Maternity & Delivery Services

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. 1.Admit patients with any of the following;
2. a.1:10 Contraction lasting 10 seconds
3. b.Rupture of fetal membranes, with contractions/cord prolapse
4. c.Bleeding per vaginum after 28weeks
5. 2.Review the patient on the wards
6. a.Check antenatal record
7. b.Take history and examine the patient
8. c.Obtain blood for PCV, HIV Screen
9. d.Group & Cross match 2 pints of blood
10. 3.Perform EM C/S for parturient if there is;
11. a.Contraindication to vaginal delivery
12. b.Feto-maternal compromise
13. c.Previously scheduled for EL C/S
14. 4.Perform admitting CTG for parturient in latent phase of Labour
15. a.If normal, continue FMM, perform VE in 4 hours
16. b.If abnormal, perform EM C/S
17. 5.Parturient in active phase
18. a.Perform amniotomy and review uterine contractions in 1 hour
19. b.Augment labour with oxytocin; if less than 0 contractions lasting < 40 seconds each
20. c.Monitor labour by using the partograph.
21. d.In low-risk labour; monitor FHT by intermittent auscultation with pinard stethoscope, in high-risk cases, use continuous EFM
22. e.Discuss the use of epidural analgesia/ pethidine/pentazocine with the parturient
23. f.Perform Vaginal Examination 4 hourly, or more frequently, if indicated
24. 6.In second stage of labour
25. a.Assess need for the Paediatrician's presence at delivery
26. b.Assess need for Episiotomy, and perform at crowning if deemed necessary
27. c.At delivery of the fetal head
28. I.Check for nuchal cord
29. ii.Suck baby's mouth, then nostrils
30. d.Complete delivery, and hand over baby to the Paediatrician/midwife
31. e.If baby is undelivered after 1 hour; review, and consider instrumental delivery or EM C/S
32. 7.In 3rd stage of labour
33. a.Manage actively
34. b.Inspect placenta/membranes for completeness
35. c.Inspect mother's birth canal for any laceration
36. d.Suture any Episiotomy/laceration
37. 8.8. Post delivery
38. a.Monitor mother's vital signs, uterine size and lochia over 2 hours, and if stable, transfer to lying-in ward
39. b.Practice rooming-in, except if contraindicated
40. c.Encourage breastfeeding within 30mins of delivery, if feasible
41. 9.On 2nd postpartum day
42. a.Check PCV
43. b.Discharge, if stable
44. c.See Post-natal Clinic at 6 weeks

Blood Donation by ante-natal Patients

1. 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. 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. 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. 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. 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. 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.