Antenatal
Checkup
jk"Vh; xkzeh.k LokLF; feku
l Helps in identifying complications of pregnancy on time and their management
l Ensures healthy outcomes for the mother and her baby
Registration and
l Necessary for well-being of pregnant woman and foetus
4 minimum
Antenatal Checkups
Provide ANC
whenever a
woman comes
for
check up
Supplementation
during Pregnancy
l Folic acid tab 400 g
daily in Ist trimester
during pregnancy
and more if indicated
Registration & In first 12 weeks
1st ANC of pregnancy
l Iron Folic acid tab daily
from 14 weeks onwards
l For Anemic women, Iron
2nd ANC
Between 14 and
26 weeks
3rd ANC
Between 28 and
34 weeks
Between 36
4th ANC weeks and term
Folic acid tab twice daily
First Visit
At All Visits
l Pregnancy detection test
l Physical examination
l Fill up MCP Card and ANC register
l Abdominal palpation for
l Give filled up MCP Card and Safe Motherhood booklet
to the woman
l Past and present history of any illness/complications
in this or previous pregnancy
l Physical examination (weight, BP, respiratory rate)
and check CVS/Resp system, breast, pallor, jaundice
and oedema
l Two doses of Inj. TT 4 weeks apart whenever
pregnancy is detected
Investigations
l Hb%, urine examination
l Blood group including Rh factor
l RPR/ VDRL, HBsAg, HIV screening
l RDK test for malaria (in endemic areas)
Information for pregnant woman and her family
l Encourage institutional delivery/ensure delivery by
identification of SBA
l Explain entitlement under JSSK & JSY
l Identify the nearest functional PHC/FRU for delivery
l High risk pregnancy to be attended in District Hospital
and Medical College
l Pre-identification of referral transport and blood donor
foetal growth, foetal lie
and auscultation of foetal
heart sound
Investigations
l Hemoglobin estimation
l Urine exam for protein, sugar
and micro exam
l At 2428 weeks blood sugar
(OGCT) 2nd or 3rd visit
Counselling for
l Adequate rest, nutrition and
balanced diet
l Recognition of danger signs
during pregnancy, labour and
after delivery or abortion and
signs of normal labour
l Initiation of breastfeeding
immediately after birth
l Counselling for small family
norm
l Use of contraceptives (birth
spacing or limiting) after
birth/abortion
For use in medical colleges, district hospitals and FRUs
Universal Infection
Prevention Practices
jk"Vh; xkzeh.k LokLF; feku
Hand Washing
Use of
protective
attire
Ensuring general
cleanliness
(walls, floors,
toilets and surroundings)
Waste Disposal
Bio-Medical
Waste Disposal
1. Segregation
3. Proper storage before transportation
2. Disinfection
4. Safe disposal
LE
ED
NE TER
T
CU
REL
BARR ER
TT
CU
Used mutilated
catheters, I.V bottles
and tubes, syringes,
disinfected plastic
gloves, other plastic
material
Kitchen waste, paper
bags, waste paper/
thermocol, disposable
glasses and plates, left
over food
BLE
Human tissue, placenta,
products of conception,
used swabs/gauze/
bandage, other items
(surgical waste)
contaminated with blood
STA
Black Bag
JU
Red Bag
AD
LE
ED E
NE RING YER
O
SY STR
DE
Yellow Bag
Proper handling &
disposal of sharps
All plastic bags should be properly sealed, labeled and audited before disposal
All needles/sharps/I.V.
