|Technical notes: Special Considerations for Programming in Unstable Situations (UNICEF, 2000, 490 p.)|
|Chapter 1 - Annex 8: Protecting Pregnancy in Emergencies|
Skilled assistance is essential to delivery care. Complications should be treated either at health centres or district hospitals, depending on the level of care required. For deliveries at home by trained midwives, TBAs or family members, a simple system of supervision needs to be devised. In the case of delivery complications, the woman must be transferred to the nearest health facility or hospital.
For deliveries in health centres, standard protocols should be used for the surveillance and the management of labour: initial assessment, duration, use of simplified partograph, assessment of fetal well-being, urinary catheterization, episiotomy, breech delivery, multiple births, indications for caesarean section, as well as management of post-partum haemorrhage and retained placenta.
Essential obstetric care at the level of health centres should also include:
· the use of broad spectrum antibiotics: oral, IM or IV (not tetracyclines);
· management of severe pre-eclampsia and eclampsia: anticonvulsants and low forceps;
· repair of vaginal tears;
· manual removal of placentas;
· management of haemorrhages: oxytocics or ergometrine; and
· management of shock and pre-transfer stabilization: IV plasma expanders.
Care must be taken to avoid overwhelming health facilities with the demands of refugees and displaced to the detriment of local people.
A complete range of emergency obstetric services should be available at the hospital level, including caesarean section, laparotomy, hysterectomy, repair of cervical and third-degree vaginal tears, as well as safe blood transfusion.