Antenatal

Checkup jk"Vhª; xkzeh.k LokLF; fe’ku

l Helps in identifying complications of pregnancy on time and their management

l Ensures healthy outcomes for the mother and her baby
l Necessary for well-being of pregnant woman and foetus Registration and
4 minimum
Provide ANC Antenatal Checkups
whenever a during pregnancy
Supplementation woman comes
and more if indicated
during Pregnancy
for Registration & In first 12 weeks
l Folic acid tab 400 µg 1st ANC of pregnancy
daily in Ist trimester check up
Between 14 and
2nd ANC
26 weeks
l Iron Folic acid tab daily
from 14 weeks onwards 3rd ANC
Between 28 and
34 weeks
l For Anemic women, Iron
Between 36
Folic acid tab twice daily 4th ANC weeks and term

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 foetal growth, foetal lie
to the woman and auscultation of foetal
l Past and present history of any illness/complications heart sound
in this or previous pregnancy
Investigations
l Physical examination (weight, BP, respiratory rate)
l Hemoglobin estimation
and check CVS/Resp system, breast, pallor, jaundice
l Urine exam for protein, sugar
and oedema
and micro exam
l Two doses of Inj. TT 4 weeks apart whenever
l At 24–28 weeks blood sugar
pregnancy is detected
(OGCT)– 2nd or 3rd visit
Investigations
Counselling for
l Hb%, urine examination
l Adequate rest, nutrition and
l Blood group including Rh factor
balanced diet
l RPR/ VDRL, HBsAg, HIV screening
l Recognition of danger signs
l RDK test for malaria (in endemic areas)
during pregnancy, labour and
Information for pregnant woman and her family after delivery or abortion and
l Encourage institutional delivery/ensure delivery by signs of normal labour
identification of SBA l Initiation of breastfeeding
l Explain entitlement under JSSK & JSY immediately after birth
l Identify the nearest functional PHC/FRU for delivery l Counselling for small family
l High risk pregnancy to be attended in District Hospital norm
and Medical College l Use of contraceptives (birth
l Pre-identification of referral transport and blood donor spacing or limiting) after
birth/abortion
For use in medical colleges, district hospitals and FRUs
 Universal Infection
Prevention Practices jk"Vhª; xkzeh.k LokLF; fe’ku

Hand Washing

Use of
protective
attire Ensuring general
cleanliness
(walls, floors,
toilets and surroundings)

Waste Disposal
Bio-Medical 1. Segregation 3. Proper storage before transportation
Waste Disposal 2. Disinfection 4. Safe disposal

BARR ER
CU

NE TER
TT

CU
REL

ED
T

LE
NE RING YER

AD
SY STR
DE

ED E

JU
STA
LE

BLE
O

Yellow Bag Red Bag Black Bag Proper handling &

Human tissue, placenta, Used mutilated Kitchen waste, paper disposal of sharps
products of conception, catheters, I.V bottles bags, waste paper/
All needles/sharps/I.V.
used swabs/gauze/ and tubes, syringes, thermocol, disposable
cannulae/broken ampules/
bandage, other items disinfected plastic glasses and plates, left
blades in puncture proof
(surgical waste) gloves, other plastic over food
container
contaminated with blood material

All plastic bags should be properly sealed, labeled and audited before disposal
PEP
(Post Exposure Prophylaxis)

Liquid Medical To be given in case

of accidental
Waste (LMW) Disposal exposure to blood
and body fluid of
HIV +ve woman
l Avoid splashing
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
l Shout for help, Rapid Initial Assessment - evaluate vital signs: PR, BP, RR and Temperature
l Establish two I.V. lines with wide bore cannulae (16-18 gauge)
l Draw blood for grouping and cross matching
l If heavy bleeding P/V, infuse RL/NS 1 L in 15-20 minutes
l Give O2 @ 6-8 L /min by mask, Catheterize
l Check vitals and blood loss every 15 minutes, monitor input and output

l Give Inj. Oxytocin 10 IU IM (if not given after delivery)

l Start Inj. Oxytocin 20 IU in 500 ml RL @ 40-60 drops per minute
l Check to see if placenta has been expelled

Placenta not delivered Placenta delivered

l Continue Oxytocin l Massage uterus

l Do P/V examination to l Examine placenta and
rule out inversion of membranes for
uterus completeness (if available)
l Attempt controlled cord l Explore uterus for retained
traction placental bits – if present,
evacuate uterus

