WORKBOOK for TRAINING of

WORKBOOK for TRAINING of MEDICAL OFFICERSin Pregnancy Care and Management of Common Obstetric Complications

000_PPP141_(08-09)_WHO India_Hal1 1 19/09/2009 11:21:36 AM

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Contents

Preface ��

Acknowledgement v

Foreword v��

ProgramOfficer’sMessage �x

Abbrev�at�onsandUn�ts x�

Tra�n�ngSess�on 1.1

CaseSheet:AntenatalCare 2.1.1

CaseSheet:IntrapartumRecord 3.1.1

CaseSheet:InstrumentalDel�very 4.1.1

CaseSheet:NewBornCare 5.1.1

CaseSheet:PostpartumCare 6.1.1

CaseSheet:Compl�cat�onsDur�ngPregnancyandPostNatalPer�od 7.1.1

00_PPP141_(08-09)_WHO India_Trai1 1 19/09/2009 11:24:24 AM

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TheReproduct�veandCh�ldHealthProgrammePhase-II,aflagsh�pprogrammew�th�nNat�onalRuralHealthM�ss�on,a�mstoreducematernalmortal�tyrat�otolessthan100by2010.There is a commitment from the Government of India and also from the States and UTs for providing Essential Obstetric Care at all facilities to achieve the goal of universal Skilled Birth Attendance. With this in view, Government of India has planned to operationalize all PHCs and FRUs in handling basic and comprehensive obstetric care, respectively.

UndertheRCHPhase-II,theGovernmentofInd�aenv�sagesthatfiftypercentofthePHCsandalltheCHCs�nallthed�str�ctswouldbemadeoperat�onalas24-hourdel�verycentres,�naphasedmanner,bytheyear2010.Thesecentreswould be respons�ble for prov�d�ng Bas�c and Emergency Obstetr�c Care and Essent�al Newborn Care, �nclud�ngNewbornResusc�tat�onserv�cesroundtheclock.AlmostalltheStateshavela�demphas�s�nprov�d�ngbas�cemergencyobstetr�ccareandsk�lledattendanceatb�rth�ntheProjectImplementat�onPlans(PIP)forRCHPhase-II.

As such, theMed�calOfficers,who are �n-charge of thesehealth fac�l�t�es,would, therefore, have tobe equ�ppedenoughtohandlethecommonobstetr�cemergenc�esandprov�detherequ�s�tecaresuchasadm�n�strat�onofparenteraloxytoc�cs,ant�b�ot�csandant�-convulsantdrugs,manualremovaloftheplacenta,theconduct�onofass�stedvag�naldel�ver�es,etc.

Tra�n�ngtoolforthetra�n�ngofMed�calOfficersatPHConPregnancyCareandManagementofCommonObstet�rcCompl�cat�ons have been developed �n accordance w�th the Guidelines for Pregnancy care and Management of Common Obstetric Complications by Medical Officers�ncludeandTra�nersGu�de,HandbookandWorkbookfortheTra�nees tomanageEssent�alObstetr�cCare.These toolshavebeenpreparedbyMaternalHealthD�v�s�on �ncollaborat�onw�thJawaharlalNehruMed�calCollege,Belgaumw�th �nputs fromUNFPAandWHO.Ihope theWorkbookalongw�ththeGu�del�ne’s&Handbookw�llfac�l�tateMed�calOfficersfromPr�maryHealthCentrestobu�ldtheresk�lls�npregnancycareandmanagementofcommonobstetr�ccompl�cat�onsandhelp�nensur�ngthequal�tyandun�form�ty�nthetra�n�ngs.

Date:23.04.08 Shri Naresh Dayal,SecretaryH&FW.NewDelh�,Ind�a.

PReFACe


v

ACKnoWLeDGeMent

Toach�evethegoalsforreduct�onofmaternalmortal�tyandmorb�d�ty,GoIhasacomm�tmentunderReproduct�veandCh�ldHealthProgramtoprov�dequal�tyAntenatal,PostnatalandIntranatalcaredur�ngpregnancyandch�ldb�rthbyaSk�lledB�rthAttendant.T�mely�dent�ficat�onandmanagementofobstetr�ccompl�cat�ons�sthekeytothesurv�valofmothers.

Toach�eveth�s,GovernmentofInd�aenv�sagesthatfiftypercentofthePr�maryHealthCentresandalltheCommun�tyHealthCentresshouldbeoperat�onal�sedas24-hourdel�verycentresw�thprofic�encyforprov�d�ngbas�candemergencyobstetr�c serv�ces.These centresw�ll alsobe respons�ble forprov�d�ngpre-referral emergencycare forwomenwhodevelopcompl�cat�onsdur�ngdel�very.Thetra�n�ngtools,�.e.,Tra�ners’Gu�de,Tra�nees’HandbookandWorkbookw�llhelp �n �mpart�ngknowledgeandsk�lls totheMOs,wh�chw�llhelpthem�nprov�d�ngserv�cestowomen�nlabourandobstetr�cemergenc�estherebyreduc�ngmaternalmortal�ty.

Thetra�n�ngpackagehasbeendes�gnedbythefacultyofJawaharlalNehruMed�calCollege,Belgaumpart�cularlyDr.B.S.Kodkany,Dr.KamalPat�l,Dr.M.K.SwamyandMr.K�lledar.Inputshavealsobeentakenfromprofess�onalbod�essuchasFederat�onofObstetr�candGynaecolog�calSoc�et�esofInd�a(FOGSI),espec�allyDr.C.N.PurandereandDr.HemaD�wakar,UNorgan�zat�ons,part�cularlyDr.Har�shKumarandDr.Son�aTr�khaofWHO-Ind�aandDr.D�neshAgarwalofUNFPA-Ind�a.Ithankthemallforthe�rvaluablecontr�but�ons.

Ialsotaketh�sopportun�tytoacknowledgethecontr�but�onofalltheexperts,espec�allyDr.Deok�Nandan(D�rector,NIHFW),Dr.KamalaGanesh(ExH.O.D-ObGyn,MAMC,Delh�),Dr.(Mrs)N.S.Mahanshett�andfacultyofalltheMed�calCollegesofKarnataka.IalsoacknowledgethesupportofWHO�norgan�z�ngmeet�ngs,workshopsandprov�d�ngnecessary�nputsforaccompl�sh�ngthepreparat�onofthegu�del�nes.

