS |
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CLASSIFY |
TREATAND ADVISE |
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D5 |
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Warts,keloidtissuethatmay |
RISK OF OBSTETRICAL |
Doagenerousepisiotomyandcarefullycontrol |
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interferewithdelivery. |
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COMPLICATION |
deliveryofthehead |
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Priorthirddegreetear. |
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Bleedinganytimeinthirdtrimester. |
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Iflatelabour,deliver |
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Priordeliveryby: |
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Havehelpavailableduringdelivery. |
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Õ caesareansection |
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Õ forcepsorvacuumdelivery. |
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Agelessthan14years. |
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Labourbefore8completedmonths |
PRETERM |
Reassessfetalpresentation(breechmorecommon). |
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ofpregnancy(morethanonemonth |
LABOUR |
Ifwomanislying,encouragehertolieonherleftside. |
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beforeestimateddateofdelivery). |
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Callforhelpduringdelivery. |
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Conductdeliveryverycarefullyassmallbabymaypop |
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outsuddenly.Inparticular,controldeliveryofthehead. |
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Prepareequipmentforresuscitationofnewborn |
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Fetalheartrate |
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POSSIBLE FETAL |
Manageason |
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<120or>160beatsperminute. |
DISTRESS |
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Ruptureofmembranesatterm and |
RUPTURE OF |
GiveappropriateIM/IVantibioticsifruptureof |
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beforelabour. |
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MEMBRANES |
membrane >18 hours |
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Plantotreatthenewborn |
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Iftwoormoreofthefollowingsigns: |
DEHYDRATION |
Giveoralfluids. |
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Õ thirsty |
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Ifnotabletodrink,give1litreIVfluidsover3hours |
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Õ sunkeneyes |
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Õ drymouth |
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Õ skinpinchgoesbackslowly. |
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HIVtestpositive. |
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HIV-POSITIVE |
EnsurethatthewomantakesARVdrugsassoonas |
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Counselledon ARVtreatmentand |
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labourstarts |
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infantfeeding. |
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Supportherchoiceofinfantfeeding |
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Nofetalmovement,and |
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POSSIBLE FETAL DEATH |
Explaintotheparentsthatthebabyisnotdoingwel. |
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Nofetalheartbeaton |
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NEXT:Givesupportivecarethroughoutlabour |
repeatedexamination |
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Respondtoobstetricalproblemsonadmission |
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D5 |
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Givesupportivecarethroughoutlabour |
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D6 |
D6 |
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GIVE SUPPORTIVE CARE THROUGHOUT LABOUR |
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Usethischarttoprovideasupportive,encouragingatmosphereforbirth,respectfulofthewoman’swishes. |
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Communication |
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Eating,drinking |
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Explainallprocedures,seekpermission,anddiscussfindingswiththewoman. |
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Encouragethewomantoeatanddrinkasshewishesthroughoutlabour. |
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Keepherinformedabouttheprogressoflabour. |
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Nutritiousliquiddrinksareimportant,eveninlatelabour. |
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Praiseher,encourageandreassureherthatthingsaregoingwel. |
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Ifthewomanhasvisibleseverewastingortiresduringlabour,makesuresheeatsanddrinks. |
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Ensureandrespectprivacyduringexaminationsanddiscussions. |
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Breathingtechnique |
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IfknownHIVpositive,findoutwhatshehastoldthecompanion.Respectherwishes. |
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Cleanliness |
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Teachhertonoticehernormalbreathing. |
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Encouragehertobreatheoutmoreslowly,makingasighingnoise,andtorelaxwitheachbreath. |
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Ifshefeelsdizzy,unwel,isfeelingpins-and-needles(tingling)inherface,handsandfeet,encourage |
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Encouragethewomantobatheorshowerorwashherselfandgenitalsattheonsetoflabour. |
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Washthevulvaandperinealareasbeforeeachexamination. |
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hertobreathemoreslowly. |
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Washyourhandswithsoapbeforeandaftereachexamination.Usecleanglovesforvaginal |
Topreventpushingattheendoffirststageoflabour,teachhertopant,tobreathewithanopen |
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examination. |
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mouth,totakein2shortbreathsfollowedbyalongbreathout. |
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Ensurecleanlinessoflabourandbirthingarea(s). |
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Duringdeliveryofthehead,askhernottopushbuttobreathesteadilyortopant. |
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Cleanupspillsimmediately. |
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Painanddiscomfortrelief |
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DO NOTgiveenema. |
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Mobility |
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Suggestchangeofposition. |
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Encouragemobility,ascomfortableforher. |
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Encouragecompanionto: |
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Encouragethewomantowalkaroundfreelyduringthefirststageoflabour. |
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Supportthewoman’schoiceofposition(leftlateral,squating,kneeling,standingsupportedbythe |
Õ massagethewoman’sbackifshefindsthishelpful. |
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companion)foreachstageoflabouranddelivery. |
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Õ holdthewoman’shandandspongeherfacebetweencontractions. |
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Urination |
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Encouragehertousethebreathingtechnique. |
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Encouragewarmbathorshower,ifavailable. |
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Encouragethewomantoemptyherbladderfrequently.Remindherevery2hours. |
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Ifwomanisdistressedoranxious,investigatethecause |
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Ifpainisconstant(persistingbetweencontractions)andverysevereorsuddeninonset |
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D7
Birthcompanion
Encouragesupportfromthechosenbirthcompanionthroughoutlabour.
Describetothebirthcompanionwhatsheorheshoulddo:
Õ Alwaysbewiththewoman. Õ Encourageher.
Õ Helphertobreatheandrelax.
Õ Rubherback,wipeherbrowwithawetcloth,doothersupportiveactions. Õ Givesupportusinglocalpracticeswhichdonotdisturblabourordelivery.
Õ Encouragewoman to movearoundfreelyasshewishesandtoadoptthepositionofherchoice. Õ Encouragehertodrinkfluidsandeatasshewishes.
Õ Assisthertothetoiletwhenneeded.
Askthebirthcompaniontocallforhelpif:
Õ Thewomanisbearingdownwithcontractions. Õ Thereisvaginalbleeding.
Õ Sheissuddenlyinmuchmorepain. Õ Shelosesconsciousnessorhasfits. Õ Thereisanyotherconcern.
Tellthebirthcompanionwhatsheorhe SHOULD NOTDO andexplainwhy: DO NOTencouragewomantopush.
DO NOTgiveadviceotherthanthatgivenbythehealthworker. DO NOTkeepwomaninbedifshewantstomovearound.
Birthcompanion |
D7 |
РЕАГИРУЙТЕНАВОЗНИКНОВЕНИЕ АКУШЕРСКИХОСЛОЖНЕНИЙ ВМОМЕНТ ПОСТУПЛЕНИЯ(2)
ОКАЗЫВАЙТЕПОДДЕРЖКУЖЕНЩИНЕВ РОДАХ
КОМПАНЬРОЖЕНИЦЫ
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DELIVER THEBABY |
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TREATAND ADVISE,IFREQUIRED |
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D11 |
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CARE |
Ensurecontrolleddeliveryofthehead: |
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Ifpotentiallydamagingexpulsiveefforts, exertmorepressureonperineum. |
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Keeponehandgentlyontheheadasitadvanceswithcontractions. |
Discardsoiledpadtopreventinfection. |
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ÕÕ Supportperineumwithotherhandandcoveranuswithpadheldinpositionbysideofhandduringdelivery. |
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Õ Leavetheperineumvisible(betweenthumbandfirstfinger). |
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POSTPARTUM |
Õ Askthemothertobreathesteadilyandnottopushduringdeliveryofthehead. |
Ifdelayindeliveryofshoulders: |
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Awaitspontaneousrotationofshouldersanddelivery(within1-2minutes). |
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Õ Encouragerapidbreathingwithmouthopen. |
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Feelgentlyaroundbaby’sneckforthecord. |
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Ifcordpresentandloose,deliverthebabythroughtheloopofcordorslipthecordoverthebaby’shead;if |
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Checkifthefaceisclearofmucusandmembranes. |
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cordistight,clampandcutcord,thenunwind. |
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Gentlywipefacecleanwithgauzeorcloth,ifnecessary. |
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IMMEDIATE |
Applygentledownwardpressuretodelivertopshoulder. |
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Õ DO NOTpanicbutcallforhelpandaskcompaniontoassist |
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Assessbaby’sbreathingwhiledrying. |
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Ifthebabyisnotbreathingorgasping (unlessbabyisdead,macerated,severelymalformed): |
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Thenliftbabyup,towardsthemother’sabdomentodeliverlowershoulder. |
Õ Manageasin Stuckshoulders |
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Placebabyonabdomenorinmother’sarms. |
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Ifplacingnewbornonabdomenisnotacceptable,orthemothercannotholdthebaby,placethebabyin |
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Notetimeofdelivery. |
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aclean,warm,safeplaceclosetothemother. |
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Thoroughlydrythebabyimmediately.Wipeeyes.Discardwetcloth. |
DO NOTleavethebabywet-she/hewillbecomecold. |
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Ifthebabyisnotcrying,observebreathing: |
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Õ Cutcordquickly:transfertoafirm,warmsurface;startNewbornresuscitation |
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Õ breathingwell(chestrising)? |
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CALLFORHELP-onepersonshouldcareforthemother. |
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Õ notbreathingorgasping? |
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LABOUR,DELIVERY |
Õ observeforoozingblood. |
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Ifsecondbaby,DO NOTgiveoxytocinnow.GET HELP. |
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Excludesecondbaby. |
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Palpatemother’s abdomen. |
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Deliverthesecondbaby.Manageasin Multiplepregnancy |
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Give10IUoxytocinIMtothemother. |
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Ifheavybleeding,repeatoxytocin10UIM. |
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Watchforvaginalbleeding. |
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Changegloves.Ifnotpossible,washglovedhands. |
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Ifbloodoozing,placeasecondtiebetweentheskinandthefirsttie. |
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Clampandcutthecord. |
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DO NOTapplyanysubstancetothestump. |
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Õ puttiestightlyaroundthecordat2cmand5cmfrombaby’s abdomen. |
DO NOTbandageorbindthestump. |
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Õ cutbetweentieswithsterileinstrument. |
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Leavebabyonthemother’schestinskin-to-skincontact.Placeidentificationlabel. |