cannulae/broken ampules/
blades in puncture proof
container
PEP
(Post Exposure Prophylaxis)
Liquid Medical
Waste (LMW) Disposal
l Avoid splashing
To be given in case
of accidental
exposure to blood
and body fluid of
HIV +ve woman
l Treat the used cleaning/disinfectant solution as LMW
l Pour LMW down a sink/drain/flushable toilet or bury in a pit
l Rinse sink/drain/toilet with water after pouring LMW
l Pour disinfectant solution in used sink/drain/toilet at the end of each day (12 hrly)
l Decontaminate LMW container with 0.5% bleaching solution for 10 minutes
before final washing
For use in medical colleges, district hospitals and FRUs
Management
of PPH
Shout for help, Rapid Initial Assessment - evaluate vital signs: PR, BP, RR and Temperature
Establish two I.V. lines with wide bore cannulae (16-18 gauge)
Draw blood for grouping and cross matching
If heavy bleeding P/V, infuse RL/NS 1 L in 15-20 minutes
Give O2 @ 6-8 L /min by mask, Catheterize
Check vitals and blood loss every 15 minutes, monitor input and output
Give Inj. Oxytocin 10 IU IM (if not given after delivery)
Start Inj. Oxytocin 20 IU in 500 ml RL @ 40-60 drops per minute
Check to see if placenta has been expelled
l
l
l
l
l
l
Placenta delivered
Placenta not delivered
l
l
Continue Oxytocin
Do P/V examination to
rule out inversion of
uterus
Attempt controlled cord
traction
Placenta not delivered
l Do manual removal of
placenta under anesthesia
l Give IV antibiotics
l
l
Placenta delivered
l Continue uterine massage
and Oxytocin drip
Massage uterus
Examine placenta and
membranes for
completeness (if available)
Explore uterus for retained
placental bits if present,
evacuate uterus
P/A for uterine consistency
Uterus well contracted
(Traumatic PPH)
Look for cervical/ vaginal/
perineal tear - repair tear,
continue Oxytocin
Scar dehiscence / rupture
uterus Laparotomy
Uterus soft flabby
(Atonic PPH)
Manage as Atonic PPH
Chart
If bleeding continues check for Coagulopathy
Blood transfusion if indicated
For use in medical colleges, district hospitals and FRUs
Processing of
Items for Reuse
jk"Vh; xkzeh.k LokLF; feku
Instruments, Gloves and Glass Syringes
Wear utility gloves
DECONTAMINATION
Soak in 0.5% chlorine solution for 10 min
Thoroughly wash and rinse instruments
Acceptable Method
Sterilization
High Level Disinfection (HLD)
Hot Air Oven
Autoclave
Chemical
l
Preferred Method
Soak for
10-24 hrs in 2%
Glutraldehyde
Rinse with
sterile water
and dry
Used for
endoscopes
l
l
l
l
106 kPa
pressure, 121C
20 minutes
unwrapped
30 minutes
wrapped
Used for linen,
rubber tubing,
gloves, cotton,
instruments,
and surgical
dressing etc.
l
l
l
l
l
160C
Holding time
1 hour
Used for
glassware and
sharps
Boil or Steam
l
Lid on, 20
minutes after
water boils
Articles should
be completely
immersed in
water
Used for gloves
instruments and
glass syringes
Chemical
l
Soak for 20
minutes in 2%
Glutraldehyde
Rinse with
sterile water
and dry
Used for
endoscopes
Use only after drying
Can be stored for 1 week
Preparation of 1 Litre Bleaching Solution
Wear utility gloves and plastic apron
l
l
Take 1 L water in a plastic
bucket
Make thick paste in plastic mug
with 3 level teaspoons (15 g)
bleaching powder and some
water from bucket
Mix paste in water to make
0.5% of chlorine solution
l
l
Mix 6 part water with one part
of Sodium Hypochlorite
solution (Liquid bleach)
+
Bleach
Water
Maintain same ratio for large volumes
Make fresh solution in every shift and preferably keep covered
For use in medical colleges, district hospitals and FRUs
Postnatal
Care
Post natal
care
ensures
well-being