Thes�ncereandhardworkofDrNar�kaNamshum,Dr.H�manshuBhushan,Dr.Man�shaMalhotra,Dr.Avan�PathakandDr.RajeevAggarwalfromMaternalHealthD�v�s�on,MoHFWneedsspec�alment�on.

IhopetheHandbookalongw�ththeWorkbook&Gu�del�nesw�ll fac�l�tatemed�calofficers frompr�maryhealthcentrestobu�ldthe�rsk�lls�npregnancycareandmanagementofcommonobstet�rccompl�cat�onsandhelp�nensur�ngh�ghqual�tyoftra�n�ngs.

Date:23.04.08 Aradhana JohriJo�ntSecretary,MoHFW

NewDelh�,Ind�a


v��

FoReWoRD

NRHMhasacomm�tmentforreduct�onofmaternal&�nfantmortal�ty/morb�d�tysoastomeettheNat�onalandInternat�onal goals. The reduct�on of MMR �s related to qual�ty of serv�ces rendered and also handl�ng of Bas�candComprehens�veObstetr�cCareserv�cesatthehealthfac�l�t�espart�cularlyatPr�maryandSecondarylevelofthefac�l�t�es.

Nat�onalRuralHealthM�ss�onhasthegoalofreduc�ngthematernalmortal�tyrat�otolessthan100per100,000l�veb�rthsby2012&�nfantmortal�tyratetolessthan30per1000l�veb�rths.Toach�evetheseobject�ves,stepshavebeentakenunderNRHMtoappropr�atelystrengthenallPHCsandFRUs�nhandl�ngBas�candComprehens�veObstetr�cCare�nclud�ngCareatB�rth.However,forthe�mprovementofserv�cedel�very,�t�s�mportantthatmed�calofficersarere-or�entedoncaredur�ngpregnancy&ch�ldb�rthsothatfac�l�t�escanbecomeeffic�ent�nhandl�ngcompl�cat�onsrelatedtopregnancy&careofnewborn.

GoIhasalreadylaunchedthetra�n�ngofparamed�calworkers�.e.,Nurses,ANMs&LHVsformak�ngthemsk�lled�nprov�s�onofcaredur�ngpregnancy&ch�ldb�rthbutthemed�calofficers�nruralpr�marycarefac�l�t�eshavenotbeenreor�ented�nthesesk�lls.Thesemed�calofficersarealsosupposedtobethesuperv�sors&tra�nersfortheSBAtra�n�ngofNurses,ANMs&LHVs.ThereforethePHCMOsneedtoup-gradethe�rsk�lls&knowledge�nordertomanage&supportthe�rteam�nsk�llb�rthattendance.

Toach�eve th�s,GoIhasdeveloped tra�n�ng tools&gu�del�nes forMed�calOfficersatpr�maryhealth fac�l�t�es. It�ncludesTra�nersGu�deHandbookandWorkbookfortheTra�neestomanageEssent�alObstetr�cCare.ThesehavebeenpreparedbyMaternalHealthD�v�s�onof th�sM�n�stryw�th �nputs fromexperts,profess�onals,developmentpartners&leaders�nthefield.

Ihopethesetra�n�ngtoolsw�llfac�l�tatethetra�ners�nor�ent�ngthemed�calofficersfrompr�maryhealthfac�l�t�es�nprofic�entuseofessent�alproceduresdescr�bed�ntra�n�ngmanual.S�m�larly,tra�neesw�llalsobebenefittedbythehandbookandworkbookwh�chhasbeenprepared�nl�new�ththeGu�del�nesforPregnancycareandManagementofCommonObstetr�cCompl�cat�onsbyMed�calOfficers”.Ihopeth�sw�llhelp�nreduc�ngther�sk&traumaofpregnancy&ch�ldb�rth�ncommun�ty.

Date:28.08.09 (Amit Mohan Prasad)Jo�ntSecretaryH&FW

GovernmentofInd�a


�x

PRoGRAM oFFICeR’s MessAGe

W�th the launch of Nat�onal Rural Health M�ss�on, many pos�t�ve changes have taken place �n publ�c health,�nfrastructureandserv�cedel�verybutst�llthere�sascopefor�mprovement�nthequal�tyofserv�cesbe�ngrendered.Reduct�onofmaternaland�nfantmortal�ty�sl�nkedw�ththequal�tyofcaredur�ngpregnancyandch�ldb�rth.Sk�lledattendance�neverypregnancyanddur�ngb�rth�saprovenstrategyforensur�ngqual�tyofserv�cesandforreduc�ngmaternalmortal�ty.Tra�n�ngofm�dw�fesandor�entat�onofdoctors�sthekeystepwh�chw�llhelp�nprov�d�ngsk�lledattendancedur�ngeverypregnancyandb�rthtak�ngplaceatpubl�chealthfac�l�t�es.

To�mprovesk�llsofprov�ders,tra�n�ngofANMs/LHVs/SNsasSk�lledB�rthAttendanthasalreadybeen�nplacebuttheMed�calofficerswhoarealsothesuperv�sorsofth�stra�n�ngneedtobere-or�entedonthesk�lls.Agu�del�neonPregnancyCareandManagementofCommonObstetr�cCompl�cat�onsforMed�calofficerswork�ngatPHCandCHClevelwaspreparedforth�spurpose�ntheyear2005.However,statescouldnot�mplement�tbecausethetra�n�ngtoolswerenotava�lable.Assuch,w�ththehelpoftheexpertsanddevelopmentpartners,wehavenowdevelopedthreebooks�.e.Tra�nersGu�de,Tra�neesHandbookandWorkbookasatra�n�ngtoolforthemed�calofficers.

Therewassomedelay�nbr�ng�ngthesebookstothefinalshapebecausecerta�ntechn�calstrateg�esl�keUseofOxytoc�natallthehealthfac�l�t�esandupdatedpackageofEssent�alNewBornCareandResusc�tat�onetc.werebe�ngfirmedup.A10days’packageforMed�calofficers�snow�nplacebutthegu�del�nesareafac�l�tat�ngtool.Object�vesofthegu�del�nesw�llonlybeach�eved�fthere�sapropercoord�nat�on,plann�nganddec�s�onmak�ngamongallthekeystakeholdersw�th�nthestateforconduct�ngth�stra�n�ngandut�l�z�ngthetra�neddoctorsatproperplace.