Placenta not delivered Placenta delivered

l Do manual removal of l Continue uterine massage P/A for uterine consistency
placenta under anesthesia and Oxytocin drip
l Give IV antibiotics

Uterus well contracted Uterus soft flabby

(Traumatic PPH) (Atonic PPH)

l Look for cervical/ vaginal/ Manage as Atonic PPH

perineal tear - repair tear, Chart
continue Oxytocin
l Scar dehiscence / rupture
uterus – Laparotomy

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"Vhª; xkzeh.k LokLF; fe’ku

Instruments, Gloves and Glass Syringes

Wear utility gloves

DECONTAMINATION
Soak in 0.5% chlorine solution for 10 min

Thoroughly wash and rinse instruments

Preferred Method Acceptable Method

Sterilization High Level Disinfection (HLD)

Chemical Autoclave Hot Air Oven Boil or Steam Chemical

l Soak for l 106 kPa l 160ºC l Lid on, 20 l Soak for 20
10-24 hrs in 2% pressure, 121ºC l Holding time minutes after minutes in 2%
Glutraldehyde l 20 minutes 1 hour water boils Glutraldehyde
l Rinse with unwrapped l Used for l Articles should l Rinse with
sterile water l 30 minutes glassware and be completely sterile water
and dry wrapped sharps immersed in and dry
l Used for water l Used for
l Used for linen,
endoscopes rubber tubing, l Used for gloves endoscopes
gloves, cotton, instruments and
instruments, glass syringes
and surgical
dressing etc.

l Use only after drying

l Can be stored for 1 week

Preparation of 1 Litre Bleaching Solution

Wear utility gloves and plastic apron

l Take 1 L water in a plastic l Mix 6 part water with one part

bucket of Sodium Hypochlorite
l Make thick paste in plastic mug solution (Liquid bleach)
with 3 level teaspoons (15 g)
bleaching powder and some
water from bucket +
l Mix paste in water to make
Bleach
0.5% of chlorine solution
Water

l Maintain same ratio for large volumes

l Make fresh solution in every shift and preferably keep covered

For use in medical colleges, district hospitals and FRUs

 Postnatal
Care jk"Vhª; xkzeh.k LokLF; fe’ku

Post natal
1st Check up 1st day of delivery
care
2nd Check up 3rd day of delivery
ensures
3rd Check up 7th day of delivery
well-being
of the 4th Check up 6 weeks after delivery

mother and Additional check ups for

the baby Low Birth Weight babies on
14th, 21st and 28th days

SERVICE PROVISION DURING CHECK UPs

Mother Newborn

l Heavy bleeding l Confirm passage of urine (within

l Breast engorgement 48 hours) and stool (within 24 hours)
Ask
l For convulsions, diarrhea and
vomiting

l Pallor, pulse, BP and l Activity, color and congenital

temperature malformation
l Urinary problems and l Temperature, jaundice, cord stump
Observe perineal tears and skin for pustules
& Check l Excessive bleeding (PPH) l Breathing, chest in drawing
l Foul smelling discharge l Suckling by the baby during breast
(Puerperal sepsis) feeding

l Danger signs l Keeping the baby warm

l Correct position of breast feeding l No bathing on first day
and care of breast and nipples l Keep the cord stump clean and dry
l Exclusive breast feeding for l Additional check up for the Low Birth
Counsel 6 months Weight babies
l Nutritious diet and calcium rich
For foods
l On importance of Routine
Immunisation
l Maintaining hygiene and use of l Danger signs in baby
sanitary napkins
l Choosing contraceptive method

l Hb% estimation l Give 0 dose BCG, OPV, Hepatitis B

Do 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 Placenta expelled, uterus soft and flabby
l Traumatic causes excluded

l Shout for help, Rapid Initial Assessment
to evaluate vital signs: PR, BP, RR and
Temperature
l Establish two I.V. lines with wide bore
cannulae (16-18 gauge)
l Draw blood for grouping and cross
matching
l If heavy bleeding, infuse NS/RL 1L
in 15-20 minutes
l Give O2 @ 6-8 L /min by mask,
Catheterize
l Check vitals & blood loss every
15 minutes, Monitor input & output

l Perform continuous uterine massage

l Give Inj. Oxytocin 20 IU in 500 ml RL/ NS @ 40 drops/minute
l 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 µg IM (contraindicated in Asthma)