of the
mother and
the baby
jk"Vh; xkzeh.k LokLF; feku
1st Check up
1st day of delivery
2nd Check up
3rd day of delivery
3rd Check up
7th day of delivery
4th Check up
6 weeks after delivery
Additional check ups for
Low Birth Weight babies on
14th, 21st and 28th days
SERVICE PROVISION DURING CHECK UPs
Mother
Ask
Observe
& Check
Counsel
For
l Heavy bleeding
l Confirm passage of urine (within
l Breast engorgement
48 hours) and stool (within 24 hours)
l For convulsions, diarrhea and
vomiting
l Pallor, pulse, BP and
l Activity, color and congenital
temperature
l Urinary problems and
perineal tears
l Excessive bleeding (PPH)
l Foul smelling discharge
(Puerperal sepsis)
malformation
l Temperature, jaundice, cord stump
and skin for pustules
l Breathing, chest in drawing
l Suckling by the baby during breast
feeding
l Danger signs
l Keeping the baby warm
l Correct position of breast feeding
l No bathing on first day
l
l
l
l
Do
Newborn
and care of breast and nipples
Exclusive breast feeding for
6 months
Nutritious diet and calcium rich
foods
Maintaining hygiene and use of
sanitary napkins
Choosing contraceptive method
l Keep the cord stump clean and dry
l Additional check up for the Low Birth
Weight babies
l On importance of Routine
Immunisation
l Danger signs in baby
l Hb% estimation
l Give 0 dose BCG, OPV, Hepatitis B
l Give IFA supplementation to the
l Give Inj. Vitamin K 1 mg IM
mother for 3 months
For use in medical colleges, district hospitals and FRUs
Management of
Atonic PPH
l
l
l
l
Placenta expelled, uterus soft and flabby
Traumatic causes excluded
Shout for help, Rapid Initial Assessment
to evaluate vital signs: PR, BP, RR and
Temperature
Establish two I.V. lines with wide bore
cannulae (16-18 gauge)
Draw blood for grouping and cross
matching
l
l
l
l
l
If heavy bleeding, infuse NS/RL 1L
in 15-20 minutes
Give O2 @ 6-8 L /min by mask,
Catheterize
Check vitals & blood loss every
15 minutes, Monitor input & output
Perform continuous uterine massage
Give Inj. Oxytocin 20 IU in 500 ml RL/ NS @ 40 drops/minute
Do not give Inj. Oxytocin as IV bolus
Uterus still not contracted
If bleeding P/V not controlled
Inj Ergometrine* 0.2 mg IM or IV slowly (contraindicated in high BP, severe anemia, heart disease)
Inj Carboprost* (PGF2) 250 g IM (contraindicated in Asthma)
If bleeding P/V not controlled
Tab Misoprostol (PGE1) 800 g Per rectal
Bleeding not controlled by drugs
Bleeding controlled by drugs
Explore uterine cavity for retained placental bits
l
l
l
l
Perform bimanual compression
If fails perform compression of abdominal
aorta
Check for coagulation
defects
If present give blood
products
Uterine Tamponade
(Indwelling Catheters/
Condom/ Sangstaken tube/
Ribbon gauze packing) as
life saving measure
Continue vital monitoring
Repeat uterine massage every 15 minutes
for first 2 hours
Monitor vitals closely every 10 minutes for
30 minutes, every 15 minutes for next
30 minutes and every 30 minutes for next
3-6 hours or until stable
Continue Oxytocin infusion (Total Oxytocin
not to exceed 100 IU in 24 hours)
Surgical intervention
l Uterine compression
suture (B-Lynch)
l Uterine/Ovarian A ligation
l Hysterectomy
Transfuse blood if indicated
Monitor Input/ Output
* Wherever needed
Inj. Ergometrine can be repeated every 15 minutes (max 5 doses =1 mg)
Inj Carboprost can be repeated every 15 minutes (max 8 doses= 2 mg)
For use in medical colleges, district hospitals and FRUs
Neonatal
Resuscitation
Birth
Approximate time
Routine care
Term gestation?
Amniotic fluid clear?
l
l
Yes
Place baby on mothers abdomen
Breathing or crying?