Ifroomcool(lessthan25°C),useadditionalblankettocoverthemotherandbaby. |
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Coverthebaby,covertheheadwithahat. |
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Encourageinitiationofbreastfeeding |
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IfHIV-positivemotherhaschosenreplacementfeeding,feedaccordingly. |
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Check ARVtreatmentneeded |
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Secondstageoflabour:deliverthebabyandgiveimmediatenewborncare(2) |
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D11 |
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CARE |
Thirdstageoflabour:delivertheplacenta |
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D12 |
D12 |
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THIRD STAGE OF LABOUR: DELIVER THE PLACENTA |
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Usethischartforcareofthewomanbetweenbirthofthebabyanddeliveryofplacenta. |
MONITOR BABY EVERY 15 MINUTES: |
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POSTPARTUM |
MONITOR MOTHER EVERY 5 MINUTES: |
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Timesincethirdstagebegan(timesincebirth). |
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Breathing:listenforgrunting,lookforchestin-drawingandfastbreathing |
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Foremergencysigns,usingrapidassessment(RAM) |
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Feelifuterusiswellcontracted. |
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Warmth:checktoseeiffeetarecoldtotouch |
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Mood and behaviour(distressed,anxious) |
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IMMEDIATE |
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Recordfindings,treatmentsandproceduresin Labourrecordand Partograph (pp.N4-N6). |
TREATAND ADVISEIFREQUIRED |
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DELIVER THEPLACENTA |
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GiveSupportivecare |
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Neverleavethewomanalone. |
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AND |
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Ensure10IUoxytocinIMisgiven |
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If,after30minutesofgivingoxytocin,theplacentaisnotdeliveredandthewomanis NOTbleeding: |
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Awaitstronguterinecontraction(2-3minutes)anddeliverplacenta bycontrolledcordtraction: |
Õ Emptybladder |
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LABOUR,DELIVERY |
Õ Placesideofonehand(usuallyleft)above symphysispubiswithpalmfacingtowardsthemother’s |
Õ Encouragebreastfeeding |
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umbilicus.Thisappliescountertractiontotheuterusduringcontrolledcordtraction.Atthesame |
DO NOTexertexcessivetractiononthecord. |
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Õ Repeatcontrolledcordtraction. |
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time,applysteady,sustainedcontrolledcordtraction. |
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Ifwomanisbleeding,manageason |
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Õ Ifplacentadoesnotdescendduring30-40secondsofcontrolledcordtraction,releasebothcord |
Ifplacentaisnotdeliveredinanother30minutes(1hourafterdelivery): |
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tractionandcountertractionontheabdomenandwaituntiltheuterusiswellcontractedagain. |
Õ Removeplacentamanually |
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Thenrepeatcontrolledcordtractionwithcountertraction. |
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Õ GiveappropriateIM/IVantibiotic |
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Õ Astheplacentaiscomingout,catchinbothhandstopreventtearingofthemembranes. |
Ifin1hourunabletoremoveplacenta: |
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Õ Ifthemembranesdonotslipoutspontaneously,gentlytwistthemintoaropeandmovethemup |
Õ Referthewomantohospital |
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anddowntoassistseparationwithouttearingthem. |
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Õ InsertanIVlineandgivefluidswith20IUofoxytocinat30dropsperminute |
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duringtransfer |
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CHILDBIRTH: |
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DO NOTsqueezeorpushtheuterustodelivertheplacenta. |
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Checkthatplacentaandmembranesarecomplete. |
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Ifplacentaisincomplete: |
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Removeplacentalfragmentsmanually |
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GiveappropriateIM/IVantibiotic |
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D13 |
CARE |
DELIVER THEPLACENTA |
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TREATAND ADVISE,IF REQUIRED |
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Checkthatuterusiswellcontractedandthereisnoheavybleeding. |
Ifheavybleeding: |
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Repeatcheckevery5minutes. |
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Massageuterustoexpelclotsifany,untilitishard |
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POSTPARTUM |
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Giveoxytocin10IUIM |
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ContinueIVfluidswith20IUofoxytocinat30dropsperminute. |
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Callforhelp. |
,add20IUofoxytocintoIVfluidsandgiveat60dropsperminute |
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StartanIVline |
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Emptythebladder |
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Ifbleedingpersistsanduterusissoft: |
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Continuemassaginguterusuntilitishard. |
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Applybimanualoraorticcompression |
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IMMEDIATE |
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Refer woman urgentlytohospital |
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Examineperineum,lowervaginaandvulvafortears. |
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Checkafter5minutes.Ifbleedingpersists,repairthetear |
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Ifthirddegreetear(involvingrectumoranus),referurgentlytohospital |
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Forothertears:applypressureoverthetearwithasterilepadorgauzeandputlegstogether. |
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DO NOTcrossankles. |
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AND |
Collect,estimateandrecordbloodlossthroughoutthirdstageandimmediatelyafterwards. |
Ifbloodloss ≈250ml,butbleedinghasstopped: |
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Õ Plantokeepthewomaninthefacilityfor24hours. |
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LABOUR,DELIVERY |
Keepthemotherandbabyindeliveryroomforaminimumofonehourafterdeliveryofplacenta. |
Õ BP,pulse |
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Õ vaginalbleeding |
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Õ uterus,tomakesureitiswellcontracted. |
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Õ Assistthewoman whenshefirstwalksafterrestingandrecovering. |
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Õ Ifnotpossibletoobserveatthefacility,refertohospital |
. |
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Cleanthewomanandtheareabeneathher.Putsanitarypadorfoldedcleanclothunderherbuttocks |
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tocollectblood.Helphertochangeclothesifnecessary. |
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CHILDBIRTH: |
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Disposeofplacentainthecorrect,safeandculturallyappropriatemanner. |
Ifdisposingplacenta: |
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Õ Usegloveswhenhandlingplacenta. |
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Õ Putplacentaintoabagandplaceitintoaleak-proofcontainer. |
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Õ Alwayscarryplacentainaleak-proofcontainer. |
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Õ Incineratetheplacentaorburyitatleast10mawayfromawatersource,ina2mdeeppit. |
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Thirdstageoflabour:delivertheplacenta |
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D13 |
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ВТОРОЙПЕРИОДРОДОВ:ПРИМИТЕ РОДЫИПРЕДОСТАВЬТЕНЕОТЛОЖНУЮ ПОМОЩЬНОВОРОЖДЕННОМУ(2)
ТРЕТИЙПЕРИОДРОДОВ:ПРИМИТЕ РОЖДЕНИЕПЛАЦЕНТЫ(1)
ТРЕТИЙПЕРИОДРОДОВ:ПРИМИТЕ РОЖДЕНИЕПЛАЦЕНТЫ(2)
CARE |
Respondtoproblemsduringlabouranddelivery(1) |
If FHR <120 or >160 bpm |
|
D14 |
D14 |
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RESPOND TO PROBLEMS DURING LABOUR AND DELIVERY |
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POSTPARTUM |
IFFETAL HEART RATE (FHR) <120 OR >160 BEATS PER MINUTE |
CLASSIFY |
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TREATAND ADVISE |
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ASK,CHECK RECORD |
LOOK,LISTEN,FEEL |
SIGNS |
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IMMEDIATE |
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Positionthewomanonherleftside. |
Cordseenatvulva. |
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Manageurgentlyason . |
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Ifmembraneshaveruptured,lookat |
FHRremains>160or<120after30 |
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Ifearlylabour: |
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vulvaforprolapsedcord. |
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Seeifliquorwasmeconiumstained. |
minutesobservation. |
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Õ Refer the womanurgentlytohospital |
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RepeatFHRcountafter15 |
minutes. |
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Õ Keepherlyingonherleftside. |
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Iflatelabour: |
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AND |
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Õ Monitoraftereverycontraction.IfFHRdoesnot |
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returntonormalin15minutesexplaintothe |
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woman(andhercompanion)thatthebabymay |
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DELIVERYLABOUR,CHILDBIRTH: |
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notbewel. |
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Õ Preparefornewbornresuscitation . |
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FHRreturnstonormal. |
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MonitorFHRevery15minutes. |
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NEXT:Ifprolapsedcord |
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D15 |
|||||
CARE |
IFPROLAPSED CORD |
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POSTPARTUM |
Thecordisvisibleoutsidethevaginaorcanbefeltinthevaginabelowthepresentingpart. |
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ASK,CHECK RECORD |
Dovaginalexaminationtodetermine |
SIGNS |
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CLASSIFY |
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Pushtheheadorpresentingpartoutofthepelvis |
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LOOK,LISTEN,FEEL |
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TREAT |
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Lookatorfeelthecordgentlyfor |
Transverselie |
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OBSTRUCTED LABOUR |
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Referurgentlytohospital |
. |
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pulsations. |
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Cordispulsating |
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FETUS ALIVE |
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Ifearlylabour: |
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Feelfortransverselie. |
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IMMEDIATE |
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statusoflabour. |
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andholditabovethebrim/pelviswithyourhandon |
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Iftransfernotpossible,allowlabourtocontinue. |
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theabdomenuntilcaesareansectionisperformed. |
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Instructassistant(family,staff)topositionthe |
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woman’sbuttockshigherthantheshoulder. |
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Referurgentlytohospital |
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AND |
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Iflatelabour: |
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Callforadditionalhelpifpossible(formotherandbaby). |
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LABOUR,DELIVERYCHILDBIRTH: |
NEXT:Ifbreechpresentation |
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Askthewomantoassumeanuprightorsquatting |
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positiontohelpprogress. |
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Expeditedeliverybyencouragingwoman topush |
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withcontraction. |
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Cordisnotpulsating |
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FETUS |
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Explaintotheparentsthatbabymaynotbewel. |
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PROBABLY DEAD |
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Respondtoproblemsduringlabouranddelivery(2) |
Ifprolapsedcord |
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D15 |