Ihopethesetra�n�ngtoolsw�llfac�l�tateboththetra�nersandtra�nees�nreor�entat�onofknowledgeandsk�llsforcaredur�ngpregnancyandch�ldb�rthandw�llhelp�nreduc�ngther�sk&traumaofpregnancy&ch�ldb�rth�ncommun�ty.Itaketh�sopportun�tytothankeveryonewhohascontr�buted�nfram�ngthetra�n�ngpackage.

Date:02.09.09 (Dr. Himanshu Bhushan)Ass�stantComm�ss�oner

MaternalHealthD�v�s�onMOHFW

New-Delh�,INDIA


x�

@ Attherateof

% Percent

AMTSL Act�veManagementofTh�rdStageofLabour.

ANC Ante-natalCare

ANM Aux�l�aryNurse-m�dw�fe

APH AntepartumHaemorrhage

ASHA Accred�tedSoc�alHealthAct�v�st

BP BloodPressure

BPM BeatsPerM�nute

c/o Compla�ntof

CCT ControlledCordTract�on

CHC Commun�tyHealthCentre

CPD Cephalopelv�cD�sproport�on

D&C D�lat�onandCurettage

e.g. Forexample

EDD ExpectedDateofDel�very

ENBC Essent�alNewBornCare

Etc. Etcetra

FHR FoetalHeartRate

FHS FoetalHeartSound

FTD FullTermDel�very

FOGSI Federat�onofObstetr�csandGynecolog�calSoc�et�esofInd�a

FRU F�rstReferralUn�t

G(no.) P(no.) A(no.) L(no.) Grav�da(no.)Para(no.)Abort�on(no.)L�veB�rth(no.)

GoI GovernmentofInd�a

GPE GeneralPhys�calExam�nat�on

h/o H�storyof

Hb Haemoglob�n

Hg Mercury

HIV HumanImmunodefic�encyV�rus

HLD H�ghLevelD�s�nfect�on

i.e. That�s

IFA IronFol�cAc�d

I/o Input/output

AbbRevIAtIons AnD UnIts


x��

IM Intramuscular

ICTC IntegratedCounsell�ngandTest�ngCenter

Inj. Inject�on

IUD Intrauter�neDeath

IUGR Intrauter�neGrowthRetardat�on

IV Intravenous

LLIN LongLast�ngInsect�deTreatedBednets

LBW LowB�rthWe�ght

LMP LastMenstrualPer�od

LR LabourRoom

MMR MaternalMortal�tyRat�o

MOS Med�calOfficers

MoHFW M�n�stryofHealthandFam�lyWelfare

MRP ManualRemovalofPlacenta

MTP Med�calTerm�nat�onofPregnancy

MVA ManualVacuumAsp�rat�on

N/A NotAppl�cable

NBC NewBornCare

NIHFW Nat�onalInst�tuteofHealthandFam�lyWelfare

NRHM Nat�onalRuralHealthM�ss�on

NVBDCP Nat�onalVectorBorneD�seaseControlProgramme

NSAID Non-stero�dalAnt�-�nflammatoryDrug

O/E OnExam�nat�on

OPD OutPat�entDepartment

OT Operat�onTheater

P/A PerAbdomen

P/S PerSpeculum

P/V PerVag�num

P(no.) L(no.) A(no.) Pregnancy(no.)L�ve-b�rth(no.)Abort�on(no.)

PHC Pr�maryHealthCentre

PIH PregnancyInducedHypertens�on

PIP ProjectImplementat�onPlan

PNC PostnatalCare

PPH PostpartumHaemorrhage


x��

PROM PrematureorPrelabourRuptureofMembranes

RL R�ngerLactate

RCH Reproduct�veandCh�ldHealth

RR Resp�ratoryRate

RPR Rap�dPlasmaReag�n

RTI Reproduct�veTractInfect�on

SBA Sk�lledB�rthAttendant

STI SexuallyTransm�ttedInfect�on

Tab Tablet

TBA Trad�t�onalB�rthAttendant

TT TetanusToxo�d

UIP Un�versalImmun�zat�onProgramme

UTI Ur�naryTractInfect�on

UNFPA Un�tedNat�onPopulat�onFundAgency

VDRL VenerealD�seaseResearchLaboratory

vs Versus

WHO WorldHealthOrgan�zat�on

ºC DegreeCent�grade

mg/mcg M�ll�gram/M�crogram

cc Cub�cCent�metre

cm Cent�metre

dl Dec�l�tre

gm Gram

IU Internat�onalUn�ts

kcal K�localor�es

kg K�logram

L L�tre

Lb Pound

mg M�ll�gram

ml M�ll�l�tre

mm M�ll�metre

U Un�ts


1.1

Training SeSSion

Name of the Medical Officer

Name of work place

Taluka and District

Name of Training Institute

Names of the Trainers 1.

2.

3.

4.

Training Duration w.e.f. _________________________ to ______________________

Dates of Joining

Assessment (Tick any) Satisfactory/Needs re-orientation

Name and Designation of Supervisor

Signature with date

01_PPP 141_(08-09)_WHO India_Tra1 1 19/09/2009 11:26:46 AM

1.2

Training SeSSion

General Instructions to Trainees

This workbook is a compulsory component of your training. You are required to maintain record of all your learning activities and other tasks that you perform during the course. These activities are to be performed under the supervision of the supervisor initially, whose remarks will guide you in improving your skills while practising independently.

The workbook would enable your trainers to have the first hand information about various tasks performed by you and help in assessing the practical hands-on experience gained by you. This would also be very useful to you for planning your activities in advance of the actual performance of the task. This record will also be given due weightage for your final assessment. You should keep this document with you whenever you are practising a skill, complete it and show it to your supervisor for his/her remarks and suggestions.

You are expected to keep the records in this workbook whenever you carry out any procedure under the supervision of the designated supervisor. You may add more items after discussion with your supervisor, whenever required. You must show the record to your supervisor after he/she has observed the procedure and request him/her to give the remarks and suggestions regarding where you need to improve your competencies. Please be honest in completing this workbook, since this is meant to help you acquire competencies. It is very important that you know your weak areas and improve upon them during the training period.

