Contents

  1. Acknowledgements
  2. Introduction
    1. About the Bettercare series
    2. Why decentralised learning?
    3. Bettercare Online Learning Station
    4. Books in the Bettercare series
    5. Format of the courses
    6. Contributors
    7. Updating the course material
    8. Contact information
    9. Registration
  3. 1. Antenatal care
    1. Objectives
    2. Goals of good antenatal care
    3. Diagnosing pregnancy
    4. The first antenatal visit
    5. Determining the duration of pregnancy
    6. Side-room and special screening investigations
    7. The second antenatal visit
    8. Assessing the results of the screening investigations
    9. Grading the risk
    10. Subsequent visits
    11. The visit at 28 weeks
    12. The visit at 34 weeks
    13. The visit at 41 weeks
    14. Managing pregnant women with HIV infection
    15. Case studies
  4. 1a. Skills: General examination at the first antenatal visit
    1. Objectives
    2. History taking
    3. Examination of the patient
    4. Testing the patient’s urine
    5. Doing a pregnancy test
  5. 1b. Skills: Examination of the abdomen in pregnancy
    1. Objectives
    2. General examination of the abdomen
    3. Examination of the uterus and the fetus
  6. 1c. Skills: Vaginal examination in pregnancy
    1. Objectives
    2. Indications for a vaginal examination
    3. Method of vaginal examination
  7. 1d. Skills: Screening tests for syphilis
    1. Objectives
    2. Syphilis screening
    3. Syphilis rapid test
  8. 1e. Skills: Screening tests for HIV
    1. Objectives
    2. HIV screening
  9. 1f. Skills: Examination of the breasts
    1. Objectives
    2. History taking
    3. Examination of the breasts
  10. 2. Assessment of fetal growth and condition during pregnancy
    1. Objectives
    2. Introduction
    3. Fetal growth
    4. Fetal movements
    5. Antenatal fetal heart rate monitoring
    6. Case studies
  11. 2a. Skills: Routine use of the antenatal card
    1. Objectives
    2. The Antenatal card
  12. 3. Hypertensive disorders of pregnancy
    1. Objectives
    2. The hypertensive disorders of pregnancy
    3. The classification of hypertension during pregnancy
    4. Pre-eclampsia
    5. Patients at increased risk of pre-eclampsia
    6. The management of pre-eclampsia
    7. The emergency management of severe pre-eclampsia and imminent eclampsia
    8. The management of eclampsia
    9. The further management of severe pre-eclampsia and imminent eclampsia at the referral hospital
    10. Gestational hypertension
    11. Chronic hypertension
    12. Postpartum hypertension
    13. Case studies
  13. 3a. Skills: Measuring blood pressure and proteinuria
    1. Objectives
    2. Measuring blood pressure
    3. Measuring proteinuria
  14. 4. Antepartum haemorrhage
    1. Objectives
    2. Antepartum haemorrhage
    3. The initial emergency management of antepartum haemorrhage
    4. Diagnosing the cause of the bleeding
    5. Antepartum bleeding caused by abruptio placentae
    6. Antepartum bleeding caused by placenta praevia
    7. Antepartum haemorrhage of unknown cause
    8. Referral of a patient with an antepartum haemorrhage
    9. A blood-stained vaginal discharge
    10. Case studies
  15. 5. Preterm labour and preterm rupture of the membranes
    1. Objectives
    2. Preterm labour and preterm rupture of the membranes
    3. Diagnosis of preterm labour and preterm rupture of the membranes
    4. Management of preterm labour
    5. Management of preterm rupture of the membranes
    6. Prelabour rupture of the membranes
    7. Case studies
  16. 6. Monitoring the condition of the mother during the first stage of labour
    1. Objectives
    2. Monitoring labour
    3. Assessing the general condition of the patient
    4. Assessing the temperature
    5. Assessing the pulse rate
    6. Assessing the blood pressure
    7. Assessing the urine
    8. Maternal exhaustion