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CARE |
Respondtoproblemsduringlabouranddelivery(3) |
Ifbreechpresentation |
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D16 |
D16 |
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IF BREECH PRESENTATION |
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POSTPARTUM |
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LOOK,LISTEN,FEEL |
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SIGN |
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TREAT |
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Legsorbuttockspresentingat |
Ifearlylabour |
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Ensurebladderisempty.IfunabletoemptybladderseeEmptybladder . |
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Onexternalexaminationfetalheadfelt |
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Referurgentlytohospital |
. |
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infundus. |
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Iflatelabour |
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Callforadditionalhelp. |
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Softbodypart(legorbuttocks) |
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IMMEDIATE |
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feltonvaginalexamination. |
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Confirmfulldilatationofthecervixbyvaginalexamination . |
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perineum. |
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Preparefornewbornresuscitation . |
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Õ Afterdeliveryoftheshouldersallowthebabytohanguntilnextcontraction. |
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Deliverthebaby: |
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Õ Assistthewomanintoapositionthatwillallowthebabytohangdownduringdelivery,forexample, |
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proppedupwithbuttocksatedgeofbedorontoherhandsandknees(allfoursposition). |
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Õ Whenbuttocksaredistending,makeanepisiotomy. |
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Õ Allowbuttocks,trunkandshoulderstodeliverspontaneouslyduringcontractions. |
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AND |
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Iftheheaddoesnotdeliver |
Placethebabyastrideyourleftforearmwithlimbshangingoneachside. |
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afterseveralcontractions |
Placethemiddleandindexfingersofthelefthandoverthemalarcheekbonesoneithersidetoapplygentle |
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LABOUR,DELIVERY |
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Thenturnthebabyback,againkeepingthebackuppermosttodelivertheotherarm. |
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downwardspressuretoaidflexionofhead. |
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Keepingthelefthandasdescribed,placetheindexandringfingersoftherighthandoverthebaby’s |
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shouldersandthemiddlefingeronthebaby’sheadtogentlyaidflexionuntilthehairlineisvisible. |
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Whenthehairlineisvisible,raisethebabyinupwardandforwarddirectiontowardsthemother’sabdomenuntil |
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thenoseandmoutharefree.Theassistantgivessuprapubicpressureduringtheperiodtomaintainflexion. |
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Iftrappedarmsorshoulders |
Feelthebaby’schestforarms.Ifnotfelt: |
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Holdthebabygentlywithhandsaroundeachthighandthumbsonsacrum. |
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Gentlyguidingthebabydown,turnthebaby,keepingthebackuppermostuntiltheshoulderwhichwas |
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CHILDBIRTH: |
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posterior(below)isnowanterior(atthetop)andthearmisreleased. |
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Thenproceedwithdeliveryofheadasdescribedabove. |
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Iftrappedhead(andbabyisdead) |
trapped. |
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Tiea1kgweighttothebaby’sfeetandawaitfulldilatation. |
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Thenproceedwithdeliveryofheadasdescribedabove. |
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NEVER pullonthebreech |
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DO NOTallowthewomantopushuntilthecervixisfullydilated.Pushingtoosoonmaycausetheheadtobe |
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NEXT:Ifstuckshoulders |
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D17 |
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CARE |
IF STUCK SHOULDERS (SHOULDER DYSTOCIA) |
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POSTPARTUM |
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SIGN |
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Askthewomantolieonherbackwhilegrippingherlegstightlyflexedagainsther |
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TREAT |
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Fetalheadisdelivered,but |
Callforadditionalhelp. |
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shouldersarestuckandcannotbe |
Preparefornewbornresuscitation. |
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delivered. |
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Explaintheproblemtothewoman and her companion. |
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IMMEDIATE |
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chest,withkneeswideapart.Askthecompanionorotherhelpertokeepthelegsin |
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downwardtractiononthefetalhead. |
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thatposition. |
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Performanadequateepisiotomy. |
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Askanassistanttoapplycontinuouspressuredownwards,withthepalmofthe |
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handontheabdomendirectlyabovethepubicarea,whileyoumaintaincontinuous |
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AND |
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Iftheshouldersarestillnot |
Remaincalmandexplaintothewomanthatyouneedhercooperationtotry |
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deliveredandsurgicalhelpisnot |
anotherposition. |
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availableimmediately. |
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Assisthertoadoptakneelingon “allfours”positionandaskhercompaniontohold |
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LABOUR,DELIVERY |
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DO NOTpullexcessivelyonthehead. |
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hersteady-thissimplechangeofpositionissometimessufficienttodislodgethe |
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impactedshoulderandachievedelivery. |
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Introducetherighthandintothevaginaalongtheposteriorcurveofthesacrum. |
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Attempttodelivertheposteriorshoulderorarmusingpressurefromthefingerofthe |
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righthandtohooktheposteriorshoulderandarm downwardsandforwardsthrough |
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thevagina. |
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Completetherestofdeliveryasnormal. |
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Ifnotsuccessful,referurgentlytohospital |
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CHILDBIRTH: |
NEXT:Ifmultiplebirths |
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Respondtoproblemsduringlabouranddelivery(4) |
Ifstuckshoulders |
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D17 |
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CARE |
Respondtoproblemsduringlabouranddelivery(5) |
Ifmultiplebirths |
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D18 |
D18 |
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IF MULTIPLE BIRTHS |
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SIGN |
TREAT |
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POSTPARTUM |
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Preparefordelivery |
Arrangeforahelpertoassistyouwiththebirthsandcareofthebabies. |
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Preparedeliveryroomandequipmentforbirthof2ormorebabies.Include: |
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Õ morewarmcloths |
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Õ twosetsofcordtiesandrazorblades |
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IMMEDIATE |
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Õ resuscitationequipmentfor2babies. |
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Secondstageoflabour |
Staywiththewomanandcontinuemonitoringherandthefetalheartrateintensively. |
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Deliverthefirstbabyfollowingtheusualprocedure.Resuscitateifnecessary.Labelher/him Twin1. |
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Askhelpertoattendtothefirstbaby. |
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Palpateuterusimmediatelytodeterminethelieofthesecondbaby.Iftransverseorobliquelie,gentlyturnthebabybyabdominalmanipulationtoheadorbreechpresentation. |
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Checkthepresentationbyvaginalexamination.Checkthefetalheartrate. |
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Awaitthereturnofstrongcontractionsandspontaneousruptureofthesecondbagofmembranes,usuallywithin1hourofbirthoffirstbaby,butmaybelonger. |
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AND |
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Removewetclothsfromunderneathher.Iffeelingchilled,coverher. |
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When the membranes rupture,performvaginalexamination |
tocheckforprolapsedcord.Ifpresent,seeProlapsedcord . |
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Whenstrongcontractionsrestart,askthemothertobeardown whenshefeelsready. |
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LABOUR,DELIVERY |
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Examinetheplacentaandmembranesforcompleteness.Theremaybeonelargeplacentawith2umbilicalcords,oraseparateplacentawithanumbilicalcordforeachbaby. |
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Deliverthesecondbaby.Resuscitateifnecessary.Labelher/him Twin 2. |
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Aftercuttingthecord,askthehelpertoattendtothesecondbaby. |
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Palpatetheuterusforathirdbaby.Ifathirdbabyisfelt,proceedasdescribedabove.Ifnothirdbabyisfelt,gotothirdstageoflabour. |
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DO NOTattempttodelivertheplacentauntilallthebabiesareborn. |
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DO NOTgivethemotheroxytocinuntilafterthebirthofallbabies. |
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Thirdstageoflabour |
Giveoxytocin10IUIMaftermakingsurethereisnotanotherbaby. |
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Whentheuterusiswellcontracted,delivertheplacentaandmembranesbycontrolledcordtraction,applyingtractiontoallcordstogether |
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Beforeandafterdeliveryoftheplacentaandmembranes,observecloselyforvaginalbleedingbecausethiswomanisatgreaterriskofpostpartum haemorrhage.fI |
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CHILDBIRTH: |
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bleeding,see . |
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Immediatepostpartumcare |
Õ Givespecialsupportforcareandfeedingofbabies |
and |
. |
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Monitorintensivelyasriskofbleedingisincreased. |
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ProvideimmediatePostpartumcare |
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Inaddition: |
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Õ Keepmotherinhealthcentreforlongerobservation |
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Õ Plantomeasurehaemoglobinpostpartumifpossible |
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NEXT:Careofthemotherandnewbornwithinfirsthourofdeliveryofplacenta |
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D19 |
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CARE |
CARE OF THE MOTHER AND NEWBORN WITHIN FIRST HOUR OF DELIVERYOFPLACENTA |
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Usethischart for woman and newbornduringthefirsthouraftercompletedeliveryofplacenta. |
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MONITOR MOTHER EVERY 15 MINUTES: |
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MONITOR BABY EVERY 15 MINUTES: |
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POSTPARTUM |
Neverleave the woman and newbornalone. |
. |
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Breathing:listenforgrunting,lookforchestin-drawingandfastbreathing . |
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Foremergencysigns,usingrapidassessment(RAM) |
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Feelifuterusishardandround. |
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Warmth:checktoseeiffeetarecoldtotouch . |
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Recordfindings,treatmentsandproceduresin Labourrecordand Partograph |
. |
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Keepmother and babyindeliveryroomdonotseparatethem. |
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IMMEDIATE |
Encouragethewomantoeatanddrink. |
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Ifbleedingfromaperinealtear,repairifrequired |
orrefertohospital . |
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CARE OF MOTHER AND NEWBORN |
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INTERVENTIONS,IF REQUIRED |
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WOMAN |
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Ifpadsoakedinlessthan5minutes,orconstanttrickleofblood,manageason |