We have also given case studies in your handbook to stimulate your analytic and decision-making skills in relation to selected essential and emergency obstetric care and newborn care which you are likely to face in the field settings. Please go through these and also discuss these with your supervisors. Please keep the workbook even after you finish your training. This would be handy in your practice later on.

Wish you the best of luck


1.3

Training SeSSion

Training SeSSion

Day Session Topic Time

1 1a Registration, Welcome and Introduction to problems of Maternal Health –Maternal Mortality and objectives of Medical Officers Training,Pre-test questionnaire,Orientation to the services and facilities available in hospital

2 hours

1b Care during pregnancy – Antenatal Care 1 hour2 2a Intrapartum care and partograph 2 hours

2b Active Management of Third Stage of Labour (AMTSL) 1 hour3 3a Instrumental delivery 1 hour

3b Postpartum hemorrhage and shock 1 hour4 4 Essential newborn care

Care of baby at the time of birthCare of New Born in post natal ward

a)b)

2 hours

5 5a Hypertension in pregnancy 1 hour5b Eclampsia 1 hour

6 6a Postpartum care 1 hour6b Puerperal sepsis 1 hour

7 7a Anemia 1 hour7b Other problems during pregnancy

Urinary tract infectionHyperemesis gravidumRetention of urinePremature or prelabour rupture of membranes

•

•

•

•

1 hour

8 8a Abortion 1 hour8b Antepartum hemorrhage 1 hour

9 9a Other problems during labour and deliveryProlonged and obstructed labour and partographPreterm labourFoetal distressProlapsed cordTwins

•

•

•

•

•

2 hour

9b Other problems during postpartum periodInversion of uterusProblems with breast feeding

•

•

1 hour

10 10a Prevention of infection 1 hour10b Revision of 9 days’ sessions

Post-test questionnaire and feedback from trainees2 hours

• Monitoring and assessment will be on a daily basis

• Final certification will be done on the last day of training


1.4

Training SeSSion

recommended Client Practice by Trainee

activity observe Perform independently

1. Antenatal check-up 5 202. Identification and Management of different complications of

pregnancy5 5

3. Preparing delivery trolley/equipment 5 -4. Perform PV examination 2 55. Monitor labour, plot and interpret partograph 2 56. a) Conduct normal delivery 2 5

b) Active Management of 3rd stage of labour 2 5c) Examination of placenta, membranes, Umbilical Cord 2 5

7. ENBC procedures and assess and provide NBC including resuscitation of *new born and check weight.

2 5

8. Assist the mother to initiate and continue BF 2 59. Management of PPH* 2 110. Removal of products of conception/clots under supervision* 2 211. Identification and Management of perineal tears 2 212. Emergency management of eclampsia* 1 113. Identification and Management of other complications of labour 3 -14. Postnatal checkup 2 515. Identification and Management of complications of post partum

period2 3

16. Identification and Management of danger signs in neonate 2 217 Emergency obstetric procedure

Forceps delivery/Vacuum extraction*2 2

The trainers will ensure practising of these skills by trainees and monitor quality.Trainee should keep a daily signed Cumulative Client Practice record. This record will be utilized by Trainer for certification.

* note: In case there is no client/patient available on whom any of the above skills can be performed, the trainer should use models and innovative approaches to enable the trainees perform the requisite skills.

•

•

•


1.5

Training SeSSion

record/assessment Form for the Trainee

recommended Client Practice by Trainee

activity observe Perform independently

grading by Trainer

Satisfactory/Unsatisfactory

1. Antenatal check-up2. Identification and Management of different

complications of pregnancy3. Preparing delivery trolley/equipment4. Perform PV examination5. Monitor labour, plot and interpret partograph 6. a) Conduct normal delivery

b) Active Management of 3rd stage of labourc) Examination of placenta, membranes, umbilical cord

7. ENBC procedures and assess and provide NBC including Resuscitation of new born and check weight.

8. Assist the mother to initiate and continue BF 9. Management of PPH10. Removal of products of conception/clots under

supervision11. Identification and Management of perineal tears12. Emergency management of eclampsia13. Identification and Management of other complications

of labour14. Postnatal checkup15. Identification and Management of complications of post

partum period16. Identification and Management of danger signs in

neonate17 Emergency obstetric procedure

Forceps delivery/Vacuum extraction

Remarks: _________________________________________________________

Grading: Satisfactory/needs re-orientation

Name and Signature: ________________________________________________

Date: ______________

note: In the Trainers’ guide there is same form for filling and keeping record by the trainer.


Case sheet: antenatal Care

AntenAtAl cAse record

Name : RegistrationNo:

Age : DateofExamination:

Address :

HistoryofAmenorrhoea : months days

Anycomplaints :

MenstrualHistory : Regular/IrregularCycles

LMP

EDD

ObstetricHistory : G P A L

order of delivery

Mode of delivery complication outcome of the pregnancy

1234

ContraceptiveHistory :

PastHistory :

FamilyHistory :

2.1.1



GPE Weight Pulse PallorBloodPressure OedemaRR JaundiceTemperature Breasts Nipples:Normal/Inverted

SystemicExamination

CVS

RS

PerAbdomen : FundalHeight

Lie

Presentation

FHS

PreviousScar/anyotherobservation

VaginalExamination(ifnecessary)

ProvisionalDiagnosis :

Investigations : Hb

(*optional) BloodGroup&Rhtyping

UrineRoutineExamination:

RPR/VDRL*

HIV*

HBsAg*

USG*

Prophylaxis : TabIFA Inj.TT1stDose 2ndDose

Anyothertreatmentgiven :

Counselling :

Assessment Grading (satisfactory/Unsatisfactory)

NameandSignatureofTrainer/Supervisor:

2.1.2



2.2.1




Address :


Anycomplaints :


LMP

EDD


order of delivery


1234


PastHistory :

FamilyHistory :



2.2.2


SystemicExamination

CVS

RS


Lie

Presentation

FHS




Investigations : Hb



RPR/VDRL*

HIV*

HBsAg*

USG*



Counselling :





2.3.1




Address :


Anycomplaints :


LMP

EDD


order of delivery


1234


PastHistory :

FamilyHistory :



