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Reference Manual - ReproLinePlus

Reference Manual - ReproLinePlus Reference Manual - ReproLinePlus

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Basic Maternal and Newborn Care: A Guide for Skilled Providers 4-10 JHPIEGO/Maternal and Neonatal Health Program

ANNEX FOUR ADDITIONAL PROCEDURES ARTIFICIAL RUPTURE OF MEMBRANES Indications This procedure is not a routine part of basic care. It should be performed only if membranes have not ruptured spontaneously before application of vacuum cup (when performing vacuum extraction is necessary). Note: In areas where HIV and/or hepatitis are highly prevalent, the membranes should be left intact for as long as possible to reduce mother-to-child transmission of infection. Pre-Procedure Steps and Considerations • In performing the following procedure, adhere to the general principles of basic care as outlined in Chapter 1 (page 1-5). Procedure • Listen to and note the fetal heart rate. • Ask the woman to lie on her back with her legs bent, feet together, and knees apart. • Wearing high-level disinfected or sterile gloves, use one hand to examine the cervix and note the consistency, position, and dilation. • Use the other hand to insert an amniotic hook or a Kocher clamp into the vagina. • Guide the clamp or hook toward the membranes along the fingers in the vagina. • Place two fingers against the membranes and gently rupture the membranes with the instrument in the other hand. Allow the amniotic fluid to drain slowly around the fingers. • Note the color of the fluid (clear, greenish, bloody). • If thick meconium is present, ACT NOW!—see Textbox 3-42 (page 3-111) before proceeding. Post-Procedure Steps and Considerations • Listen to the fetal heart rate during and after a contraction. If the fetal heart rate is abnormal (less than 100 or more than 180 beats per minute), ACT NOW!— see Textbox 3-45 (page 3-113). BREECH BIRTH (IN EMERGENCY SITUATIONS ONLY) Indications This procedure is not a routine part of basic care. It should be performed only in the case of frank or complete breech presentation (Figure 4-3, page 4-12), when the cervix is completely dilated, there is no evidence of cephalopelvic disproportion, AND there is no time for urgent referral/transfer (i.e., the woman was already in the 2 nd stage of labor when condition was detected). JHPIEGO/Maternal and Neonatal Health Program 4-11

Basic Maternal and Newborn Care: A Guide for Skilled Providers<br />

4-10 JHPIEGO/Maternal and Neonatal Health Program

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