.. |
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Assesstheamountofvaginalbleeding. |
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Ifuterussoft,manageason |
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AND |
Askthecompaniontostaywiththemother. |
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Encouragethewomantopassurine. |
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NEWBORN |
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Ifbreathingwithdifficulty—grunting,chestin-drawingorfastbreathing,examinethebabyason |
. |
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LABOUR,DELIVERY |
DO NOTgiveartificialteatsorpre-lactealfeedstothenewborn:nowater,sugarwater,orlocalfeeds. |
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Iffeetarecoldtotouchormotherandbabyareseparated: |
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Wipetheeyes. |
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Applyanantimicrobialwithin1hourofbirth. |
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Õ Ensuretheroomiswarm.Covermotherandbabywithablanket |
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. |
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Õ either1%silvernitratedropsor2.5%povidoneiodinedropsor1%tetracyclineointment. |
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Õ Reassessin1hour.Ifstillcold,measuretemperature.Iflessthan36.5 C,manageason |
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DO NOTwashawaytheeyeantimicrobial. |
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Ifunabletoinitiatebreastfeeding(motherhascomplications): |
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Ifbloodormeconium,wipeoffwithwetclothanddry. |
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Õ Planforalternativefeedingmethod |
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. |
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DO NOTremovevernixorbathethebaby. |
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Õ IfmotherHIV+andchoosesreplacementfeeding,feedaccordingly |
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Continuekeepingthebabywarmandinskin-to-skincontactwiththemother. |
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Ifbabyisstillbornordead,givesupportivecaretomotherandherfamily |
. |
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Encouragethemothertoinitiatebreastfeedingwhenbabyshowssignsofreadiness.Offerherhelp. |
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CHILDBIRTH: |
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Examinethemotherandnewbornonehourafterdeliveryofplacenta. |
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Refertohospital nowifwomanhadseriouscomplicationsatadmissionorduringdeliverybutwas |
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Use Assessthemotherafterdelivery |
andExaminethenewborn |
. |
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inlatelabour. |
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Careofthemother withinfirsthour ofdeliveryofplacenta |
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D19 |
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РЕАГИРУЙТЕНАВОЗНИКНОВЕНИЕ ПРОБЛЕМВОВРЕМЯРОДОВ(1)
Если чсс плода <120 или >160 уд/мин
РЕАГИРУЙТЕНАВОЗНИКНОВЕНИЕ ПРОБЛЕМВОВРЕМЯРОДОВ(2)
Если произошло выпадение пуповины
РЕАГИРУЙТЕНАВОЗНИКНОВЕНИЕ ПРОБЛЕМВОВРЕМЯРОДОВ(3)
Если имеется тазовое предлежание
РЕАГИРУЙТЕНАВОЗНИКНОВЕНИЕ ПРОБЛЕМВОВРЕМЯРОДОВ(4)
Если возникла дистоция плечиков
РЕАГИРУЙТЕНАВОЗНИКНОВЕНИЕ ПРОБЛЕМВОВРЕМЯРОДОВ(5)
Если многоплодная беременность
УХОДЗАМАТЕРЬЮИ НОВОРОЖДЕННЫМВТЕЧЕНИЕ ПЕРВОГОЧАСАПОСЛЕРОЖДЕНИЯ ПЛАЦЕНТЫ
РОДЫ:ПЕРИОДРАСКРЫТИЯ,ИЗГНАНИЯИРАННИЙПОСЛЕРОДОВЫЙПЕРИОД
CARE |
Careofthemother onehourafter deliveryofplacenta |
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D20 |
||||||||||||
CARE OF THE MOTHER ONE HOUR AFTER DELIVERYOFPLACENTA |
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Usethischartforcontinuouscareofthemotheruntildischarge.See |
forcareofthebaby. |
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|||||||||
POSTPARTUM |
MONITOR MOTHER AT2,3AND 4 HOURS, |
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Feeluterusifhardandround. |
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THEN EVERY 4 HOURS: |
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Foremergencysigns,usingrapidassessment(RAM). |
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IMMEDIATE |
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Recordfindings,treatmentsandproceduresin Labourrecordand Partograph |
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INTERVENTIONS,IF REQUIRED |
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CARE OF MOTHER |
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Keepthemotherandbabytogether. |
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Neverleave the woman and newbornalone. |
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DO NOTdischargebefore12hours. |
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AND |
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Accompanythemotherandbabytoward. |
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Makesurethewomanhassomeonewithherandtheyknowwhentocallforhelp. |
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Adviseon Postpartumcareandhygiene . |
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uncomfortable,helpherbygentlypouringwateronvulva. |
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LABOUR,DELIVERY |
passedurine. |
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Ensurethemotherhassanitarynapkinsorcleanmaterialtocollectvaginalblood. |
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Encouragethemothertoeat,drinkandrest. |
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Ensuretheroomiswarm (25°C). |
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Askthemother’scompaniontowatchherandcallforhelpifbleedingorpainincreases,ifmother |
Ifheavyvaginalbleeding,palpatetheuterus. |
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feelsdizzyorhassevereheadaches,visualdisturbanceorepigastricdistress. |
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Ifuterusnotfirm,massagethefundustomakeitcontractandexpelanyclots . |
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Ifpadissoakedinlessthan5minutes,manageason . |
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Ifbleedingisfromperinealtear,repairorrefertohospital . |
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CHILDBIRTH: |
Encouragethemothertoemptyherbladderandensurethatshehas |
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Ifthemothercannotpassurineorthebladderisfull(swellingoverlowerabdomen)andsheis |
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DO NOTcatheterizeunlessyouhaveto. |
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baby,see |
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IftuballigationorIUDdesired,makeplansbeforedischarge. |
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Checkrecordandgiveanytreatmentorprophylaxiswhichisdue. |
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Advisethemotheronpostpartumcareandnutrition . |
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Ifmotherisonantibioticsbecauseofruptureofmembranes>18hoursbutshowsnosignsof |
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Advisewhentoseekcare . |
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infectionnow,discontinueantibiotics. |
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Counselonbirthspacingandotherfamilyplanningmethods . |
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Repeatexaminationofthemotherbeforedischargeusing Assessthemotherafterdelivery .For |
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CARE |
ASSESS THE MOTHER AFTER DELIVERY |
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Usethischarttoexaminethemotherthefirsttimeafterdelivery(at1hourafterdeliveryorlater)andfordischarge. |
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Forexaminingthenewbornusethecharton |
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Nopallor. |
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Adviseonpostpartumcareandhygiene . |
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POSTPARTUM |
membranes? |
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Lookforvaginalbleeding |
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CLASSIFY |
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ASK,CHECK RECORD |
LOOK,LISTEN,FEEL |
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SIGNS |
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TREATAND ADVISE |
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Checkrecord: |
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Measuretemperature. |
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Uterushard. |
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MOTHER WELL |
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Keepthemotheratthefacilityfor12hoursafter |
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Õ bleedingmorethan250ml? |
Feeltheuterus.Isithardand |
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Littlebleeding. |
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delivery. |
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Õ completenessofplacentaand |
round? |
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Noperinealproblem. |
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Ensurepreventivemeasures . |
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IMMEDIATE |
Õ complicationsduringdeliveryor |
Lookatperineum. |
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Nofever. |
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Counselonnutrition . |
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Doyouhaveanyconcerns? |
Õ Isthereatearorcut? |
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Bloodpressurenormal. |
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Iftuballigationdesired,refertohospitalwithin7 |
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postpartum? |
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Counselonbirthspacingandfamilyplanning . |
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Õ specialtreatmentneeds? |
Õ Isitred,swollenordrainingpus? |
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Pulsenormal. |
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Adviseonwhentoseekcareandnextroutine |
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Õ needstuballigationorIUD? |
Lookforconjunctivalpallor. |
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postpartumvisit . |
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Howareyoufeeling? |
Lookforpalmarpallor. |
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Reassessfordischarge . |
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Doyouhaveanypains? |
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Continueanytreatmentsinitiatedearlier. |
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AND |
Howisyourbaby? |
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daysofdelivery.IfIUDdesired,refertoappropriate |
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Howdoyourbreastsfeel? |
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serviceswithin48hours. |
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LABOUR,DELIVERY |
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CHILDBIRTH: |
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Ifnoproblems,gotopage . |
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NEXT:Respondtoproblemsimmediatelypostpartum |
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Assessthemotherafterdelivery |
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D21 |
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CARE |
Respondtoproblemsimmediatelypostpartum(1) |
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D22 |
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ASK,CHECK RECORD |
LOOK,LISTEN,FEEL |
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SIGNS |
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CLASSIFY |
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TREATAND ADVISE |
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IFVAGINAL BLEEDING |
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POSTPARTUM |
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Apadissoakedinlessthan5 |
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Morethan1padsoakedin |
HEAVY |
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See |
fortreatment. |
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minutes. |
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5minutes |
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BLEEDING |
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Referurgentlytohospital . |
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Uterusnothardandnotround |
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IMMEDIATE |
IF FEVER (TEMPERATURE >38ºC) |
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Timesinceruptureofmembranes |
Õ Listentofetalheartrate |
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minutesofobservation |
UTERINE AND |
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Assessthenewborn |
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Repeat temperature measurement |
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Temperaturestill>38 Candanyof: |
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InsertanIVlineandgivefluidsrapidly . |
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Abdominalpain |
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after2hours |
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Õ |
Chills |
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FETAL INFECTION |
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GiveappropriateIM/IVantibiotics . |
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Chills |
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Iftemperatureisstill>38ºC |
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Õ Foul-smellingvaginaldischarge |
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Ifbabyandplacentadelivered: |
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Õ Lookforabnormalvaginal |
