Contents

1. Acknowledgements
2. Introduction
   1. About Bettercare
   2. Why decentralised learning?
   3. Free Bettercare Online Learning Platform
   4. Learning programmes
   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 special 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 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
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 The puerperium and family planning
    1. Objectives
    2. The puerperium
    3. Management of the puerperium
    4. The 6 week postnatal visit
    5. Puerperal pyrexia
    6. Genital tract infection
    7. Urinary tract infection
    8. Thrombophlebitis
    9. Respiratory tract infection
    10. Puerperal psychiatric disorders
    11. Secondary postpartum haemorrhage
    12. Self-monitoring
    13. HIV positive mothers
    14. Family planning in the puerperium
    15. Case studies
17. 7 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
18. Appendix
    1. Guidelines for the management of patients with risk factors and medical problems during pregnancy, labour and the puerperium
    2. BMI table