Dry and cover mother and baby
Good muscle tone?
Wipe mouth and nose
Clamp and cut cord
(after 1-3 minutes of birth)
Watch color and breathing
Initiate breastfeeding
If any no
30 secs
l
Cut cord
Shift to newborn corner, provide warmth
Position the baby
Clear airway (oropharyngeal suction)*
Dry, stimulate, reposition
Breathing
HR>100 and Pink
Evaluate respiration, heart rate and color
Apneic
or
HR<100
Observe
Breathing, HR>100
But Cyanotic
Breathing
HR>100 and Pink
Give supplemental
oxygen by
face mask
30 secs
Persistent cyanosis
Provide bag and mask ventilation*
Call for Pediatrician
HR<60
HR>60
Continue bag and mask ventilation*
Administer chest compression
30 secs
PostResuscitation
Care
HR<60
Administer epinephrine if needed 1 in 10000, 0.1-0.3 ml/kg IV/umbilical vein
Vol expander NS/RL 10 ml/kg in 5-10 minutes through umbilical vein
*Endotracheal Intubation can be done at these stages by Pediatrician/Anesthetist if available
For use in medical colleges, district hospitals and FRUs
Active Management of
Third Stage of Labour
(AMTSL)
l Mandatory for all deliveries (vaginal and abdominal)
l Exclude presence of another baby after delivery of first baby
Step 1
Inj. Oxytocin 10 units IM immediately after birth
Step 2
l Controlled cord traction once uterus is contracted
and cord is cut
l Apply cord traction (pull) downwards and give
counter-traction with other hand by pushing
uterus up towards umbilicus
Step 3
Uterine massage to keep uterus contracted
For use in medical colleges, district hospitals and FRUs
Breastfeeding
l Start
breastfeeding
within 1 hour
of delivery
l Feed on demand
l Feed completely
on one breast,
then shift to
other breast
Correct Attachment
Baby well attached to the mothers breast
l Chin touching breast
l Mouth wide open
l Lower lip turned outward
l More areola visible above than below
the mouth
Exclusive
breastfeeding
for 6 months;
continue
breastfeeding
for 2 years
Wrong Attachment
Baby poorly attached
to the mothers breast
For use in medical colleges, district hospitals and FRUs
Antenatal
Examination
FUNDAL HEIGHT
Preliminaries
36wk
l
Respect womans rights
Xiphisternum
40wk
32wk
l Explain procedure and ensure
privacy
28wk
l Ensure bladder is empty
24wk
l Examiner stands on right side
20wk
l Abdomen is fully exposed from
16wk
Umbilicus
xiphisternum to pubis symphysis
Pubis Symphysis
(Uterus becomes
an abdominal organ)
12 wk
l Keep womans legs straight
l Centralise uterus
Correct dextrorotation
Symphsio-fundal height in
cms corresponds to weeks
of gestation after 28 weeks
Ulnar border of left hand is placed on upper
most level of fundus and marked with pen
Measure distance between
upper border of pubic
symphysis and marked point
GRIPS
Legs are slightly flexed and separated for obstetrical grips
Fundal Grip
First Pelvic Grip
Lateral Grip
Second Pelvic Grip
Foetal heart sound is usually located along the lines
as shown
For use in medical colleges, district hospitals and FRUs
Partograph
Name
Gravida
Para
Hospital number
Date of admission
Time of admission
Ruptured membranes
Hours
200
190
Foetal heart rate
180
170
160
150
140
130
120
110
100
90
80
Amniotic fluid
Moulding
10
9
8
Cervix (cm)
[Plot x]
Aler t
o
Acti
Hours
6
5
4
Descent
of head
[Plot o]
3
2
1
0
Hours
Contractions
per 10 mins
Time
<20 Sec
20 - 40 Sec
>40 Sec
5
4
3
2
1
Oxytocin IU/Litre
drops/min
Drugs given
and IV fluids
180
170
Pulse
[Plot ]
BP
[Plot ]
160
150
140
130
120
110
100
90
80
70
60
Temp C
Urine
Protein
Acetone
Volume
For use in medical colleges, district hospitals and FRUs
10
11
12
Vaginal Bleeding
jk"Vh; xkzeh.k LokLF; feku
(Before 20 Weeks)
Light
Bleeding
Heavy
l Mild pain
l No H/O expulsion of
l Mild pain
l H/O expulsion of
l Severe pain
l Uterus normal
Product of Conception