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Õ Low abdomen tenderness |
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Õ Giveoxytocin10IUIM . |
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AND |
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discharge. |
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Õ FHRremains>160after30 |
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Refer woman urgentlytohospital . |
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Õ feellowerabdomenfor |
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Õ ruptureofmembranes >18 hours |
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Treatifanysignofinfection. |
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tenderness |
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Temperaturestill>38 C |
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RISK OF UTERINE AND |
Encouragewomantodrinkplentyoffluids. |
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LABOUR,DELIVERY |
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Doesitextendtoanusorrectum? |
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Perinealtear |
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SMALL PERINEAL TEAR |
Ifbleedingpersists,repairthetearorepisiotomy . |
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FETAL INFECTION |
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Measuretemperatureevery4hours. |
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Iftemperaturepersistsfor>12hours,isveryhighor |
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risesrapidly,giveappropriateantibioticand |
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refertohospital . |
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IFPERINEAL TEAR OR EPISIOTOMY (DONE FOR LIFESAVING CIRCUMSTANCES) |
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Istherebleedingfromthetearor |
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Tearextendingtoanusorrectum. |
THIRD DEGREE TEAR |
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Refer woman urgentlytohospital . |
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CHILDBIRTH: |
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episiotomy |
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Episiotomy |
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NEXT:Ifelevateddiastolicbloodpressure |
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CARE |
IFELEVATED DIASTOLIC BLOOD PRESSURE |
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mmHg,askthewomanifshehas: |
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and2+proteinuriaandanyof: |
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Iflatelabour: |
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POSTPARTUM |
ASK,CHECK RECORD |
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CLASSIFY |
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LOOK,LISTEN,FEEL |
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SIGNS |
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TREATAND ADVISE |
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Ifdiastolicbloodpressureis |
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Diastolicbloodpressure ≥110 |
SEVERE |
|
Givemagnesiumsulphate . |
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≥90 mmHg,repeatafter1hourrest. |
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mmHg OR |
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PRE-ECLAMPSIA |
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Ifinearlylabourorpostpartum, |
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Ifdiastolicbloodpressureisstill ≥90 |
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Diastolicbloodpressure ≥90 mmHg |
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referurgentlytohospital . |
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IMMEDIATE |
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Õ severeheadache |
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Õ severeheadache |
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Õ continuemagnesiumsulphatetreatment |
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Õ blurredvision |
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mmHg on tworeadings. |
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Iflatelabour: |
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Õ blurredvision |
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Õ monitorbloodpressureeveryhour. |
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Õ epigastricpainand |
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Õ epigastricpain. |
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Õ DO NOTgiveergometrineafterdelivery. |
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Õ checkproteininurine. |
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Referurgentlytohospitalafterdelivery . |
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Diastolicbloodpressure90-110 |
PRE-ECLAMPSIA |
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Ifearlylabour,referurgentlytohospital . |
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AND |
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2+proteinuria(onadmission). |
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Õ monitorbloodpressureeveryhour |
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Õ DO NOTgiveergometrineafterdelivery. |
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LABOUR,DELIVERYCHILDBIRTH: |
NEXT:Ifpalloronscreening,checkforanaemia |
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refertohospital . |
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Diastolicbloodpressure ≥90 |
HYPERTENSION |
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Monitorbloodpressureeveryhour. |
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mmHgon2readings. |
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DO NOTgiveergometrineafterdelivery. |
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Ifbloodpressureremainselevatedafterdelivery, |
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referwomantohospital . |
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Respondtoproblemsimmediatelypostpartum(2) |
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D23 |
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CARE |
Respondtoproblemsimmediatelypostpartum(3) |
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D24 |
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ASK,CHECK RECORD |
LOOK,LISTEN,FEEL |
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SIGNS |
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CLASSIFY TREATAND ADVISE |
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IFPALLOR ON SCREENING,CHECK FOR ANAEMIA |
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POSTPARTUM |
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Bleedingduringlabour,deliveryor |
Õ Somepallor? |
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Haemoglobin<7g/dl. |
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SEVERE |
Õ minimizebloodloss |
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|||||
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Measure haemoglobin,ifpossible. |
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Ifearlylabour orpostpartum,referurgentlytohospital . |
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postpartum. |
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Lookforconjunctivalpallor. |
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AND/OR |
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ANAEMIA |
Iflatelabour: |
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Lookforpalmarpallor.Ifpallor: |
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Severepalmarandconjunctivalpalloror |
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Õ Isitseverepallor? |
|
Anypallorwith>30breathsperminute. |
|
Õ monitorintensively |
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IMMEDIATE |
|
|
Õ Countnumberofbreathsin |
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Õ referurgentlytohospitalafterdelivery . |
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1minute |
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Anybleeding. |
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MODERATE |
DO NOTdischargebefore24hours. |
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Haemoglobin 7-11g/dl. |
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ANAEMIA |
Checkhaemoglobinafter3days. |
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Palmarorconjunctivalpallor. |
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Givedoubledoseofironfor3months . |
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Followupin4weeks. |
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AND |
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Haemoglobin >11g/dl |
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NO ANAEMIA |
Giveiron/folatefor3months . |
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Nopallor. |
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IF MOTHER SEVERELYILLORSEPARATED FROM THE BABY |
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LABOUR,DELIVERY |
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Õ Informtheparentsassoonaspossibleafterthebaby’sdeath. |
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Teachmothertoexpressbreastmilkevery3hours . |
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Helphertoexpressbreastmilkifnecessary.Ensurebaby |
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receivesmother’smilk . |
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Helphertoestablishorre-establishbreastfeedingassoonas |
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IFBABYSTILLBORN OR DEAD |
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possible.See |
. |
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Givesupportivecare: |
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CHILDBIRTH: |
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Õ Showthebabytothemother,givethebabytothemotherto |
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|
Counselonappropriatefamilyplanningmethod . |
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hold,whereculturallyappropriate. |
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Õ Offertheparentsandfamilytobewiththedeadbabyin |
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privacyaslongastheyneed. |
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|
Õ Discusswiththemtheeventsbeforethedeathandthe |
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possiblecausesofdeath. |
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Advisethemotheronbreastcare . |
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|
NEXT:Givepreventivemeasures |
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|
Providecertificateofdeathandnotifyauthoritiesasrequired . |
||||||||
CARE |
GIVE PREVENTIVE MEASURES |
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||
Ensurethatallaregivenbeforedischarge. |
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ASSESS,CHECK RECORDS |
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TREATAND ADVISE |
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POSTPARTUM |
Check whenlastdoseofmebendazolewasgiven. |
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Givemebendazoleoncein6months . |
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CheckRPRstatusinrecords. |
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IfRPRpositive: |
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IfnoRPRduringthispregnancy,dotheRPRtest . |
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Õ Treatwomanandthepartnerwithbenzathinepenicillin . |
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Õ Treatthenewborn . |
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Checktetanustoxoid(TT)immunizationstatus. |
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Givetetanustoxoidifdue . |
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IMMEDIATE |
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Check woman’ssupplyofprescribeddoseofiron/folate. |
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Counselonnutrition . |
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Give3month’ssupplyofironandcounseloncompliance . |
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Checkifvitamin Agiven. |
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Givevitamin Aifdue . |
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Askwhetherwoman and babyaresleepingunderinsecticidetreatedbednet. |
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Encouragesleepingunderinsecticidetreatedbednet . |
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Counselandadviseallwomen. |
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Adviseonpostpartumcare . |
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AND |
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Counselonbirthspacingandfamilyplanning . |
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Counselonbreastfeeding . |
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Counseloncorrectandconsistentuseofcondoms . |
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LABOUR,DELIVERYCHILDBIRTH: |
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Adviseonroutineandfollow-uppostpartumvisits . |
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Adviseondangersigns . |
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Discusshowtoprepareforanemergencyinpostpartum . |
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Recordalltreatmentsgiven . |
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Givepreventivemeasures |
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D25 |
D20 УХОДЗАМАТЕРЬЮЧЕРЕЗЧАСПОСЛЕ РОЖДЕНИЯПЛАЦЕНТЫ
D21 ОЦЕНИТЕСОСТОЯНИЕРОДИЛЬНИЦЫ
D22 РЕАГИРУЙТЕНАВОЗНИКНОВЕНИЕ ПРОБЛЕМВ РАННЕМПОСЛЕРОДОВОМ ПЕРИОДЕ(1)
есликровотечениеизвлагалища еслилихорадка еслиразрывпромежностиили
эпизиотомия
D23 РЕАГИРУЙТЕНАВОЗНИКНОВЕНИЕ ПРОБЛЕМВРАННЕМПОСЛЕРОДОВОМ ПЕРИОДЕ(2)
еслиповышенноедиастолическое давление
D24 РЕАГИРУЙТЕНАВОЗНИКНОВЕНИЕ ПРОБЛЕМВРАННЕМПОСЛЕРОДОВОМ ПЕРИОДЕ(3)
еслиприосмотревыявленабледность, проверьте,имеетсялианемия еслиженщинасерьезнобольнаили отделенаотребенка
еслиребенокмертворожденныйилиумер.