2.3.2


SystemicExamination

CVS

RS


Lie

Presentation

FHS




Investigations : Hb



RPR/VDRL*

HIV*

HBsAg*

USG*



Counselling :





2.4.1




Address :


Anycomplaints :


LMP

EDD


order of delivery


1234


PastHistory :

FamilyHistory :



2.4.2


SystemicExamination

CVS

RS


Lie

Presentation

FHS




Investigations : Hb



RPR/VDRL*

HIV*

HBsAg*

USG*



Counselling :





2.5.1




Address :


Anycomplaints :


LMP

EDD


order of delivery


1234


PastHistory :

FamilyHistory :



2.5.2


SystemicExamination

CVS

RS


Lie

Presentation

FHS




Investigations : Hb



RPR/VDRL*

HIV*

HBsAg*

USG*



Counselling :





2.6.1




Address :


Anycomplaints :


LMP

EDD


order of delivery


1234


PastHistory :

FamilyHistory :



2.6.2


SystemicExamination

CVS

RS


Lie

Presentation

FHS




Investigations : Hb



RPR/VDRL*

HIV*

HBsAg*

USG*



Counselling :





2.7.1




Address :


Anycomplaints :


LMP

EDD


order of delivery


1234


PastHistory :

FamilyHistory :



2.7.2


SystemicExamination

CVS

RS


Lie

Presentation

FHS




Investigations : Hb



RPR/VDRL*

HIV*

HBsAg*

USG*



Counselling :





2.8.1




Address :


Anycomplaints :


LMP

EDD


order of delivery


1234


PastHistory :

FamilyHistory :



2.8.2


SystemicExamination

CVS

RS


Lie

Presentation

FHS




Investigations : Hb



RPR/VDRL*

HIV*

HBsAg*

USG*



Counselling :





2.9.1




Address :


Anycomplaints :


LMP

EDD


order of delivery


1234


PastHistory :

FamilyHistory :



2.9.2


SystemicExamination

CVS

RS


Lie

Presentation

FHS




Investigations : Hb



RPR/VDRL*

HIV*

HBsAg*

USG*



Counselling :





2.10.1




Address :


Anycomplaints :


LMP

EDD


order of delivery


1234


PastHistory :

FamilyHistory :



2.10.2


SystemicExamination

CVS

RS


Lie

Presentation

FHS




Investigations : Hb



RPR/VDRL*

HIV*

HBsAg*

USG*



Counselling :





2.11.1




Address :


Anycomplaints :


LMP

EDD


order of delivery


1234


PastHistory :

FamilyHistory :



2.11.2


SystemicExamination

CVS

RS


Lie

Presentation

FHS




Investigations : Hb



RPR/VDRL*

HIV*

HBsAg*

USG*



Counselling :





2.12.1




Address :


Anycomplaints :


LMP

EDD


order of delivery


1234


PastHistory :

FamilyHistory :



2.12.2


SystemicExamination

CVS

RS


Lie

Presentation

FHS




Investigations : Hb



RPR/VDRL*

HIV*

HBsAg*

USG*



Counselling :





2.13.1




Address :


Anycomplaints :


LMP

EDD


order of delivery


1234


PastHistory :

FamilyHistory :



2.13.2


SystemicExamination

CVS

RS


Lie

Presentation

FHS




Investigations : Hb



RPR/VDRL*

HIV*

HBsAg*

USG*



Counselling :





2.14.1




Address :


Anycomplaints :


LMP

EDD


order of delivery


1234


PastHistory :

FamilyHistory :



2.14.2


SystemicExamination

CVS

RS


Lie

Presentation

FHS




Investigations : Hb



RPR/VDRL*

HIV*

HBsAg*

USG*



Counselling :





2.15.1




Address :


Anycomplaints :


LMP

EDD


order of delivery


1234


PastHistory :

FamilyHistory :



2.15.2


SystemicExamination

CVS

RS


Lie

Presentation

FHS




Investigations : Hb



RPR/VDRL*

HIV*

HBsAg*

USG*



Counselling :





2.16.1




Address :


Anycomplaints :


LMP

EDD


order of delivery


1234


PastHistory :

FamilyHistory :



2.16.2


SystemicExamination

CVS

RS


Lie

Presentation

FHS




Investigations : Hb



RPR/VDRL*

HIV*

HBsAg*

USG*



Counselling :





2.17.1




Address :


Anycomplaints :


LMP

EDD


order of delivery


1234


PastHistory :

FamilyHistory :



2.17.2


SystemicExamination

CVS

RS


Lie

Presentation

FHS




Investigations : Hb



RPR/VDRL*

HIV*

HBsAg*

USG*



Counselling :





2.18.1




Address :


Anycomplaints :


LMP

EDD


order of delivery


1234


PastHistory :

FamilyHistory :



2.18.2


SystemicExamination

CVS

RS


Lie

Presentation

FHS




Investigations : Hb



RPR/VDRL*

HIV*

HBsAg*

USG*



Counselling :





2.19.1




Address :


Anycomplaints :


LMP

EDD


order of delivery


1234


PastHistory :

FamilyHistory :



2.19.2


SystemicExamination

CVS

RS


Lie

Presentation

FHS




Investigations : Hb



RPR/VDRL*

HIV*

HBsAg*

USG*



Counselling :





2.20.1




Address :


Anycomplaints :


LMP

EDD


order of delivery


1234


PastHistory :

FamilyHistory :



2.20.2


SystemicExamination

CVS

RS


Lie

Presentation

FHS




Investigations : Hb



RPR/VDRL*

HIV*

HBsAg*

USG*



Counselling :




case sheet: intrapartum record

Intrapartum record

Name: Age: RegistrationNo.

DateofAdmission :

Address :

Registered/Unregistered :

Complaints : Amenorrhea months days

PainAbdomensince:

BleedingP/V :

WaterydischargeP/V :

Anyothercomplaints :

MenstrualHistory : Regular/IrregularCycles Lmp:

edd:


order of delivery

mode of delivery-normal/instrumental/LScS

complicationif any

outcome of the pregnancy- live birth/stillbirth

1

2

3

PastMedicalHistory:

FamilyHistory:

GPE

Pulse Pallor

BloodPressure Oedema

RR Icterus

Temp

3.1.1



SystemicExamination:

CVS

RS

PerAbdomen : FundalHeight Presentation UterineContractions

FHS

Anyotherobservation

VaginalExamination : Cervicaleffacement Cervicaldilation

Statusofmembranes Absent Present

Stationofpresentingpart:

Colourofliquor

PelvicAssessment : Adequate/notadequate

Diagnosis :

Investigations : Hb Urine BloodGroup&Rh Anyother

3.1.2



InLatentPhase:

date & time pulse Bp contractions FHS pV advice

*PlottingofPartographtobeinitiatedfrom4cm.dilatationonwards(MANDATORY).

