6.6 CONTINUING TREATMENT

Universal Measures

Continue monitoring the woman's vital signs, urine output, and fluids, as she could suddenly worsen and go into shock. Continue and adjust supportive treatment (oxygen, fluids, medicine) according to the above guidelines.

Oxygen

If oxygen was started because the woman became unstable, then continue as long as she remains unstable. If possible, continue during transfer of unstable patients. As the woman stabilizes, the oxygen can be gradually shut off. However, if she begins to worsen with the oxygen turned down or off, then turn the oxygen back on, at the initial rate of 6 to 8 litres per minute.

Fluids

IV Fluids. For stable women who are receiving intravenous fluids ONLY for the purpose of giving antibiotics, use the rate and volume recommended for the antibiotics. See Chapter 7.

For initially unstable women who are receiving intravenous fluids to correct low blood volume and to give IV antibiotics, adjust the IV fluid rate once she improves and her low fluid volume has been corrected (systolic blood pressure of at least 100 mmHg, stabilizing heart rate (under 90), urine output of at least 100 ml per 4 hours). The adjusted rate is 1 litre in 6-8 hours. See Chapter 7.

Blood transfusion. A haemoglobin of g/100 ml or less, or a haematocrit of 15% or less is life threatening and will require blood transfusion. Follow Chapter 7 guidelines and warnings for blood transfusion. Remember to include the volume of blood given when monitoring and recording the total amount of fluids given to a patient.

Medicines

Antibiotic therapy should already be started for ALL women at risk for septic shock. If not, start antibiotics immediately. If pain control or tetanus toxoid have NOT been given, reassess the need. Follow treatment guidelines in the medicine section above. If treatment has been started, continue according to the schedules for antibiotics and pain control in Chapter 7.