D25 ПРОВЕДИТЕ ПРОФИЛАКТИЧЕСКИЕ МЕРОПРИЯТИЯ
CARE |
Adviseonpostpartumcare |
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D26 |
D26 |
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ADVISE ON POSTPARTUM CARE |
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Adviseonpostpartumcareandhygiene |
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Counselonnutrition |
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POSTPARTUM |
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Theimportanceofwashingtopreventinfectionofthemotherandherbaby: |
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Spendmoretimeonnutritioncounsellingwithverythinwomenandadolescents. |
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Adviseandexplaintothewoman: |
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Advisethewomantoeatagreateramountandvarietyofhealthyfoods,suchasmeat,fish,oils,nuts, |
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Toalwayshavesomeonenearherforthefirst24hourstorespondtoanychangeinhercondition. |
seeds,cereals,beans,vegetables,cheese,milk,tohelpherfeelwellandstrong(giveexamplesof |
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Nottoinsertanythingintothevagina. |
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typesoffoodandhowmuchtoeat). |
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Tohaveenoughrestandsleep. |
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Reassurethemotherthatshecaneatanynormalfoods–thesewillnotharmthebreastfeedingbaby. |
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CHILDBIRTH: LABOUR,DELIVERYAND IMMEDIATE |
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Õ washhandsbeforehandlingbaby |
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Determineifthereareimportanttaboosaboutfoodswhicharenutritionallyhealthy. |
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Õ washperineumdailyandafterfaecalexcretion |
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Advisethewoman againstthesetaboos. |
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Õ changeperinealpadsevery4to6hours,ormorefrequentlyifheavylochia |
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Talktofamilymemberssuchaspartnerandmother-in-law,toencouragethemtohelpensurethe |
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Õ washusedpadsordisposeofthemsafely |
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womaneatsenough and avoidshardphysicalwork. |
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Õ washthebodydaily. |
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Toavoidsexualintercourseuntiltheperinealwoundheals. |
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CARE |
COUNSEL ON BIRTH SPACING AND FAMILY PLANNING |
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D27 |
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Counselontheimportanceoffamilyplanning |
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Lactationalamenorrhoeamethod(LAM) |
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POSTPARTUM |
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Ifappropriate,askthewomanifshewouldlikeherpartneroranotherfamilymembertobeincluded |
Abreastfeedingwomanisprotectedfrompregnancyonlyif: |
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waitingatleast2-3yearsbetweenpregnanciesishealthierforthemotherandchild. |
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Õ sheisnomorethan6monthspostpartum,and |
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inthecounsellingsession. |
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Explainthatafterbirth,ifshehassexandisnotexclusivelybreastfeeding,shecanbecomepregnant |
Õ sheisbreastfeedingexclusively(8ormoretimesaday,includingatleastonceatnight:no |
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assoonas4weeksafterdelivery.Thereforeitisimportanttostartthinkingearlyaboutwhatfamily |
daytimefeedingsmorethan4hoursapartandnonightfeedingsmorethan6hoursapart;no |
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planningmethodtheywilluse. |
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complementaryfoodsorfluids),and |
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Õ Askaboutplansforhavingmorechildren.Ifshe(andherpartner)wantmorechildren,advisethat |
Õ hermenstrualcyclehasnotreturned. |
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IMMEDIATE |
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Õ Informationonwhentostartamethodafterdeliverywillvarydependingonwhetherawomanis |
Abreastfeedingwomancanalsochooseanyotherfamilyplanningmethod,eithertousealoneor |
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orHIVandpregnancy.Promotetheiruse,especiallyifatriskforsexuallytransmittedinfection(STI)orHIV . |
togetherwithLAM. |
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breastfeedingornot. |
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Õ Makearrangementsforthewomantoseeafamilyplanningcounsellor,orcounselherdirectly(see |
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the Decision-makingtoolforfamilyplanningprovidersandclients forinformation onmethodsand |
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onthecounsellingprocess). |
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Advisethecorrectandconsistentuseofcondomsfordualprotectionfromsexuallytransmittedinfection(STI) |
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AND |
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ForHIV-positivewomen,see |
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forfamilyplanningconsiderations |
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Herpartnercandecidetohaveavasectomy(malesterilization)atanytime. |
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Diaphragm |
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LABOUR,DELIVERY |
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Combinedinjectables |
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Methodoptionsforthenon-breastfeedingwoman |
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Methodoptionsforthebreastfeedingwoman |
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Canbeusedimmediatelypostpartum |
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Condoms |
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Canbeusedimmediatelypostpartum |
Lactationalamenorrhoeamethod (LAM) |
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Progestogen-onlyoralcontraceptives |
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Condoms |
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Progestogen-onlyinjectables |
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Spermicide |
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Implant |
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Femalesterilisation(within7daysordelay6weeks) |
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Spermicide |
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IUD(within48hoursordelay4weeks) |
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Femalesterilization(within7daysordelay6weeks) |
Delay6weeks |
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Progestogen-onlyoralcontraceptives |
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IUD(within48hoursordelay4weeks) |
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Progestogen-onlyinjectables |
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CHILDBIRTH: |
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Delay3weeks |
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Combinedoralcontraceptives |
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Implants |
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Diaphragm |
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Delay6months |
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Combinedoralcontraceptives |
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Fertilityawareness methods |
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Combinedinjectables |
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Fertilityawareness methods |
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Counselonbirthspacingandfamilyplanning |
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D27 |
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CARE |
Adviseonwhentoreturn |
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D28 |
D28 |
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ADVISEON WHEN TO RETURN |
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Usethischartforadvisingonpostpartumcareon |
.Fornewbornbabiesseethescheduleon |
. |
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POSTPARTUM |
Encouragewomantobringherpartnerorfamilymembertoatleastonevisit. |
Õ morethan2or3padssoakedin20-30minutesafterdeliveryOR |
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SECOND VISIT |
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4-6weeks |
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Routinepostpartumcarevisits |
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Adviseondangersigns |
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FIRST VISIT |
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Withinthefirstweek,preferablywithin2-3days |
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Advisetogotoahospitalorhealthcentreimmediately,dayornight,WITHOUT WAITING,ifanyof |
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thefollowingsigns: |
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IMMEDIATE |
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vaginalbleeding: |
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Õ bleedingincreasesratherthandecreasesafterdelivery. |
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Lowerurinarytractinfection |
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2days |
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Gotohealthcentre assoonaspossible ifanyofthefollowingsigns: |
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Follow-upvisitsforproblems |
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convulsions. |
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feverandtooweaktogetoutofbed. |
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fastordifficultbreathing. |
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Iftheproblemwas: |
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Returnin: |
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severeabdominalpain. |
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Fever |
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2days |
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AND |
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fever |
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Perinealinfectionorpain |
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2days |
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Hypertension |
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1week |
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abdominalpain |
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Urinaryincontinence |
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1week |
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feelsill |
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LABOUR,DELIVERY |
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Severeanaemia |
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2weeks |
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breastsswollen,redortenderbreasts,orsorenipple |
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Postpartumblues |
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2weeks |
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urinedribblingorpainonmicturition |
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HIV-positive |
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2weeks |
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painintheperineumordrainingpus |
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Moderate anaemia |
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4weeks |
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foul-smellinglochia |
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Iftreatedinhospital |
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Accordingtohospitalinstructionsoraccordingtonational |
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Discusshowtoprepareforanemergencyinpostpartum |
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foranycomplication |
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guidelines,butnolaterthanin2weeks. |
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Advisetoalwayshavesomeonenearforatleast24hoursafterdeliverytorespondtoanychangein |
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condition. |
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Discusswithwomanandherpartnerandfamilyaboutemergencyissues: |
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CHILDBIRTH: |
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Õ wheretogoifdangersigns |
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Õ costsinvolved |
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Õ familyandcommunitysupport. |
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Advisethewomantoaskforhelpfromthecommunity,ifneeded . |
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Advisethewomantobringherhome-basedmaternalrecordtothehealthcentre,evenforan |
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emergencyvisit. |
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CARE |
HOME DELIVERYBYSKILLED ATTENDANT |
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Usetheseinstructionsifyouareattendingdeliveryathome. |
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D29 |
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Preparationforhomedelivery |
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Immediatepostpartumcareofmother |
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POSTPARTUM |
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Check emergencyarrangements. |
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. |
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Staywiththewomanforfirsttwohoursafterdeliveryofplacenta |
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Followthelabouranddeliveryprocedures |
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Stayuntilbabyhashadthefirstbreastfeedandhelpthemothergoodpositioningandattachment |
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Keep emergencytransportarrangementsup-to-date. |
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Examinethemotherbeforeleavingher |
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Carrywithyouallessentialdrugs |
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,records,andthedeliverykit. |
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Adviseonpostpartumcare,nutritionandfamilyplanning |
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Ensurethatthefamilyprepares,ason |
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Ensurethatsomeonewillstaywiththemotherforthefirst24hours. |
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IMMEDIATE |
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Deliverycare |
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Postpartumcareofnewborn |
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Adviseonbreastfeedingandbreastcare |
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Observeuniversalprecautions |
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GiveSupportivecare.Involvethecompanionincareandsupport |
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Adviseapostpartumvisitforthemotherandbabywithinthefirstweek . |
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Examinethebabybeforeleaving |
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Maintainthepartographandlabourrecord |
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Immunizethebabyifpossible . |
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Providenewborncare |
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Adviseonnewborncare |
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Refertofacilityassoonaspossibleifanyabnormalfindinginmotherorbaby |
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Advisethefamilyaboutdangersignsandwhenandwheretoseekcare . |
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CHILDBIRTH: LABOUR,DELIVERYAND |
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Ifpossible,returnwithinadaytocheckthemotherandbaby. |
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Homedeliverybyskilledattendant |
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D29 |
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КОНСУЛЬТИРОВАНИЕПО ПОСЛЕРОДОВОМУУХОДУ
проконсультируйте повопросам послеродовогоуходаигигиены
проконсультируйтеповопросампитания
КОНСУЛЬТИРОВАНИЕПО ВОПРОСАМ СОБЛЮДЕНИЯИНТЕРГЕНЕТИЧЕСКОГО ИНТЕРВАЛАИПЛАНИРОВАНИЯСЕМЬИ
обсудитеважностьпланированиясемьи методлактационнойаменореи(мла)
КОНСУЛЬТИРОВАНИЕПОВОПРОСАМ ПЛАНОВЫХИПОСЛЕДУЮЩИХВИЗИТОВ
плановыепослеродовыевизиты проинформируйте обугрожающих признаках обсудите,какподготовитьсякнеотложной
ситуациивпослеродовомпериоде
РОДЫНАДОМУСУЧАСТИЕМ КВАЛИФИЦИРОВАННОГОМЕДРАБОТНИКА
подготовкакродам вдомашнихусловиях уходвродах уходзаженщинойвраннемпослеродовом периоде
уходзановорожденным
ВсегданачинайтеосмотрсБыстройОценкииВедения(БОВ) B3-B7
Затемдляоценкиклиническойситуации,сбораанамнеза, диагностикипериодародовиспользуйтетаблицу«Осмотр женщинывродах,илисразрывомплодныхоболочек» D2-D3
Еслиобнаруженпатологическийпризнак,используйтетаблицу
«Реагируйтенавозникновениеакушерскихосложнений»вмомент поступления D4-D5 .
Взависимостиотпериодародов,предоставляйтеуходженщине D8-D13,реагируйтенавозникновениепроблемвовремяродов,
какуказанов D14-D18.
Дляпредоставленияподдерживающегоуходавтечениеродов,
используйтетаблицу«Поддержкаженщиныв родах» D6-D7 .
Постоянноведитезаписиклиническихданныхвисторииродови партограмме N4-N6
Оставьтеродильницуиноворожденноговродильнойкомнатев течениеодногочасапослеродовииспользуйтетаблицу«Уходза матерьюиноворожденнымвтечениепервогочасапослерождения плаценты» D19 .
Далее,приосуществленииуходавплотьдовыписки,используйте таблицу«Уходзаматерьюиноворожденнымчерезчаспослерождения плаценты» D20 .дляпроведениянеобходимыхпрофилактических мероприятийиконсультацийпоуходу,возникновениюопасных признаков,обращениюзаплановойиэкстреннойпомощью, планированиюсемьииспользуйтетаблицы«Проведите профилактическиемероприятий» D25 ,«Консультированиепо послеродовомууходу» D26-D28.
