Overview

Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice (3rd edition) (PCPNC), has been updated to include recommendations from recently approved WHO guidelines relevant to maternal and perinatal health. These include pre-eclampsia & eclampsia; postpartum haemorrhage; postnatal care for the mother and baby; newborn resuscitation; prevention of mother-to- child transmission of HIV; HIV and infant feeding; malaria in pregnancy, interventions to improve preterm birth outcomes, tobacco use and second-hand exposure in pregnancy, post-partum depression, post-partum family planning and post abortion care.

The aim of PCPNC is to provide evidence-based recommendations to guide health care professionals in the management of women during pregnancy, childbirth and postpartum, and newborns, and post abortion, including management of endemic diseases like malaria, HIV/AIDS, TB and anaemia.

The PCPNC is a guide for clinical decision-making. All recommendations are for skilled attendants working at the primary level of health care, either at the facility or in the community. They apply to all women attending antenatal care, in delivery, postpartum or post abortion care, or who come for emergency care, and to all newborns at birth for routine and emergency care.

Contents

• PREFACE
• ACKNOWLEDGEMENTS
• INTRODUCTION
  • I HOW TO READ THE GUIDE
• A. PRINCIPLES OF GOOD CARE
  • A2 COMMUNICATION
  • A3 WORKPLACE AND ADMINISTRATIVE PROCEDURES
  • A4 STANDARD PRECAUTIONS AND CLEANLINESS
  • A5 ORGANIZING A VISIT
• B. QUICK CHECK, RAPID ASSESSMENT AND MANAGEMENT OF WOMEN OF CHILDBEARING AGE
  • B2 QUICK CHECK
  • RAPID ASSESSMENT AND MANAGEMENT (RAM)
• B. EMERGENCY TREATMENTS FOR THE WOMAN
  • B9 AIRWAY, BREATHING AND CIRCULATION
  • B10-B12 BLEEDING
  • B13-B14 ECLAMPSIA AND PRE-ECLAMPSIA
  • B15 INFECTION
  • B16 MALARIA
  • B17 REFER THE WOMAN URGENTLY TO THE HOSPITAL
• B. BLEEDING IN EARLY PREGNANCY AND POST-ABORTION CARE
  • B19 EXAMINATION OF THE WOMAN WITH BLEEDING IN EARLY PREGNANCY, AND POST-ABORTION CARE
  • B20 GIVE PREVENTIVE MEASURES
  • B21 ADVISE AND COUNSEL ON POST-ABORTION CARE
• C. ANTENATAL CARE
  • C2 ASSESS THE PREGNANT WOMAN: PREGNANCY STATUS, BIRTH AND EMERGENCY PLAN
  • C7-C11 RESPOND TO OBSERVED SIGNS OR VOLUNTEERED PROBLEMS
  • C12 GIVE PREVENTIVE MEASURES
  • C13 ADVISE AND COUNSEL ON NUTRITION AND SELF-CARE AND SUBSTANCE ABUSE
  • C14-C15 DEVELOP A BIRTH AND EMERGENCY PLAN
  • C16 ADVISE AND COUNSEL ON FAMILY PLANNING
  • C17 ADVISE ON ROUTINE AND FOLLOW-UP VISITS
  • C18 HOME DELIVERY WITHOUT A SKILLED ATTENDANT
• 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
  • D8 FIRST STAGE OF LABOUR: NOT IN ACTIVE LABOUR
  • D9 FIRST STAGE OF LABOUR: 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
  • RESPOND TO PROBLEMS DURING LABOUR AND DELIVERY
  • 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-D24 RESPOND TO PROBLEMS IMMEDIATELY POSTPARTUM
  • D25 GIVE PREVENTIVE MEASURES
  • D26 ADVISE ON POSTPARTUM CARE
  • D27 COUNSEL ON BIRTH SPACING AND FAMILY PLANNING
