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We have taken every care to ensure that drug dosages and related medical advice in this book are accurate. However, drug and disinfectant dosages can change and are updated often, so always double-check dosages and procedures against a reliable, up-to-date formulary and the given drug’s documentation before administering it.

Maternal Care: A health professional’s guide to pregnancy and childbirth

First published in 2010 by Bettercare. Updated March 2011, August 2011 (layout), August 2012, March 2014, August 2014, February 2015 (layout), January 2017 (significant changes), April 2017, May 2020 (significant changes). This version produced on 26 February 2025.

Text © Perinatal Education Trust 2010

ISBN (paperback): 978-1-920218-27-0
ISBN (international paperback edition): 978-1-717897-76-3 ISBN (reflowable ebook): 978-1-920218-89-8

Excluding content explicitly credited to others, this book is published under a Creative Commons Attribution Non-Commercial No Derivatives License. For details, see creativecommons.org/licenses/by-nc-nd/4.0.

This licence means you may share, copy and redistribute the material in any medium or format under the following terms:

  • Attribution — You must give appropriate credit, provide a link to the licence, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
  • Non-Commercial — You may not use the material for commercial purposes.
  • No Derivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.

For any other uses, please contact Bettercare.

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      1. Home
      1. How to use our books
      2. Buy printed books
      3. About Bettercare
      4. FAQs
      5. Contact us
      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 screening investigations
        9. Grading the risk
        10. Subsequent visits
        11. The visit at 26 weeks
        12. The visits at 30, 34 and 36 weeks
        13. The visit at 40 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 record
        1. Objectives
        2. The Antenatal record
      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 pre-eclampsia with severe features
        8. The management of eclampsia
        9. The further management of pre-eclampsia with severe features 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. Management of suspected labour
        4. The two phases of the first stage of labour
        5. Monitoring of the first stage of labour
        6. Management of a patient in the latent phase of the first stage of labour
        7. Management of a patient in the active phase of the first stage of labour
        8. Poor progress in the active phase of the first stage of labour
        9. Cephalopelvic disproportion
        10. Inadequate uterine action
        11. The referral of patients with poor progress during the active phase of the first stage of labour
        12. Prolapse of the umbilical cord
        13. Women living with HIV
        14. 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 perinatal-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
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