Обследуйтематьпередвыпискойизмедучреждения,используя таблицу D21 .
НЕвыписывайтеродильницуизмедучрежденияраньшечем через12часовпослеокончанияродов.
Еслиженщинавич-инфицирована,подростокилинуждаетсяв специальнойпомощи,используйте G1-G8 H1-H4
Еслипринимаетеродывдомашнихусловиях,см D29 .
Роды:периодраскрытия,изгнанияираннийпослеродовыйпериод |
D1 |
Осмотрженщинывродах,илисразрывомплодныхоболочек |
D2 |
РОДЫ:ПЕРИОДРАСКРЫТИЯ,ИЗГНАНИЯИРАННИЙПОСЛЕРОДОВЫЙПЕРИОД
ОСМОТРЖЕНЩИНЫВРОДАХ,ИЛИСРАЗРЫВОМПЛОДНЫХОБОЛОЧЕК
ВпервуюочередьпроведитеБыструюоценкуиведение. B3-B7 Затемиспользуйтеданнуютаблицудляоценкисостоянияженщиныиплода,определениястадииродов
СПРОСИТЕИЗАПИШИТЕ |
ОСМОТРИТЕ,ПРОВЕДИТЕ |
АУСКУЛЬТАЦИЮ,ПАЛЬПИРУЙТЕ |
Течениеданныхродов:
Когданачалисьсхватки?
Какчастовозникаютсхватки?Насколькоонисильны?
ПроизошлолиуВасотхождениевод?Еслида,товкакое время?Онибылисветлыеилиимелизеленыйцвет?
ОтмечалосьлиуВаскакое-либокровотечение?Еслида, товкакоевремя?Какойинтенсивности?
Шевелитсялиребенок?
Желаетелиобсудитькакие-либодополнительные вопросы?
Проверьтезаписи,или,вслучаееслиихнет:
Спросите,когданаступитпредполагаемаядатародов.
Определите,неявляютсялиродыпреждевременными (срокгестациименее8месяцев).
Просмотритепланродов.
Еслиимелисьбеременностивпрошлом:
Количествопредыдущихбеременностей/родов.
Имеетсяливанамнезекесаревосечение,применение акушерскихщипцов,вакуум-экстракцииплода,или другиеосложнениякакнапримеркровотечениев послеродовомпериоде?
Имеютсяливанамнезеразрывытретьейстепени?
Настоящаябеременность:
RPR-статус. C5
Уровеньгемоглобина. C4
Проведениеиммунизациистолбнячныманатоксином.
F2
ВИЧ-статус. C6
Планкормленияребенка. G7-G8
Наблюдайте,какженщинареагируетнасхватки:Хорошолионаихвыдерживает,или испытывает
невыносимуюбольЭнергичнолионанастроенаилипостоянностонет?
Проверьтеживотнаналичие:
Шрамапослекесаревасечения
Горизонтальнойскладки,пересекающейнижниеотделы живота(еслиприсутствует,опорожнитемочевойпузырь B12 ,проведитеповторныйосмотр)
Проведитепальпациюживотасцельюопределения:Частотыипродолжительностисхваток,тетанических
сокращенийматкиПоложенияплодапродольноеилипоперечное?
Предлежанияплода–головное,тазовоеилидругое?МногоплоднойбеременностиДвиженийплода.
Выслушайтесердцебиения плода:
Произведитеподсчет сердечныхсокращенийвминуту.
Еслименее100илиболее180ударов вминуту, переведитеженщину вположениеналевыйбоки повторитеподсчет.
ИзмерьтеАД.
Измерьтетемпературутела.
Длявыявлениябледности,осмотритекожныепокровы.
Осмотритенаналичиезападенияглаз сухостиротовой полости.
Оценитетургоркожинапредплечье,быстроли расправляетсякожнаяскладка?
ДАЛЕЕ:Проведитевлагалищноеобследованиеиопределитестадиюродов
РОДЫ:ПЕРИОДРАСКРЫТИЯ,ИЗГНАНИЯИРАННИЙПОСЛЕРОДОВЫЙПЕРИОД
ОПРЕДЕЛИТЕСТАДИЮРОДОВ
СПРОСИТЕИ |
ОСМОТРИТЕ,ПРОВЕДИТЕ |
ЗАПИШИТЕ |
АУСКУЛЬТАЦИЮ,ПАЛЬПИРУЙТЕ |
Объяснитеженщине, чтоВысобираетесь провестивлагалищное
исследование,получитеее согласие.
Осмотритенаружныеполовыеорганысцельювыявления:ВыбуханияпромежностиВыпадениячастейплодаВлагалищногокровотечения
Подтеканияоколоплодныхвод;еслиподтекают,то имеется лимеконийилинеприятныйзапах?
Наростов,кейлоидныхрубцовилишрамов, препятствующихродовомупроцессу.
Проведитевлагалищноеобследование.
НЕбрейтеобластьпромежности.
Приготовьте:
Чистыеперчатки
Тампоны, прокладки.
Доипослекаждогообследованиямойтерукисмылом.
Обмойтенаружныеполовыеорганыипромежность.
Наденьтеперчатки.
Переведитеженщинувположениессогнутымии разведенныминогами.
НЕпроводитевлагалищногоисследования,если кровотечениенаблюдаетсявнастоящиймомент,или имелосьвлюбоевремяпосле7месяцевбеременности.
Бережнопроведитевлагалищноеобследование(не начинайтевовремясхватки):
Определитераскрытиешейкиматкивсантиметрах.
Пальпируйтепредлежащуючасть.Определяетсяли твердое,круглоеигладкоеобразование(голова)?Еслинет, определитепредлежащуючасть.
Пальпируйтеплодныйпузырь-целлион?
Пальпируйтепуповину-определяетсялиона?Пульсирует? Еслида,немедленнодействуйтекакуказанов D15 .
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ПРИЗНАКИ |
КЛАССИФИЦИРУЙТЕ |
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ЛЕЧЕНИЕ |
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Промежностьтонкая,выбухает, |
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См.раздел,посвященный второму |
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половаящельзияет,видна |
СКОРОЕОКОНЧАНИЕРОДОВ |
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периодуродов D10-D11 |
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головкаплода,полное |
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Сделайтезаписьвпартограмме |
N5 |
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раскрытиешейкиматки. |
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Раскрытиешейкиматки: |
ПОЗДНЯЯАКТИВНАЯФАЗА |
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См.раздел,посвященный первому |
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Повторнородящая ≥5см |
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периодуродов-вактивнойфазе |
D9 |
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Первородящая≥6см |
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Начнитезаполнениепартограммы |
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N5 |
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Раскрытиешейкиматки≥4см |
НАЧАЛОАКТИВНОЙФАЗЫ |
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Сделайтезаписьвисторииродов |
N5 |
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Раскрытиешейкиматки:0-3 |
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См.раздел,посвященный первому |
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см;схваткислабые,количество |
АКТИВНОЙФАЗЫНЕТ |
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периодуродов-активнойфазынет D8 |
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их<2за10минут |
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Сделайтезаписьвисторииродов |
N4 |
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ДАЛЕЕ:реагируйтенавозникновениеакушерскихосложненийвмоментпоступления.
Определитестадиюродов |
D3 |
Реагируйтенавозникновениеакушерскихосложненийвмоментпоступления |
D4 |
РОДЫ:ПЕРИОДРАСКРЫТИЯ,ИЗГНАНИЯИРАННИЙПОСЛЕРОДОВЫЙПЕРИОД
РЕАГИРУЙТЕНАВОЗНИКНОВЕНИЕАКУШЕРСКИХОСЛОЖНЕНИЙВМОМЕНТПОСТУПЛЕНИЯ
Используйтеданнуютаблицу,есливовремяоценкистатусабеременностиисостоянияплода,зарегистрированыпатологическиеклиническиеданные D2-D3 .