If bleeding P/V not controlled

Tab Misoprostol (PGE1) 800 µg Per rectal

Bleeding not controlled by drugs Bleeding controlled by drugs

l Repeat uterine massage every 15 minutes

for first 2 hours
Explore uterine cavity for retained placental bits
l 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
l Perform bimanual compression
l If fails perform compression of abdominal
l Continue Oxytocin infusion (Total Oxytocin
aorta not to exceed 100 IU in 24 hours)

l Check for coagulation Uterine Tamponade Surgical intervention

defects (Indwelling Catheters/
l If present give blood Condom/ Sangstaken tube/
products Ribbon gauze packing) as
life saving measure
l Uterine compression
suture (B-Lynch)
l Uterine/Ovarian A ligation
l Hysterectomy

Continue vital monitoring 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

l Term gestation? Routine care

l Amniotic fluid clear? Yes l Place baby on mother’s abdomen
l Breathing or crying? l Dry and cover mother and baby
l Good muscle tone? l Wipe mouth and nose
l Clamp and cut cord
If any no (after 1-3 minutes of birth)
30 secs l Watch color and breathing
l Initiate breastfeeding
l Cut cord
l Shift to newborn corner, provide warmth
l Position the baby
l Clear airway (oropharyngeal suction)*
l Dry, stimulate, reposition

Breathing
HR>100 and Pink
Evaluate respiration, heart rate and color Observe

Apneic Breathing, HR>100

or But Cyanotic Breathing
HR<100 HR>100 and Pink
Give supplemental
oxygen by
30 secs face mask

Persistent cyanosis

Post-
l Provide bag and mask ventilation* Resuscitation
l Call for Pediatrician Care

HR<60 HR>60

l Continue bag and mask ventilation*

l Administer chest compression

30 secs HR<60

l Administer epinephrine if needed 1 in 10000, 0.1-0.3 ml/kg IV/umbilical vein

l 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 mother’s 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 mother’s breast

For use in medical colleges, district hospitals and FRUs

 Antenatal
Examination
FUNDAL HEIGHT

Preliminaries
36wk
Xiphisternum
l Respect woman’s rights 40wk
32wk
l Explain procedure and ensure
privacy 28wk

l Ensure bladder is empty 24wk Umbilicus

l Examiner stands on right side 20wk

l Abdomen is fully exposed from 16wk

xiphisternum to pubis symphysis
12 wk Pubis Symphysis
l Keep woman’s legs straight (Uterus becomes
an abdominal organ)
l Centralise uterus
Symphsio-fundal height in
cms corresponds to weeks
of gestation after 28 weeks

Correct dextrorotation Ulnar border of left hand is placed on upper Measure distance between
most level of fundus and marked with pen upper border of pubic
symphysis and marked point

GRIPS

Legs are slightly flexed and separated for obstetrical grips

Fundal Grip Lateral Grip

Foetal heart sound is usually located along the lines

First Pelvic Grip Second Pelvic Grip 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
180
Foetal heart rate

170
160
150
140
130
120
110
100
90
80

Amniotic fluid
Moulding
10
9
8
Cervix (cm) 7 Aler t
on
[Plot x] 6 Acti
Hours

5
4
Descent 3
of head 2
[Plot o] 1
0
Hours 1 2 3 4 5 6 7 8 9 10 11 12

Time

5
Contractions
per 10 mins

<20 Sec
4

20 - 40 Sec 3

>40 Sec 2

Oxytocin IU/Litre
drops/min

Drugs given
and IV fluids

180
170
160
150
Pulse 140
[Plot ] 130
120
110
100
BP 90
[Plot ] 80
70
60

Temp ºC

Protein
Urine
{ Acetone
Volume

For use in medical colleges, district hospitals and FRUs

 Vaginal Bleeding
jk"Vhª; xkzeh.k LokLF; fe’ku

(Before 20 Weeks)
Light Bleeding Heavy Bleeding Any Bleeding with

l Mild pain l Mild pain l Severe pain l H/O expulsion of Product of Conception H/O passage l Pain
l No H/O expulsion of l H/O expulsion of l Uterus normal l Uterine size < Period of Gestation of vesicles l H/O interference
Product of Conception Product of size/bulky l Os may be open
l Uterus size Conception l Tenderness in
corresponds to Period l Uterus normal size/ fornix/mass
of Gestation bulky Vesicular mole Septic abortion
l Os closed l Os closed Incomplete / Inevitable abortion

Complete abortion Ectopic pregnancy

Threatened abortion l Broad spectrum
Confirm by UPT and USG Confirm by USG
l Rapid Initial Assessment
IV Antibiotics
l Resuscitate if in shock l USG
Manage as ectopic
USG Observe and follow up
pregnancy

Transfuse blood if needed l S.

