Pregnant women who intend to have their babies delivered at UCTH, are advised to book for ante-natal care from around 13 weeks (3 months) gestation. Any pregnant woman presenting to the hospital with complaints should be handled as a clinical emergency; they can present to the A&E, or to any clinic run by the O&G department, or directly to the maternity ward to seek the attention of any of the O&G Doctors.

All pregnant women with complaints MUST be assessed by the Senior Registrar on call (even if first seen by a Registrar), and thereafter, the following protocol should be applied in their management: 

1.     Admit patients with any of the following;

a.         1:10 Contraction lasting 10 seconds

b.        Rupture of fetal membranes, with contractions/cord prolapse

c.         Bleeding per vaginum after 28weeks

 

2.        Review the patient on the wards

a.         Check antenatal record

b.        Take history and examine the patient

c.         Obtain blood for PCV, HIV Screen

d.        Group & Cross match 2 pints of blood

 

 3.       Perform EM C/S for parturient if there is;

a.         Contraindication to vaginal delivery

b.        Feto-maternal compromise

c.         Previously scheduled for EL C/S

 

4.        Perform admitting CTG for parturient in latent phase of Labour

a.         If normal, continue FMM, perform VE in 4 hours

b.        If abnormal, perform EM C/S

 

5.        Parturient in active phase

a.         Perform amniotomy and review uterine contractions in 1 hour

b.       Augment labour with oxytocin; if less than 0 contractions lasting < 40 seconds each

c.        Monitor labour by using the partograph.

d.       In low-risk labour; monitor FHT by intermittent auscultation with pinard stethoscope, in high-risk cases, use continuous EFM

e.       Discuss the use of epidural analgesia/ pethidine/pentazocine with the   parturient

f.         Perform Vaginal Examination 4 hourly, or more frequently, if indicated

 

6.        In second stage of labour

a.         Assess need for the Paediatrician's presence at delivery

b.        Assess need for Episiotomy, and perform at crowning if deemed     necessary

c.         At delivery of the fetal head

I.          Check for nuchal cord

ii.         Suck baby's mouth, then nostrils

d.        Complete delivery, and hand over baby to the Paediatrician/midwife

e.         If baby is undelivered after 1 hour; review, and consider instrumental     delivery or EM C/S

 

7.        In 3rd stage of labour

a.         Manage actively

b.        Inspect placenta/membranes for completeness

c.         Inspect mother's birth canal for any laceration

d.        Suture any Episiotomy/laceration

 

8.        8. Post delivery

a.         Monitor mother's vital signs, uterine size and lochia over 2 hours,                 and if stable, transfer to lying-in ward

b.        Practice rooming-in, except if contraindicated

 

c.         Encourage breastfeeding within 30mins of delivery, if feasible

 

9.        On 2nd postpartum day

a.         Check PCV

b.        Discharge, if stable

c.         See Post-natal Clinic at 6 weeks

 

Blood Donation by ante-natal Patients

1.       At booking, all ante-natal patients must be educated about the importance of donating blood in preparation for their delivery. They should be informed that blood donation is mandatory for all ante-natal patients; and thereafter they are to proceed to the blood bank, so that their spouses/ family members will make arrangements to donate a pint of blood each.

2.       Blood must be donated by the end of the 6th month of gestation, (though it can be done earlier in some cases) after which a slip will be issued to the pregnant woman to confirm to the Nurse in charge of the ante-natal clinic, and the Doctor, that the patient has fulfilled this particular obligation

3.       Any patient who has not made arrangements for blood donation by the end of the 6th month of gestation will not be allowed to continue their ante-natal care in UCTH, until they comply.

4.       All patients for non-emergency surgeries who have not made arrangements for blood donation will have their surgeries postponed to such a time when they have blood ready in the blood bank, in case they eventually require blood transfusion.

5.      Only cases that present as genuine emergencies will be entitled to blood from the blood bank without having previously donated, and the blood given MUST mandatorily be replaced by the very next day.

6.       A blood use audit committee will be set up which should include the Head of the labs, the Matron in charge of ante-natal clinic, the Chief Resident of O&G, and the Chief Resident (or a PMO/CMO) from Anaesthesia. This committee will be saddled with the monitoring of blood donation and usage; to ensure that blood is used judiciously in the hospital. It will meet monthly, and report to the HCS.