l Uterus size
corresponds to Period
of Gestation
l Os closed
Product of
Conception
l Uterus normal size/
bulky
l Os closed
size/bulky
l Tenderness in
fornix/mass
Threatened abortion
USG
Foetus viable
Threatened abortion
l
l
Reassure
Rest and
abstinence
Bleeding
stops
routine
ANC
Complete abortion
Observe and follow up
Bleeding persists
repeat USG for foetal
viability after 1 week
Any Bleeding with
Bleeding
l H/O expulsion of Product of Conception
l Uterine size < Period of Gestation
l Os may be open
H/O passage
of vesicles
Vesicular mole
Ectopic pregnancy
Confirm by USG
Confirm by UPT and USG
Manage as ectopic
pregnancy
l Rapid Initial Assessment
l Resuscitate if in shock
Transfuse blood if needed
Septic abortion
Missed abortion
Uterus <12 wk size
Uterus >12 wk size
l Broad spectrum
IV Antibiotics
l USG
l S.
S.HCG
HCG
l Evacuate uterus
l Chest X-ray
l Laparotomy if
l TVS for theca-
Manual Vacuum
Aspiration/ Electric
Vacuum Aspiration
l H/O interference
Incomplete / Inevitable abortion
Foetus not viable
Uterus <12 wk size
l Pain
lutein cyst cyst
thecalutein
bowel injury/
pyoperitoneum
Uterus >12 wk size
Misoprost 400 mcg
oral 4 hourly max
5 doses (2000 mcg)
Manual Vacuum
Aspiration/
Electric Vacuum
Aspiration
Check for completeness
l Start 10-20 U
Oxytocin in
500 ml NS/RL @
40-60 drops/min
Manual Vacuum
Aspiration/
Electric Vacuum
Aspiration
l Evacuate uterus
If still bleeding-MVA/
EVA/check curettage
Counsel to avoid pregnancy for at least 6 months
For use in medical colleges, district hospitals and FRUs
Follow up as mole
Advise contraception
Antepartum Haemorrhage
(Vaginal bleeding after 20 weeks)
l
Rapid Initial Assessment monitor PR, BP, RR
Ask for pain; check for uterine contour/tenderness
Arrange & transfuse blood if needed
Resuscitate if necessary and start IV fluids
Exclude local causes by P/S examination
Confirm diagnosis by USG if available
Placenta Previa
Immediate LSCS
Bleeding PV heavy and
continuous irrespective
of gestational age
Term pregnancy with
Type II post, III, IV
placenta
Dead/Malformed foetus
(irrespective of POG)
with Type III and IV
placenta
Term pregnancy with
malpresentation or other
obstetric indication
Expectant Management
l
l
l
l
Bleeding PV light/stopped
POG < 37 weeks
Live baby, no gross foetal
anomaly
Women not in labor
LSCS
l
Heavy bleeding PV
with vaginal
delivery not
imminent
Fetal distress
ARM + Oxytocin
l
l
l
Bleeding PV light/
moderate
FHS normal
Dead foetus
l
l
l
l
l
l
l
l
l
l
l
l
Hospitalize
Correct Anemia
Arrange Blood
Feto-maternal surveillance
Steriods if POG < 34 weeks
Bleeding PV light/moderate
H/o labor followed by sudden cessation of pains
Previous LSCS
Tender abdomen
Loss of uterine contour
FHS absent
Foetal parts superficially palpable
Monitor for
l
l
l
Rupture Uterus
Abruptio Placentae
No PV to be done
jk"Vh; xkzeh.k LokLF; feku
Hemorrhage and
shock
Coagulopathy
Renal failure
Laparotomy and repair of uterus/Hysterectomy
Terminate if 37 weeks or persistent/heavy bleeding PV
P/V under double set up in OT
Type I, II Ant
l ARM + Oxytocin
l Deliver vaginally
Type II post, III and IV
l LSCS
If previous LSCS with Placenta previa keep Placenta accreta in mind
For use in medical colleges, district hospitals and FRUs
Be prepared for PPH in all cases of APH
Hand Washing
Surgical Hand Washing
Routine Hand Washing
Medicated soap and water for about 3-5 minutes
Using plain soap and water for about 30 60 seconds
l
Before touching (or handling) neonate
When hands visibly soiled
Before and after examining any patient
After removing gloves
Wet hands with water
Right palm over left dorsum with
interlaced fingers and vice versa
Rotational rubbing of left
thumb clasped in right palm
and vice versa
Apply enough soap.