S.HCG
HCG l Evacuate uterus
Foetus viable Bleeding persists – Foetus not viable
l Chest X-ray l Laparotomy if
repeat USG for foetal
viability after 1 week l TVS for theca- bowel injury/
Threatened abortion Missed abortion lutein cyst cyst
thecalutein pyoperitoneum
Uterus <12 wk size Uterus >12 wk size

l Reassure Uterus <12 wk size Uterus >12 wk size

l Rest and
abstinence Misoprost 400 mcg Manual Vacuum l Start 10-20 U Manual Vacuum
Manual Vacuum
Aspiration/ Electric oral 4 hourly max Aspiration/ Oxytocin in Aspiration/
Vacuum Aspiration 5 doses (2000 mcg) Electric Vacuum 500 ml NS/RL @ Electric Vacuum
Bleeding Aspiration 40-60 drops/min Aspiration
stops –
routine Check for completeness l Evacuate uterus
ANC
If still bleeding-MVA/
EVA/check curettage Follow up as mole

Counsel to avoid pregnancy for at least 6 months Advise contraception

For use in medical colleges, district hospitals and FRUs
 Antepartum Haemorrhage
(Vaginal bleeding after 20 weeks) jk"Vhª; xkzeh.k LokLF; fe’ku

l Rapid Initial Assessment– monitor PR, BP, RR l Ask for pain; check for uterine contour/tenderness l Arrange & transfuse blood if needed
l Resuscitate if necessary and start IV fluids l Exclude local causes by P/S examination l Confirm diagnosis by USG if available

Placenta Previa Abruptio Placentae Rupture Uterus

No PV to be done

Immediate LSCS Expectant Management LSCS ARM + Oxytocin l Bleeding PV light/moderate

l Bleeding PV heavy and
continuous irrespective
of gestational age
l Term pregnancy with
Type II post, III, IV
placenta
l Dead/Malformed foetus
(irrespective of POG)
with Type III and IV
placenta
l Term pregnancy with
malpresentation or other
obstetric indication
l Bleeding PV light/stopped l Heavy bleeding PV l Bleeding PV light/ l H/o labor followed by sudden cessation of pains
l POG < 37 weeks with vaginal moderate l Previous LSCS
delivery not l FHS normal l Tender abdomen
l Live baby, no gross foetal
imminent
anomaly l Dead foetus l Loss of uterine contour
l Fetal distress
l Women not in labor l FHS absent
l Foetal parts superficially palpable
l Hospitalize
Monitor for
l Correct Anemia
l Arrange Blood l Hemorrhage and
l Feto-maternal surveillance shock Laparotomy and repair of uterus/Hysterectomy
l Steriods if POG < 34 weeks l Coagulopathy
l Renal failure

l Terminate if 37 weeks or persistent/heavy bleeding PV

l P/V under double set up in OT

Type I, II Ant Type II post, III and IV

l ARM + Oxytocin l LSCS
l Deliver vaginally

If previous LSCS with Placenta previa keep Placenta accreta in mind Be prepared for PPH in all cases of APH
For use in medical colleges, district hospitals and FRUs
 Hand Washing jk"Vhª; xkzeh.k LokLF; fe’ku

Routine Hand Washing Surgical Hand Washing

Using plain soap and water for about 30 – 60 seconds Medicated soap and water for about 3-5 minutes
l Before touching (or handling) neonate l When hands visibly soiled l Before all invasive procedures including surgery
l Before and after examining any patient l After removing gloves l Repeat after 4 cases/1 hour which ever is earlier

0 1 2 1&2 3 4

Wet hands with water
3 4
Right palm over left dorsum with
interlaced fingers and vice versa
Apply enough soap.
Cover all hand surfaces
Palm to palm with fingers
interlaced
Rub hand palm to palm
5 and wet your hands and
Backs of finger to opposing
palms with fingers interlocked
Remove all jewelry on your
hand and wrists. Adjust the
water to a warm temperature
forearms thoroughly
Clean each fingernail with a
stick or brush. It is important
for all surgical staff to keep
their fingernails short
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

6 7 8 5 6 7

Rotational rubbing of left Rotational rubbing, backwards Rinse hands with water Rinse each arm separately, Using a sterile towel, dry your Keep your hand above the level
thumb clasped in right palm and forwards with clasped fingertips first, holding your hands and arms-from of your waist and do not touch
and vice versa fingers of right hand in left hands above the level of fingertips to elbow-using a anything before putting on
palm and vice-versa your elbow different side of the towel on surgical gloves
each arm
9 10 11