3.1.3



partoGrapH

name: W/o: age: parity: reg. no:

date & time of admission date & time of rom:

a) Foetal condition

Foetal heart rate

2001901801701601501401301201101009080

Amnioticfluid

B) Labour

cervix (cm) [plot X]

10987654

HoursTime 1 2 3 4 5 6 7 8 9 10 11 12

Alert Action

Contrac-tionsper10min

54321

c) Interventions

DrugsandIVfluidsgiven

d) maternal condition

pulse and Bp

18017016015014013012011010090807060

Temp(0C)

3.1.4




NeedsreferraltoFRUfor :(ifapplicable)

Dateandtimeofdelivery :

delivery notes

Mother : Modeofdelivery:Normal Assisted LSCS

IndicationincaseofInstrumentaldelivery/LSCS Date&Timeofdelivery

AMTSL : IMOxytocin10U

CCT

UterineMassage

Pulse

BP

UterusContracted&Retracted

BleedingPV

Placenta&Membranes : Complete/Incomplete Baby : Sex M F

Criedimmediately/Resuscitationneeded

Colour:Pink/Blue/Pale

Tone:Normal/Flaccid

Weight:

Urine : Passed/notpassed

Meconium : Passed/notpassed

Congenital : anomalies Yes/No

IfYes,specify

assessment Grading (Satisfactory/unsatisfactory)


Date:

3.1.5



3.2.1

Intrapartum record


DateofAdmission :

Address :



PainAbdomensince:

BleedingP/V :




edd:


order of delivery


complicationif any


1

2

3

PastMedicalHistory:

FamilyHistory:

GPE

Pulse Pallor


RR Icterus

Temp



3.2.2


CVS

RS


FHS

Anyotherobservation




Colourofliquor


Diagnosis :




3.2.3

InLatentPhase:





3.2.4

partoGrapH



a) Foetal condition

Foetal heart rate

2001901801701601501401301201101009080

Amnioticfluid

B) Labour


10987654

HoursTime 1 2 3 4 5 6 7 8 9 10 11 12

Alert Action


54321

c) Interventions



pulse and Bp

18017016015014013012011010090807060

Temp(0C)




3.2.5



delivery notes




CCT

UterineMassage

Pulse

BP


BleedingPV




Tone:Normal/Flaccid

Weight:




IfYes,specify



Date:



3.3.1

Intrapartum record


DateofAdmission :

Address :



PainAbdomensince:

BleedingP/V :




edd:


order of delivery


complicationif any


1

2

3

PastMedicalHistory:

FamilyHistory:

GPE

Pulse Pallor


RR Icterus

Temp



3.3.2


CVS

RS


FHS

Anyotherobservation




Colourofliquor


Diagnosis :




3.3.3

InLatentPhase:





3.3.4

partoGrapH



a) Foetal condition

Foetal heart rate

2001901801701601501401301201101009080

Amnioticfluid

B) Labour


10987654

HoursTime 1 2 3 4 5 6 7 8 9 10 11 12

Alert Action


54321

c) Interventions



pulse and Bp

18017016015014013012011010090807060

Temp(0C)




3.3.5



delivery notes




CCT

UterineMassage

Pulse

BP


BleedingPV




Tone:Normal/Flaccid

Weight:




IfYes,specify



Date:



3.4.1

Intrapartum record


DateofAdmission :

Address :



PainAbdomensince:

BleedingP/V :




edd:


order of delivery


complicationif any


1

2

3

PastMedicalHistory:

FamilyHistory:

GPE

Pulse Pallor


RR Icterus

Temp



3.4.2


CVS

RS


FHS

Anyotherobservation




Colourofliquor


Diagnosis :




3.4.3

InLatentPhase:





3.4.4

partoGrapH



a) Foetal condition

Foetal heart rate

2001901801701601501401301201101009080

Amnioticfluid

B) Labour


10987654

HoursTime 1 2 3 4 5 6 7 8 9 10 11 12

Alert Action


54321

c) Interventions



pulse and Bp

18017016015014013012011010090807060

Temp(0C)




3.4.5



delivery notes




CCT

UterineMassage

Pulse

BP


BleedingPV




Tone:Normal/Flaccid

Weight:




IfYes,specify



Date:



3.5.1

Intrapartum record


DateofAdmission :

Address :



PainAbdomensince:

BleedingP/V :




edd:


order of delivery


complicationif any


1

2

3

PastMedicalHistory:

FamilyHistory:

GPE

Pulse Pallor


RR Icterus

Temp



3.5.2


CVS

RS


FHS

Anyotherobservation




Colourofliquor


Diagnosis :




3.5.3

InLatentPhase:





3.5.4

partoGrapH



a) Foetal condition

Foetal heart rate

2001901801701601501401301201101009080

Amnioticfluid

B) Labour


10987654

HoursTime 1 2 3 4 5 6 7 8 9 10 11 12

Alert Action


54321

c) Interventions



pulse and Bp

18017016015014013012011010090807060

Temp(0C)




3.5.5



delivery notes




CCT

UterineMassage

Pulse

BP


BleedingPV




Tone:Normal/Flaccid

Weight:




IfYes,specify



Date:



3.6.1

Intrapartum record


DateofAdmission :

Address :



PainAbdomensince:

BleedingP/V :




edd:


order of delivery


complicationif any


1

2

3

PastMedicalHistory:

FamilyHistory:

GPE

Pulse Pallor


RR Icterus

Temp



3.6.2


CVS

RS


FHS

Anyotherobservation




Colourofliquor


Diagnosis :




3.6.3

InLatentPhase:





3.6.4

partoGrapH



a) Foetal condition

Foetal heart rate

2001901801701601501401301201101009080

Amnioticfluid

B) Labour


10987654

HoursTime 1 2 3 4 5 6 7 8 9 10 11 12

Alert Action


54321

c) Interventions



pulse and Bp

18017016015014013012011010090807060

Temp(0C)