Cover all hand surfaces
Palm to palm with fingers
interlaced
Rotational rubbing, backwards
and forwards with clasped
fingers of right hand in left
palm and vice-versa
10
jk"Vh; xkzeh.k LokLF; feku
1&2
Rub hand palm to palm
Before all invasive procedures including surgery
Repeat after 4 cases/1 hour which ever is earlier
Remove all jewelry on your
hand and wrists. Adjust the
water to a warm temperature
and wet your hands and
forearms thoroughly
Clean each fingernail with a
stick or brush. It is important
for all surgical staff to keep
their fingernails short
Backs of finger to opposing
palms with fingers interlocked
Rinse hands with water
Rinse each arm separately,
fingertips first, holding your
hands above the level of
your elbow
Holding your hands up above
the level of your elbow, apply
the antiseptic. Using a circle
motion, begin at the fingertips
of the hand and lather and
wash between the fingers,
continue the fingertip to
elbow. Repeat this with the
second hand and arm.
Continue washing in this way
for 3-5 minutes
Using a sterile towel, dry your
hands and arms-from
fingertips to elbow-using a
different side of the towel on
each arm
Keep your hand above the level
of your waist and do not touch
anything before putting on
surgical gloves
11
Alcohol Hand Rub
With Alcohol for about 20 30 seconds
Dry hands thoroughly with
a single use towel
Use towel to turn off faucet
Your hands are now safe
Alternative for routine hand wash in between examination and procedures if hands
not visibly soiled
For use in medical colleges, district hospitals and FRUs
Eclampsia
jk"Vh; xkzeh.k LokLF; feku
Pregnancy with Convulsion; BP140/90 mmHg; Proteinuria
Immediate Management
1 Keep her in quiet room in bed
with padded rails on sides
2 Position her on left side, Oropharyngeal
airway to be kept patent.