Alcohol Hand Rub

With Alcohol for about 20 – 30 seconds

Dry hands thoroughly with Use towel to turn off faucet Your hands are now safe
Alternative for routine hand wash in between examination and procedures if hands
a single use towel not visibly soiled

For use in medical colleges, district hospitals and FRUs

 Eclampsia
jk"Vhª; xkzeh.k LokLF; fe’ku

Pregnancy with Convulsion; BP≥140/90 mmHg; Proteinuria

Immediate Management
1 Keep her in quiet room in bed 2 Position her on left side, Oropharyngeal 3 Ensure preparedness to manage
with padded rails on sides airway to be kept patent. 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 Deliver the baby irrespective of

Anti Convulsants
gestational age
l If Diastolic BP>100 mmHg l Magnesium Sulfate is drug of choice l Admission-delivery interval
l Strict BP monitoring l Loading dose: should not be more than 12 hours
l Oral Nifedepine 10 mg stat, ¢ 50% of 4 gm diluted to 20% (8 ml drug with 12 ml NS) to be given
repeat after 30 minutes if slowly IV in 5 minutes
needed (if pt unconscious
through ryles tube) OR ¢ 5 gm IM (50%) each buttock with 1 ml of 2% Xylocaine (Total 10 gm)
l Inj Labetalol 20 mg IV bolus, ¢ If recurrent fits after 30 minutes of loading dose – repeat 2 gm 20%
repeat 40 mg after 10 minutes (4 ml drug with 6 ml NS) slow IV in 5 minutes
again repeat 80 mg every l Maintenance dose: Favourable Cervix Unfavourable Cervix
10 minutes if needed
(maximum 220 mg) with ¢ 5 gm IM (50%) alternate buttocks after monitoring every 4 hourly
cardiac monitoring l Monitor:
u Presence of patellar jerks
u Resp. rate (RR)>16/min
u Urine output >30 ml/hr in last 4 hours l Induction with l Ripening with
ARM and Dinoprostone
l Continue till 24 hours after last fit/delivery which ever is later
Oxytocin gel/ intracervical
l If Patellar jerk absent or urine output<30 ml/hr withhold Magsulf and l 2nd stage to be indwelling
monitor hourly– restart maintenance dose if criteria fulfilled cut short by catheter and
l If RR<16/min, withhold Magsulf, give antidote – Calcium Gluconate Forceps/ after 6 hours
1 gm IV 10 ml of 10% solution in 10 minutes Ventouse

• If fits not controlled/ status eclampticus • Foetal distress • Deteriorating maternal condition
LSCS: • Failed Induction • Any other obstetric indication
For use in medical colleges, district hospitals and FRUs
 Labour Room Sterilization jk"Vhª; xkzeh.k LokLF; fe’ku

l Sterilization is a process which should l Labour Room should be centrally l Alternatively cross ventilation with
be practised and adhered to by all air conditioned with air handling unit exhaust is required if air conditioning is
individuals at all times not present

Cleaning and disinfection daily at beginning

Cleaning after each delivery Fogging
of day after wearing utility gloves

l Clean the floor and sinks with detergent (soap water) and keep Clean table top with Phenol/ Bleaching solution Need based
floor dry l Following construction/renovation work
l Clean table tops and others surfaces like light shades, almirahs, l Any infectious outbreak
lockers, trolley etc with low level disinfectant Phenol (Carbolic
Acid 2%)
l Clean monitor machines with 70% alcohol
l H2O2 based commercially available
l In case of spillage of blood, body fluids on floor, absorb with disinfectant for fogging and mopping
newspaper (discard in yellow bin), soak with bleaching solution
for 10 minutes and then mop l If fogger not available spray or mop
liberally in room, table tops etc
l Discard placenta in yellow bins
l Allowing 30 minutes contact time (shut
l Discard waste and gloves in proper bins and not on floor down of Labour Room not required)
l Discard soiled linen in laundry basket and not on floor. Disinfect
with bleaching solution followed by washing and autoclaving
l Mop the floor every 3 hours with disinfectant solution

l Unnecessary entries to the Labour Room must be restricted
General : l Labour Room doctors and paramedics should wear mask all the time
Measures l Proper clothing of Labour Room personnel necessary including cap,
mask, shoes/slippers and gown at the time of delivery
l Individual autoclaved instrument set should be provided for each delivery
l Random swab sampling to be taken from surfaces and disinfected
articles monthly
l Air quality sampling to be done by Settle plate method monthly