3.6.5



delivery notes




CCT

UterineMassage

Pulse

BP


BleedingPV




Tone:Normal/Flaccid

Weight:




IfYes,specify



Date:



3.7.1

Intrapartum record


DateofAdmission :

Address :



PainAbdomensince:

BleedingP/V :




edd:


order of delivery


complicationif any


1

2

3

PastMedicalHistory:

FamilyHistory:

GPE

Pulse Pallor


RR Icterus

Temp



3.7.2


CVS

RS


FHS

Anyotherobservation




Colourofliquor


Diagnosis :




3.7.3

InLatentPhase:





3.7.4

partoGrapH



a) Foetal condition

Foetal heart rate

2001901801701601501401301201101009080

Amnioticfluid

B) Labour


10987654

HoursTime 1 2 3 4 5 6 7 8 9 10 11 12

Alert Action


54321

c) Interventions



pulse and Bp

18017016015014013012011010090807060

Temp(0C)




3.7.5



delivery notes




CCT

UterineMassage

Pulse

BP


BleedingPV




Tone:Normal/Flaccid

Weight:




IfYes,specify



Date:



3.8.1

Intrapartum record


DateofAdmission :

Address :



PainAbdomensince:

BleedingP/V :




edd:


order of delivery


complicationif any


1

2

3

PastMedicalHistory:

FamilyHistory:

GPE

Pulse Pallor


RR Icterus

Temp



3.8.2


CVS

RS


FHS

Anyotherobservation




Colourofliquor


Diagnosis :




3.8.3

InLatentPhase:





3.8.4

partoGrapH



a) Foetal condition

Foetal heart rate

2001901801701601501401301201101009080

Amnioticfluid

B) Labour


10987654

HoursTime 1 2 3 4 5 6 7 8 9 10 11 12

Alert Action


54321

c) Interventions



pulse and Bp

18017016015014013012011010090807060

Temp(0C)




3.8.5



delivery notes




CCT

UterineMassage

Pulse

BP


BleedingPV




Tone:Normal/Flaccid

Weight:




IfYes,specify



Date:



3.9.1

Intrapartum record


DateofAdmission :

Address :



PainAbdomensince:

BleedingP/V :




edd:


order of delivery


complicationif any


1

2

3

PastMedicalHistory:

FamilyHistory:

GPE

Pulse Pallor


RR Icterus

Temp



3.9.2


CVS

RS


FHS

Anyotherobservation




Colourofliquor


Diagnosis :




3.9.3

InLatentPhase:





3.9.4

partoGrapH



a) Foetal condition

Foetal heart rate

2001901801701601501401301201101009080

Amnioticfluid

B) Labour


10987654

HoursTime 1 2 3 4 5 6 7 8 9 10 11 12

Alert Action


54321

c) Interventions



pulse and Bp

18017016015014013012011010090807060

Temp(0C)




3.9.5



delivery notes




CCT

UterineMassage

Pulse

BP


BleedingPV




Tone:Normal/Flaccid

Weight:




IfYes,specify



Date:



3.10.1

Intrapartum record


DateofAdmission :

Address :



PainAbdomensince:

BleedingP/V :




edd:


order of delivery


complicationif any


1

2

3

PastMedicalHistory:

FamilyHistory:

GPE

Pulse Pallor


RR Icterus

Temp



3.10.2


CVS

RS


FHS

Anyotherobservation




Colourofliquor


Diagnosis :




3.10.3

InLatentPhase:





3.10.4

partoGrapH



a) Foetal condition

Foetal heart rate

2001901801701601501401301201101009080

Amnioticfluid

B) Labour


10987654

HoursTime 1 2 3 4 5 6 7 8 9 10 11 12

Alert Action


54321

c) Interventions



pulse and Bp

18017016015014013012011010090807060

Temp(0C)




3.10.5



delivery notes




CCT

UterineMassage

Pulse

BP


BleedingPV




Tone:Normal/Flaccid

Weight:




IfYes,specify



Date:


case sheets: instrumental delivery

4.1.1

Instrumental DelIvery

Outlet Forceps Delivery/ventouse:

Name & Age :

Registration No. :

Indication :

Pre-Requisites :

Outcome of delivery :

Identification and repair of any tears/lacerations :

Post partum notes:

PR

BP

P/A tone of uterus

bleeding PV

assessment Grading (satisfactory/unsatisfactory)

Name and Signature of Trainer/Supervisor:

Date:



4.2.1



Name & Age :

Registration No. :

Indication :

Pre-Requisites :



Post partum notes:

PR

BP

P/A tone of uterus

bleeding PV



Date:



4.3.1



Name & Age :

Registration No. :

Indication :

Pre-Requisites :



Post partum notes:

PR

BP

P/A tone of uterus

bleeding PV



Date:



4.4.1



Name & Age :

Registration No. :

Indication :

Pre-Requisites :



Post partum notes:

PR

BP

P/A tone of uterus

bleeding PV



Date:


case sheets: new born care

MANAGEMENT OF THE YOUNG INFANT AGE UP TO 2 MONTHS

IN POSTNATAl WArd

Name: __________________________________ date of Examination: _______________________________

date and time of Birth: _____________________

Birth Weight: _____________________________ Temperature: ___________°C/°F

ASK: Does the mother or infant have any problem? _____________________________________

ASSESS:

CHECK FOr FEEdING PrOBlEM Observation remarks

ASK THE MOTHEr

Have you started breast feeding the baby? Is there any difficulty in feeding the baby? Do you have any pain while breast feeding?

If yes, then look for:

Flat or inverted nipples or sore nipples Engorged breasts or breast abscess

Have you given any other foods or drinks to the baby?

If Yes, what and how?