3 Ensure preparedness to manage
maternal and foetal complications
Oxygen by mask at 6-8 l/min, Start IV fluids-RL/ NS at 60 ml/hr, Catheterize with indwelling catheter
Anti Hypertensive
l
l
l
If Diastolic BP>100 mmHg
Strict BP monitoring
Oral Nifedepine 10 mg stat,
repeat after 30 minutes if
needed (if pt unconscious
through ryles tube) OR
Inj Labetalol 20 mg IV bolus,
repeat 40 mg after 10 minutes
again repeat 80 mg every
10 minutes if needed
(maximum 220 mg) with
cardiac monitoring
LSCS:
Anti Convulsants
Magnesium Sulfate is drug of choice
Loading dose:
50% of 4 gm diluted to 20% (8 ml drug with 12 ml NS) to be given
slowly IV in 5 minutes
5 gm IM (50%) each buttock with 1 ml of 2% Xylocaine (Total 10 gm)
If recurrent fits after 30 minutes of loading dose repeat 2 gm 20%
(4 ml drug with 6 ml NS) slow IV in 5 minutes
Maintenance dose:
Deliver the baby irrespective of
gestational age
Admission-delivery interval
should not be more than 12 hours
Favourable Cervix
Unfavourable Cervix
5 gm IM (50%) alternate buttocks after monitoring every 4 hourly
Monitor:
u
Presence of patellar jerks
Resp. rate (RR)>16/min
Urine output >30 ml/hr in last 4 hours
Continue till 24 hours after last fit/delivery which ever is later
If Patellar jerk absent or urine output<30 ml/hr withhold Magsulf and
monitor hourly restart maintenance dose if criteria fulfilled
If RR<16/min, withhold Magsulf, give antidote Calcium Gluconate
1 gm IV 10 ml of 10% solution in 10 minutes
If fits not controlled/ status eclampticus
Failed Induction
Foetal distress
Any other obstetric indication
For use in medical colleges, district hospitals and FRUs
Induction with
ARM and
Oxytocin
2nd stage to be
cut short by
Forceps/
Ventouse
Ripening with
Dinoprostone
gel/ intracervical
indwelling
catheter and
after 6 hours
Deteriorating maternal condition
Labour Room Sterilization
l Sterilization is a process which should
l Labour Room should be centrally
air conditioned with air handling unit
be practised and adhered to by all
individuals at all times
Cleaning and disinfection daily at beginning
of day after wearing utility gloves
Clean the floor and sinks with detergent (soap water) and keep
floor dry
exhaust is required if air conditioning is
not present
Clean table top with Phenol/ Bleaching solution
Fogging
Need based
l
Clean table tops and others surfaces like light shades, almirahs,
lockers, trolley etc with low level disinfectant Phenol (Carbolic
Acid 2%)
Clean monitor machines with 70% alcohol
In case of spillage of blood, body fluids on floor, absorb with
newspaper (discard in yellow bin), soak with bleaching solution
for 10 minutes and then mop
Discard placenta in yellow bins
Discard waste and gloves in proper bins and not on floor
Discard soiled linen in laundry basket and not on floor. Disinfect
with bleaching solution followed by washing and autoclaving
Mop the floor every 3 hours with disinfectant solution
General :
Measures
l Alternatively cross ventilation with
Cleaning after each delivery
jk"Vh; xkzeh.k LokLF; feku
Following construction/renovation work
Any infectious outbreak
H2O2 based commercially available
disinfectant for fogging and mopping
If fogger not available spray or mop
liberally in room, table tops etc
Allowing 30 minutes contact time (shut
down of Labour Room not required)
l Unnecessary entries to the Labour Room must be restricted
l Individual autoclaved instrument set should be provided for each delivery
l Labour Room doctors and paramedics should wear mask all the time
l Random swab sampling to be taken from surfaces and disinfected
l Proper clothing of Labour Room personnel necessary including cap,
articles monthly
l Air quality sampling to be done by Settle plate method monthly
mask, shoes/slippers and gown at the time of delivery
For use in medical colleges, district hospitals and FRUs
Operation Theatre Sterilization
l OT should be centrally air
l Sterilization is a process which should
l Alternatively cross ventilation with
conditioned with air handling unit