For use in medical colleges, district hospitals and FRUs

 Operation Theatre Sterilization jk"Vhª; xkzeh.k LokLF; fe’ku

l Sterilization is a process which should l OT should be centrally air l Alternatively cross ventilation with
be practised and adhered to by all conditioned with air handling unit exhaust is required if air
individuals at all times conditioning not present

Cleaning and disinfecting daily at beginning of day after wearing utility gloves Fogging weekly

l Clean the floor and sinks with detergent (soap water) and keep floor dry Aldehyde based spray is used
l Clean table tops and others surfaces like light shades, almirahs, lockers,
trolley etc with low level disinfectant Phenol (Carbolic acid 2%)
l Clean monitor machines with 70% alcohol
l Sprayed or mopped liberally in room, table tops etc
l 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 l Allowing 30 minutes contact time (shut down of OT not required)
then mop
l Discard waste and gloves in proper bins and not on floor
l Discard soiled linen in laundry basket and not on floor. Disinfect with
bleaching solution followed by washing and autoclaving
l Mop the floor every 3 hours with disinfectant solution

General Measures: Quality Control:

l Access to OT should be through 'Buffer Zone'
l Unnecessary entries to the OT must be restricted
l Proper occlusive clothing of OT personnel necessary
l Instruments to be sterilized by autoclaving
l Each case should have separate instrument sets
For use in medical colleges, district hospitals and FRUs
l Microbiological sample should be taken randomly at 2 months interval by Settle plate method
l Random microbiological sampling to be done by Settle plate/Air sampling method
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
 Pre Eclampsia jk"Vhª; xkzeh.k LokLF; fe’ku

l BP≥140/90 mm Hg on 2 occasions, 4 hours apart l Urine proteinuria ≥ traces or ≥ 300 mg/24 hrs sample l Period of gestation>20 weeks

Mild Pre eclampsia Severe Pre eclampsia

l BP ≥ 140/90 mm Hg
l Protienuria ≥ traces to 2 + or ≥ 300 mg/24 hrs
l Hospitalize to evaluate and investigate
l Reassure, no restriction on routine salt intake
l Rest with limited activity
l Start anti hypertensive when DBP ≥ 100 mm Hg
l Tab Alpha Methyl Dopa 250–500 mg 6-8 hourly
(max 2 gm/day) OR
l Tab Labetalol 100 mg BD (max 2.4 gm/day)
l Investigate — Hgm, LFT, KFT, S Uric acid,
S LDH and fundus exam
l BP and urine output monitoring
l BP ≥ 160/110 mm Hg
l Proteinuria ≥ 3 + by dipstick or ≥ 5 gm/24 hrs
l Headache, epigastric pain, blurring of vision, oliguria, pulmonary odema, thrombocytopenia, IUGR. Creatinine >1.2 mg/dl, serum
transaminase levels, S LDH>600 IU/L
l Urgent hospitalization
l Start anti hypertensive
l Oral Nifedepine 10 mg stat, repeat after 30 minutes if needed OR
l 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
l Continue Tab Nifedepine 10 mg TDS (max 80 mg/day) OR Tab Labetalol 100 mg BD (max 2.4 gm/day)
l Investigate — Hgm, LFT, KFT, S Uric acid, S LDH and fundus exam
l Urine output charting
l BP Monitoring

l Continue OPD management in mild disease

l Continue hospitalization in worsening < 24 weeks ≥24 -<34 weeks ≥34 weeks ≥37 weeks
hypertension/proteinureia
l Regular foetal+maternal surveillance (foetal Treatment should be individualised
movement count, NST, AFI, wt gain, BP and
urine output monitoring, weekly Hgm, LFT, KFT,
S Uric acid and S LDH) Foetal salvage difficult Inj. Betamethasone BP controlled BP uncontrolled
l 12 mg IM l Explain maternal and foetal l Worsening of clinical /
l Repeat 12 mg adverse effect to relatives biochemical parameters
after 24 hours l Regular maternal + foetal l Signs of foetal compromise
l Maintain DBP If disease severe, surveillance
90-100 mm Hg manage as severe
l No foetal compromise pre eclampsia
Terminate at 37 weeks

l Deliver at 38-39 weeks l Terminate pregnancy

l Induction of labor as per Bishop score and give Magsulf as in Eclampsia

No role of diuretics
For use in medical colleges, district hospitals and FRUs