    9. Case studies
  17. 7. Monitoring the condition of the fetus during the first stage of labour
    1. Objectives
    2. Monitoring the fetus
    3. Fetal heart rate patterns
    4. The liquor
    5. Case studies
  18. 8. Monitoring and managing the first stage of labour
    1. Objectives
    2. The diagnosis of labour
    3. The two phases of the first stage of labour
    4. Monitoring of the first stage of labour
    5. Management of a patient in the latent phase of the first stage of labour
    6. Management of a patient in the active phase of the first stage of labour
    7. Poor progress in the active phase of the first stage of labour
    8. Cephalopelvic disproportion
    9. Inadequate uterine action
    10. The referral of patients with poor progress during the active phase of the first stage of labour
    11. Prolapse of the umbilical cord
    12. HIV positive women
    13. Case studies
  19. 8a. Skills: Examination of the abdomen in labour
    1. Objectives
    2. Abdominal palpation
    3. Assessing contractions
    4. Assessing the fetal heart rate
  20. 8b. Skills: Vaginal examination in labour
    1. Objectives
    2. Preparation for a vaginal examination in labour
    3. Procedure of examination
    4. The vulva and vagina
    5. The cervix
    6. The membranes and liquor
    7. The presenting part
    8. Moulding
  21. 8c. Skills: Recording observations on the partogram
    1. Objectives
    2. The partogram
    3. Recording the condition of the mother
    4. Recording the condition of the fetus
    5. Recording the progress of labour
    6. Exercises on the correct use of the partogram
    7. Case studies
  22. 9. The second stage of labour
    1. Objectives
    2. The normal second stage of labour
    3. Managing the second stage of labour
    4. Episiotomy
    5. Prolonged second stage of labour
    6. Management of impacted shoulders
    7. Managing the newborn infant
    8. Case studies
  23. 9a. Skills: Performing and repairing an episiotomy
    1. Objectives
    2. Performing an episiotomy
    3. Repairing an episiotomy
  24. 10. Managing pain during labour
    1. Objectives
    2. Pain relief in labour
    3. Use of analgesics in labour
    4. Naloxone
    5. Sedation during labour
    6. Inhalational analgesia
    7. Local anaesthesia
    8. Epidural anaesthesia
    9. General anaesthesia
    10. Case studies
  25. 11. The third stage of labour
    1. Objectives
    2. The normal third stage of labour
    3. Managing the third stage of labour
    4. Examination of the placenta after birth
    5. The abnormal third stage of labour
    6. Managing postpartum haemorrhage
    7. Protecting the staff from HIV infection
    8. Case studies
  26. 12. The puerperium
    1. Objectives
    2. The normal puerperium
    3. Management of the puerperium
    4. The six week postnatal visit
    5. Puerperal pyrexia
    6. Genital tract infection
    7. Urinary tract infections
    8. Thrombophlebitis
    9. Respiratory tract infection
    10. Puerperal psychiatric disorders
    11. Secondary postpartum haemorrhage
    12. Self-monitoring
    13. HIV positive mothers
    14. Case studies
  27. 13. Medical problems during pregnancy, labour and the puerperium
    1. Objectives
    2. Urinary tract infection during pregnancy
    3. Anaemia in pregnancy
    4. Heart valve disease in pregnancy and the puerperium
    5. Diabetes mellitus in pregnancy
    6. Case studies
  28. 14. Family planning after pregnancy
    1. Objectives
    2. Contraceptive counselling
    3. Case studies
  29. 15. Regionalised perinatal care
    1. Objectives
    2. Regionalised perinatal care
    3. The maternal-care clinic
    4. Transferring patients safely to hospital
    5. Maternal mortality
    6. Case studies
  30. Appendix
    1. Guidelines for the management of patients with risk factors and medical problems during pregnancy, labour and the puerperium
    2. BMI table