be practised and adhered to by all
individuals at all times
Clean the floor and sinks with detergent (soap water) and keep floor dry
Clean table tops and others surfaces like light shades, almirahs, lockers,
trolley etc with low level disinfectant Phenol (Carbolic acid 2%)
Clean monitor machines with 70% alcohol
In case of spillage of blood, body fluids on floor, absorb with newspaper
(discard in yellow bin), soak with bleaching solution for 10 minutes and
then mop
Discard waste and gloves in proper bins and not on floor
Discard soiled linen in laundry basket and not on floor. Disinfect with
bleaching solution followed by washing and autoclaving
Mop the floor every 3 hours with disinfectant solution
exhaust is required if air
conditioning not present
Fogging weekly
Cleaning and disinfecting daily at beginning of day after wearing utility gloves
jk"Vh; xkzeh.k LokLF; feku
Aldehyde based spray is used
Sprayed or mopped liberally in room, table tops etc
Allowing 30 minutes contact time (shut down of OT not required)
General Measures:
Quality Control:
l Access to OT should be through 'Buffer Zone'
l Microbiological sample should be taken randomly at 2 months interval by Settle plate method
l Unnecessary entries to the OT must be restricted
l Random microbiological sampling to be done by Settle plate/Air sampling method
l Proper occlusive clothing of OT personnel necessary
l Instruments to be sterilized by autoclaving
l Each case should have separate instrument sets
Following construction/renovation work
Any infectious outbreak
l Any colony of Fungus/Staph aureus needs to be reported. If found positive, servicing of air
handling unit and/or AC duct recommended
For use in medical colleges, district hospitals and FRUs
Pre Eclampsia
l BP140/90 mm Hg on 2 occasions, 4 hours apart
Mild Pre eclampsia
l
l
l
l
l
l
l
l
BP 140/90 mm Hg
Protienuria traces to 2 + or 300 mg/24 hrs
l
l
Hospitalize to evaluate and investigate
Reassure, no restriction on routine salt intake
Rest with limited activity
Start anti hypertensive when DBP 100 mm Hg
Tab Alpha Methyl Dopa 250500 mg 6-8 hourly
(max 2 gm/day) OR
Tab Labetalol 100 mg BD (max 2.4 gm/day)
Investigate Hgm, LFT, KFT, S Uric acid,
S LDH and fundus exam
BP and urine output monitoring
l
l
l
l
l
l
l
l
l
l
Continue OPD management in mild disease
Continue hospitalization in worsening
hypertension/proteinureia
Regular foetal+maternal surveillance (foetal
movement count, NST, AFI, wt gain, BP and
urine output monitoring, weekly Hgm, LFT, KFT,
S Uric acid and S LDH)
Maintain DBP
90-100 mm Hg
No foetal compromise
l Urine proteinuria traces or 300 mg/24 hrs sample
l Period of gestation>20 weeks
Severe Pre eclampsia
jk"Vh; xkzeh.k LokLF; feku
BP 160/110 mm Hg
Proteinuria 3 + by dipstick or 5 gm/24 hrs
Headache, epigastric pain, blurring of vision, oliguria, pulmonary odema, thrombocytopenia, IUGR. Creatinine >1.2 mg/dl, serum
transaminase levels, S LDH>600 IU/L
Urgent hospitalization
Start anti hypertensive
Oral Nifedepine 10 mg stat, repeat after 30 minutes if needed OR
Inj Labetalol 20 mg IV bolus, repeat 40 mg after 10 minutes if BP not controlled again repeat 80 mg every 10 minutes (max 220 mg) with
cardiac monitoring
Continue Tab Nifedepine 10 mg TDS (max 80 mg/day) OR Tab Labetalol 100 mg BD (max 2.4 gm/day)
Investigate Hgm, LFT, KFT, S Uric acid, S LDH and fundus exam
Urine output charting
BP Monitoring
< 24 weeks
24 -<34 weeks
34 weeks
37 weeks
Treatment should be individualised
Foetal salvage difficult
BP controlled
l Explain maternal and foetal
adverse effect to relatives
l Regular maternal + foetal
surveillance
Inj. Betamethasone
l 12 mg IM
l Repeat 12 mg
after 24 hours
If disease severe,
manage as severe
pre eclampsia
BP uncontrolled
l Worsening of clinical /
biochemical parameters
l Signs of foetal compromise
Terminate at 37 weeks
l
Deliver at 38-39 weeks
No role of diuretics
l Terminate pregnancy
l Induction of labor as per Bishop score and give Magsulf as in Eclampsia
For use in medical colleges, district hospitals and FRUs