ПРИЗНАКИ |
КЛАССИФИЦИРУЙТЕ |
ЛЕЧЕНИЕИРЕКОМЕНДАЦИИ |
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Поперечноеположениеплода |
ОБСТРУКТИВНЫЕРОДЫ |
Принеудовлетворительном состоянии, установите |
Тетаническиесокращенияматки |
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системудлявнутривенныхвливаний,вводите |
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жидкости B9 |
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Постояннаябольмеждусхватками |
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Есливродах>24часов,в/милив/ввведите |
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Внезапнаяисильнаябольвобласти |
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соответствующиеантибиотики. B15 |
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живота |
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Срочнонаправьтеженщинувстационар B17 |
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Высокоестояниеконтракционного |
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кольца |
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Продолжительностьпервогопериода родов>24часов
ПРИВСЕХСИТУАЦИЯХ,ОПИСЫВАЕМЫХНИЖЕВКРАСНОМПОЛЕ,СРОЧНОНАПРАВЬТЕЖЕНЩИНУВСТАЦИОНАР,ЛЕЧИТЕТОЛЬКОВСЛУЧАЕ, КОГДАЖЕНЩИНА ВПОЗДНЕЙСТАДИИРОДОВ
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Разрывплодныхоболочек илюбойиз |
ВНУТРИМАТОЧНАЯ |
В/милив/ввведитесоответствующие |
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приведенныхнижепризнаков: |
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ИНФЕКЦИЯ. |
антибиотики. B15 |
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Лихорадкавыше380С |
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ВНУТРИУТРОБНОЕ |
Еслипоздняястацияродов,примитероды,после |
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Дурнопахнущиевлагалищные |
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ИНФИЦИРОВАНИЕПЛОДА |
направьтевстационар. B17 |
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выделения |
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Планируйтелечениеноворожденного |
J5 . |
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Разрывплодныхоболочекнасроке |
РИСКРАЗВИТИЯ |
В/милив/ввведитесоответствующие |
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гестации<8месяцев |
антибиотики. B15 |
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ВНУТРИМАТОЧНОЙИНФЕКЦИИ |
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ИВНУТРИУТРОБНОГО |
Еслипоздняястацияродов,примитероды D10-D28 |
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Прекратитевведениеантибиотиковматери,если |
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ИНФИЦИРОВАНИЯПЛОДА |
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нетпризнаковинфекции |
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Планируйтелечениеноворожденного |
J5 |
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Диастолическоедавление>90mmHg |
ПРЕЭКСЛАМПСИЯ |
Проведитедальнейшуюоценку,ведитекакуказано |
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в D23 |
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Чрезмернаябледностьладоней, |
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Ведите,какуказанов D24 |
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бледностьконъюнктивыи/или |
АНЕМИЯТЯЖЕЛОЙСТЕПЕНИ |
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уровеньгемоглобина<7г/дл |
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Тазовоеилидругоенеправильное |
АКУШЕРСКИЕОСЛОЖНЕНИЯ |
Следуйтеспециальныминструкциям(см.номера |
предлежание D16 |
страниц,указанныхвлевомстолбце). |
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Многоплоднаябеременность D18 |
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Дистрессплода D14 |
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Выпадениепетельпуповины D15 |
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РОДЫ:ПЕРИОДРАСКРЫТИЯ,ИЗГНАНИЯИРАННИЙПОСЛЕРОДОВЫЙПЕРИОД
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ПРИЗНАКИ |
КЛАССИФИЦИРУЙТЕ |
ЛЕЧЕНИЕИРЕКОМЕНДАЦИИ |
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Наросты,кейлоидныерубцы,препятствующиеродовому |
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Проведитедостаточнуюэпизиотомию,тщательно контролируйте |
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процессу |
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рождениеголовки D10-D11 . |
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Разрывтретьейстепениванамнезе |
РИСКРАЗВИТИЯАКУШЕРСКОГО |
Еслипоздняястадияродов,примитероды D10-D128 |
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Кровотечениеизвлагалища влюбоймомент третьего |
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ОСЛОЖНЕНИЯ |
Имейтевозможностьвызовапомощивовремя второгопериода |
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триместрабеременности |
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родов. |
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Припредыдущихродахпроизводилось: |
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Кесаревосечение |
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Наложениеакушерскихщипцовиливакуум-экстракцияплода |
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Возрастмоложе14лет |
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Родыначалисьвсрокеменее8полныхмесяцев |
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Проведитеповторноеопределениеположенияплода(чащевсего |
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встречаетсятазовоепредлежание) |
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беременности (ранеечемза1месяцдопредполагаемойдаты |
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Еслиженщиналежит,рекомендуйтеизбратьположениеналевомбоку. |
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родов) |
ПРЕЖДЕВРЕМЕННЫЕРОДЫ |
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Вовремявторогопериодародоввызовитедополнительнуюпомощь. |
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Принимайтеродысбольшойосторожностью,таккакнедоношенный |
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ребенокможетродитьсястремительно.Вособенностиконтролируйте |
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рождениеголовки. |
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Подготовьтенеобходимоеоборудованиедляреанимации |
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новорожденного. K11 |
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Частотасердцебиенийплода<120или>160удароввминуту |
ВОЗМОЖНОРАЗВИТИЕ |
Ведите,какуказанов D14 |
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ДИСТРЕСС-СИНДРОМАПЛОДА |
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Есливодыотошлиболее18часовназад,в/милив/ввведите |
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Разрывоболочекпроизошелвсрок,нодоначалародовй |
РАЗРЫВПЛОДНЫХОБОЛОЧЕК |
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соответствующиеантибиотикиB15 |
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деятельности. |
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Планируйтелечениеноворожденного J5 |
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Еслиимеютсядваилиболееизследующихпризнаков: |
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Пероральнодайтежидкости |
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Жажда |
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Еслиженщинаневсостояниипить,в/ввтечение3часоввведите1 |
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Западениеглазныхяблок |
ДЕГИДРАТАЦИЯ |
литринфузионногораствора. B9 |
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Сухостьворту |
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Складкакожи,образуемаянапредплечье,расправляется |
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медленно. |
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ПоложительныетестынаВИЧ. |
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Удостоверьтесь,чтоженщинаначалаприемантиретровирусных |
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препаратов,кактольконачалисьроды G6 |
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Женщинапроконсультированаповопросам лечения |
ВИЧ-ИНФИЦИРОВАНИЕ |
Поддерживайтееевыбор методакормленияребенка. G7-G8 |
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антиретровируснымипрепаратами,кормления |
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новорожденного. |
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Отсутствиедвиженийплода |
ВОЗМОЖНО,ПЛОДМЕРТВ |
Объяснитеродителям,чтосостояниеребенкавнушаетопасения. |
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Отсутствие сердцебиенийплодаприповторномобследовании |
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ДАЛЕЕ:Оказывайтеподдержкуженщиневродах |
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Реагируйтенавозникновениеакушерскихосложненийвмоментпоступления |
D5 |
Оказывайтеподдержкуженщиневродах |
D6 |
РОДЫ:ПЕРИОДРАСКРЫТИЯ,ИЗГНАНИЯИРАННИЙПОСЛЕРОДОВЫЙПЕРИОД
ОКАЗЫВАЙТЕПОДДЕРЖКУЖЕНЩИНЕВРОДАХ
Используйтеданнуютаблицудлясозданииподдерживающей,одобряющейатмосферывовремяродов,полнойуважениякжеланиямженщины.
Общение
Вовремяманипуляцийобъясняйтеихсутьиходдействий,получитеразрешение,обсудитес женщинойрезультатыпроведенныхисследований.
Информируйтеееодинамикеродов.
Подбадривайтеее,убеждайтевтом,чтовсескладываетсяхорошо.
Вовремяпроведенияобследованийи обсужденийобеспечивайтеиуважайте конфиденциальность.
Еслиженщина ВИЧинфицирована,узнайте,информированлиобэтом еекомпаньон.Относитесь суважениемкжеланиямженщины.
Чистота
Порекомендуйтеженщиневначалеродовпринятьдушиливанну,вымытьтелоигениталии.
Обмывайтенаружныеполовыеорганыипромежность.
Мойтеруки смылом доипослекаждогообследования.Используйте чистыеперчаткидля проведения влагалищногоисследования.
Удостоверьтесь,чтородыпроходятвчистоте,вчистомпомещении.
Немедленноудаляйтеобразовавшиесязагрязнениябиологическимижидкостями
НЕназначайтеклизму.
Подвижность
Поощряйтесвободноехождениеженщины вовремяпервогопериодародов.
Поддерживайтевыборпозиции впервомивторомпериодеродов(лежаналевомбоку,на корточках,наколенях,стоя,опираясьнакомпаньона).
Мочеиспускание
Рекомендоватьженщинекакможночащеопорожнятьмочевойпузырь. Напоминайтеобэтом каждые2часа.
Приемпищи,жидкостей
Рекомендуйтеженщиневовремяродовприниматьпищуипить посвоемужеланию.
Напитки,имеющиепитательнуюценность,оченьполезныдаженапозднихстадияхродов.
Есливидно,чтоженщинаоченьистощеннаилиусталаотродов,проследитезатемчтобыонапила ипринималапищу.
Техникадыхания
Научитеееследитьзасвоимнормальнымдыханием.
Рекомендуйтевыдыхатьмедленнее,издаваяпротяжныйзвук,ирасслаблятьсяприкаждом вздохе.
Еслионаощущаетголовокружение,плохоесамочувствие,покалываниявлице,рукахиногах, порекомендуйтеейзамедлитьдыхание.
Дляпредотвращенияпреждевременныхпотугвконцепервогопериодародов,обучитеженщину дышатьоткрытымртом,«пыхтеть»,делая2короткихвдоха,азатемдлинныйвыдох.
Вовремярожденияголовкиребенка,попроситееенетужиться,норавномернодышатьили
«пыхтеть».
Облегчениеболиидискомфорта
Предложитесменитьпозу.
Рекомендуйтедвигаться,какейбудетудобно.
Рекомендуйтекомпаньону:
Массироватьспинуженщины,еслионачувствует,что этопомогает
Держатьженщинузарукуивытиратьеелицомеждусхватками.
Рекомендуйтеейиспользоватьтехникудыхания.
Рекомендуйтепринятьтеплуюваннуилидуш,еслитаковыеимеются.
Еслиженщинабеспокойнаиличувствуетнедомогание,выяснитепричину. D2-D3
Еслиболь постоянная(непрекращаетсямеждусхватками),оченьинтенсивнаяилиимеетвнезапное начало,см. D4
РОДЫ:ПЕРИОДРАСКРЫТИЯ,ИЗГНАНИЯИРАННИЙПОСЛЕРОДОВЫЙПЕРИОД
КОМПАНЬОН РОЖЕНИЦЫ
Поощряйтеоказаниеподдержкивродахкомпаньономженщины.
Опишите,чтодолжен/наделатькомпаньонженщинывовремяродов:Всевремя находитьсярядомсженщинойПодбадриватьее
ПомогатьженщинеправильнодышатьирасслаблятьсяПроводитьмассажспины,вытирать лицоженщины влажнойсалфеткойипредоставлятьдругие
видыподдержки.
Предоставлятьподдержку,используяметодынародноймедицины,еслионинемешаюттечению родовогопроцесса.
Помогатьженщинесвободнопередвигаться,приниматьудобнуюдляроженицыпозу.Предлагатьженщинеприниматьедуинапитки.
Принеобходимости,помогатьсходитьвтуалет.
Попроситекомпаньонавызватьпомощь,если:
Уженщиныначалисьсхваткипотужногохарактера
Появилоськровотечениеизвлагалища
Онавнезапносталаиспытыватьнестерпимуюболь
Онапотеряласознание,иначалисьсудороги
Возникликакие-либодругиепроблемыилиопасения
Компаньон должен/назнать,что,ипокакойпричине емуделатьНЕСЛЕДУЕТ: НЕСЛЕДУЕТпредлагатьженщиненачатьтужиться.
НЕСЛЕДУЕТ даватьсоветыкрометех,которыеданымедработниками. НЕСЛЕДУЕТзаставлятьженщинулежать,когдаонажелаетдвигаться
Компаньонроженицы |
D7 |