  • D28 ADVISE ON WHEN TO RETURN
  • D29 HOME DELIVERY BY SKILLED ATTENDANT
• E. POSTPARTUM CARE
  • E2 POSTPARTUM EXAMINATION OF THE MOTHER (UP TO 6 WEEKS)
  • E3-E10 RESPOND TO OBSERVED SIGNS OR VOLUNTEERED PROBLEMS
• F. PREVENTIVE MEASURES AND ADDITIONAL TREATMENTS FOR THE WOMAN
  • F2–F3 PREVENTIVE MEASURES
  • ADDITIONAL TREATMENTS FOR THE WOMAN
• G. INFORM AND COUNSEL ON HIV
  • G2 PROVIDE KEY INFORMATION ON HIV
  • G3 HIV TESTING AND COUNSELLING
  • G4 CARE AND COUNSELLING FOR THE HIV-INFECTED WOMAN
  • G5 SUPPORT TO THE HIV-INFECTED WOMAN
  • G6 GIVE ANTIRETROVIRAL DRUGS (ART) TO TREAT HIV INFECTION
  • G7 COUNSEL ON INFANT FEEDING OPTIONS
  • G8 TEACH THE MOTHERS SAFE REPLACEMENT FEEDING
  • G9 ANTIRETROVIRAL MEDICINES (ART) FOR HIV-INFECTED WOMAN AND HER NEWBORN
  • G10 RESPOND TO OBSERVED SIGNS OR VOLUNTEERED PROBLEMS
  • G11 PREVENT HIV INFECTION IN HEALTH-CARE WORKERS AFTER ACCIDENTAL EXPOSURE WITH BODY FLUIDS (POST EXPOSURE PROPHYLAXIS)
  • G12 GIVE ANTIRETROVIRAL DRUGS (ART) TO THE HIV-INFECTED WOMAN AND HER BABY
• H. THE WOMAN WITH SPECIAL NEEDS
  • H2 EMOTIONAL SUPPORT FOR THE WOMAN WITH SPECIAL NEEDS
  • H3 SPECIAL CONSIDERATIONS IN MANAGING THE PREGNANT ADOLESCENT
  • H4 SPECIAL CONSIDERATIONS FOR SUPPORTING THE WOMAN LIVING WITH VIOLENCE
• I. COMMUNITY SUPPORT FOR MATERNAL AND NEWBORN HEALTH
  • I2 ESTABLISH LINKS
  • I3 INVOLVE THE COMMUNITY IN QUALITY OF SERVICES
• J. NEWBORN CARE
  • J2 EXAMINE THE NEWBORN
  • J3 IF PRETERM, BIRTH WEIGHT <2500-G OR TWIN
  • J4 ASSESS BREASTFEEDING
  • J5 CHECK FOR SPECIAL TREATMENT NEEDS
  • J6 LOOK FOR SIGNS OF JAUNDICE AND LOCAL INFECTION
  • J7 IF DANGER SIGNS
  • J8 IF SWELLING, BRUISES OR MALFORMATION
  • J9 ASSESS THE MOTHER'S BREASTS IF COMPLAINING OF NIPPLE OR BREAST PAIN
  • J10 CARE OF THE NEWBORN
  • J11 ADDITIONAL CARE OF A SMALL BABY (OR TWIN)
  • J12 ASSESS REPLACEMENT FEEDING
• K. BREASTFEEDING, CARE, PREVENTIVE MEASURES AND TREATMENT FOR THE NEWBORN
  • K2-K4 COUNSEL ON BREASTFEEDING
  • K5-K6 ALTERNATIVE FEEDING METHODS
  • K7 WEIGH AND ASSESS WEIGHT GAIN
  • K8 OTHER BREASTFEEDING SUPPORT
  • K9 ENSURE WARMTH FOR THE BABY
  • K10 OTHER BABY CARE
  • K11 NEWBORN RESUSCITATION
  • K12-K13 TREAT THE BABY
  • K14 ADVISE WHEN TO RETURN WITH THE BABY
• L. EQUIPMENT, SUPPLIES, DRUGS AND LABORATORY TESTS
  • L2 EQUIPMENT, SUPPLIES, DRUGS AND TESTS FOR ROUTINE AND EMERGENCY PREGNANCY AND POSTPARTUM CARE
  • L3 EQUIPMENT, SUPPLIES AND DRUGS FOR CHILDBIRTH CARE
  • L4 LABORATORY TESTS
  • L5 PERFORM RAPID PLASMAREAGIN (RPR) TEST FOR SYPHILIS
  • L6 PERFORM RAPID HIV TEST (TYPE OF TEST USED DEPENDS ON THE NATIONAL POLICY)
• M. INFORMATION AND COUNSELLING SHEETS
  • M2 CARE DURING PREGNANCY
  • M3 PREPARING A BIRTH AND EMERGENCY PLAN
  • M4 CARE FOR THE MOTHER AFTER BIRTH
  • M5 CARE AFTER AN ABORTION
  • M6 CARE FOR THE BABY AFTER BIRTH
  • M7 BREASTFEEDING
  • M8-M9 CLEAN HOME DELIVERY
• N. RECORDS AND FORMS
• GLOSSARY AND ACRONYMS

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