•

•

•

•

CHECK FOr dANGEr SIGNS

Count the breaths in one minute: _____________ breaths per minuteRepeat if fast, note down ___________________ breaths per minute

•

Look for severe chest in drawing•

Look at the umbilicus. Is it red or draining pus?•

Look for skin pustules. Are there 10 or more pustules or a big boil?•

Measure axillary temperature (if not possible, feel for fever or low body temperature):

Normal (36.5–37.4o C)Mild hypothermia (36.0–36.4o C/cold feet)Moderate hypothermia (32.0o C – 36.0o C/cold feet and abdomen)Severe hypothermia (< 32o C)Fever (> 37.4o C/feels hot)

•

See if young infant is lethargic or unconscious.Look at young infant’s movements. Less than normal?•

Look for jaundice. Are the palms and soles yellow?•

Has the infant had convulsions?•

5.1.1



ASSESS BrEASTFEEdING

Has the infant breastfed in the previous one hour? If infant has not fed in the previous hour, ask the mother to put her

infant to the breast. Observe the breastfeed for 4 minutes.

•

Is the infant able to attach? To check attachment, look for:•

Chin touching breast Yes____No___Mouth wide open Yes____No___Lower lip turned outward Yes____No___More areola above than below the mouth Yes____No___

Classify:No attachment at all Not well attached Good attachment

Is the infant suckling effectively (that is, slow deep sucks, sometimes pausing)?Classify:

Not suckling at all Not suckling effectively Suckling effectively

•

•

•

If not suckling well, then look for: ulcers or white patches in the mouth (thrush).

•

HAS THE YOUNG INFANT rECIEvEd

Vitamin KBCG, OPV 0, HEP-B 1

Assess other Problems:•

Advice at •

Discharge

Follow Up:

Danger Signs:

•

•

•

Assessment Grading (Satisfactory/Unsatisfactory)


date:

5.1.2



5.2.1


IN POSTNATAl WArd





ASSESS:


ASK THE MOTHEr






•

•

•

•



•






•






5.2.2




•






•

•

•


•




Advice at •

Discharge

Follow Up:

Danger Signs:

•

•

•



date:



5.3.1


IN POSTNATAl WArd





ASSESS:


ASK THE MOTHEr






•

•

•

•



•






•






5.3.2




•






•

•

•


•




Advice at •

Discharge

Follow Up:

Danger Signs:

•

•

•



date:



5.4.1


IN POSTNATAl WArd





ASSESS:


ASK THE MOTHEr






•

•

•

•



•






•






5.4.2




•






•

•

•


•




Advice at •

Discharge

Follow Up:

Danger Signs:

•

•

•



date:



5.5.1


IN POSTNATAl WArd





ASSESS:


ASK THE MOTHEr






•

•

•

•



•






•






5.5.2




•






•

•

•


•




Advice at •

Discharge

Follow Up:

Danger Signs:

•

•

•



date:


case sheet: PostPartum care

6.1.1

PostPartum Care

Date and Registration No.

Name of the Woman & Age

Address

Presenting complaints, if any

Fever

Pain in abdomen

Type of Delivery

Place and Date of Delivery

Time of Delivery

Time of initiation of Breast Feeding

examination:

Pallor

Pulse rate

BP

Breast examination

Involution of uterus

Lochia

Perineal care

Advice



Date:



6.2.1

PostPartum Care



Address


Fever

Pain in abdomen

Type of Delivery


Time of Delivery


examination:

Pallor

Pulse rate

BP

Breast examination


Lochia

Perineal care

Advice



Date:



6.3.1

PostPartum Care



Address


Fever

Pain in abdomen

Type of Delivery


Time of Delivery


examination:

Pallor

Pulse rate

BP

Breast examination


Lochia

Perineal care

Advice



Date:



6.4.1

PostPartum Care



Address


Fever

Pain in abdomen

Type of Delivery


Time of Delivery


examination:

Pallor

Pulse rate

BP

Breast examination


Lochia

Perineal care

Advice



Date:



6.5.1

PostPartum Care



Address


Fever

Pain in abdomen

Type of Delivery


Time of Delivery


examination:

Pallor

Pulse rate

BP

Breast examination


Lochia

Perineal care

Advice



Date:


case sheet: complications during pregnancy and post natal period

7.1.1

CompliCations during pregnanCy

(This exercise will help you to develop your skills in diagnosing obstetric complications and their management. The list of questions in history is long and covers different types of complications. By selecting the relevant ones, you will learn what to ask and look for when examining a patient. This can also be used as a ‘virtual exercise’ if enough cases of complications are not seen during your training period).

History:

During pregnancy:

Bleeding P/V- painless/with pain; duration of amenorrhea when first episode occurred; amount of bleeding; treatment taken; any blood transfused; USG done; any otherHigh BP: when first recorded as high; any pre-pregnancy hypertension; headache and blurring of vision; pain in epigastrium; urine protein absent/present; decreased urinary output; edema yes/no; Convulsions yes/no; any convulsions previously and number; treatment taken; previous h/o of epilepsy and treatment taken; unconsciousness yes/no; tongue bite yes/no; involuntary passing urine yes/no; othersBreathlessness on exertion yes/no; puffiness of face yes/no; pedal edema yes/no; Any other

During delivery

Prolonged labourSudden disappearance of labour pains (s/o uterine rupture)PPHHome delivery attended by unskilled personnel/TBA/RelativeRetained placentaAny fitsSweating, confusion, low BP; loss of consciousnessPerineal tears

Post-partum

Fever, urinary retention/incontinence; constipation/feacal incontinence; pain abdomen; foul smelling lochia; excessive bleeding p/v; breast engorgement; any other

Examination:

GE:

P/A:

P/V:

Final diagnosis

assessment grading (satisfactory/unsatisfactory)


a.

b.

c.

d.e.



7.2.1



History:

During pregnancy:


During delivery


Post-partum


Examination:

GE:

P/A:

P/V:

Final diagnosis



a.

b.

c.

d.e.



7.3.1



History:

During pregnancy:


During delivery


Post-partum


Examination:

GE:

P/A:

P/V:

Final diagnosis



a.

b.

c.

d.e.



7.4.1



History:

During pregnancy:


During delivery


Post-partum


Examination:

GE:

P/A:

P/V:

Final diagnosis



a.

b.

c.

d.e.



7.5.1



History:

During pregnancy:


During delivery


Post-partum


Examination:

GE:

P/A:

P/V:

Final diagnosis



a.

b.

c.

d.e.



7.6.1



History:

During pregnancy:


During delivery


Post-partum


Examination:

GE:

P/A:

P/V:

Final diagnosis



a.

b.

c.

d.e.


Documents

WORKBOOK for TRAINING of