Table of contents SIN3INOO ANTENATAL CARE D CHILDBIRTH-LABOUR,DELIVERY AND IMMEDIATE POSTPARTUM CARE Assess the pregnant woman:pregnancy status,birth and emergency plan D2 Examine the woman in labour or with ruptured membranes Check for pre-eclampsia Decide stage of labour C4 Check for anaemia DD5 Respond to obstetrical problems on admission 5Check for syphilis DGive supportive care throughout labour C Check for HIV status DCommunication Respond to observed signs or volunteered problems D6 Cleanliness If no fetal movement D6 Mobility C7 If ruptured membranes and no labour D6 Urination C8 If fever or burning on urination D3 Eating.drinking c9 If vaginal discharge D6 Breathing technique If signs suggesting HIV infection Pain and discomfort relief c10 If smoking.alcohol or drug abuse,or history of violence D Birth companion G11 If cough or breathing difficulty D3 First stage of labour If taking antituberculosis drugs DB Not in active labour Give preventive measures D9 In active labour Advise and counsel on nutrition and self-care Second stage of labour:deliver the baby and give immediate newbom care Develop a birth and emergency plan Third stage of labour:deliver the placenta Facility delivery Respond to problems during labour and delivery c14 Home delivery with a skilled attendant DIf fetal heart rate <120 or>160 beats per minute G15 Advise on labour signs D15 If prolapsed cord C5Advise on danger signs D1G If breech presentation Discuss how to prepare for an emergency in pregnancy If stuck shoulders(Shoulder dystocia) GAdvise and counsel on family planning D3 If multiple births 16 Counsel on the importance of family planning Care of the mother and newborn within first hour of delivery of placenta Special consideration for family planning counselling during pregnancy Care of the mother one hour after delivery of placenta Advise on routine and follow-up visits Assess the mother after delivery C18 Home delivery without a skilled attendant Respond to problems immediately postpartum Assess eligibility of ARV for HIV-positive pregnant woman If vaginal bleeding 22If fever (temperature >38C) If perineal tear or episiotomy(done for lifesaving circumstances) If elevated diastolic blood pressure 0 If pallor on screening.check for anaemia 20If mother severely ill or separated from the child 0 If baby stillbom or dead D25 Give preventive measuresTable of contents TABLE OF CONTENTS C ANTENATAL CARE C2 Assess the pregnant woman: pregnancy status, birth and emergency plan C3 Check for pre-eclampsia C4 Check for anaemia C5 Check for syphilis C6 Check for HIV status C7 Respond to observed signs or volunteered problems C7 If no fetal movement C7 If ruptured membranes and no labour C8 If fever or burning on urination C9 If vaginal discharge C10 If signs suggesting HIV infection C10 If smoking, alcohol or drug abuse, or history of violence C11 If cough or breathing difficulty C11 If taking antituberculosis drugs C12 Give preventive measures C13 Advise and counsel on nutrition and self-care C14-C15 Develop a birth and emergency plan C14 Facility delivery C14 Home delivery with a skilled attendant C15 Advise on labour signs C15 Advise on danger signs C15 Discuss how to prepare for an emergency in pregnancy C16 Advise and counsel on family planning C16 Counsel on the importance of family planning C16 Special consideration for family planning counselling during pregnancy C17 Advise on routine and follow-up visits C18 Home delivery without a skilled attendant C19 Assess eligibility of ARV for HIV-positive pregnant woman D CHILDBIRTH – LABOUR, DELIVERY AND IMMEDIATE POSTPARTUM CARE D2 Examine the woman in labour or with ruptured membranes D3 Decide stage of labour D4-D5 Respond to obstetrical problems on admission D6-D7 Give supportive care throughout labour D6 Communication D6 Cleanliness D6 Mobility D6 Urination D6 Eating, drinking D6 Breathing technique D6 Pain and discomfort relief D7 Birth companion D8-D9 First stage of labour D8 Not in active labour D9 In active labour D10-D11 Second stage of labour: deliver the baby and give immediate newborn care D12-D13 Third stage of labour: deliver the placenta D14-D18 Respond to problems during labour and delivery D14 If fetal heart rate <120 or >160 beats per minute D15 If prolapsed cord D16 If breech presentation D17 If stuck shoulders (Shoulder dystocia) D18 If multiple births D19 Care of the mother and newborn within first hour of delivery of placenta D20 Care of the mother one hour after delivery of placenta D21 Assess the mother after delivery D22-D25 Respond to problems immediately postpartum D22 If vaginal bleeding D22 If fever (temperature >38°C) D22 If perineal tear or episiotomy (done for lifesaving circumstances) D23 If elevated diastolic blood pressure D24 If pallor on screening, check for anaemia D24 If mother severely ill or separated from the child D24 If baby stillborn or dead D25 Give preventive measures