Labored breathing
issue
- The woman marked shortness of breath during pregnancy, labor or after delivery.
The main tactic
- Do a quick assessment of the general condition of the woman, including vital signs (pulse,
blood pressure, respiration, temperature).
- Place the woman on her left side
- Start / in infusion and pour the liquid / in.
- Give oxygen 4-6l / min through a mask or a new catheter.
- Determine the level of hemoglobin.
Diagnosis of respiratory difficulties
Symptoms present, other Sometimes the presence of Probable diagnosis
signs and symptoms typical symptoms and signs
of present
- Shortness of breath
- Drowsiness and fatigue
- Pallor of the conjunctiva,
tongue, nail phalanxes
and / or palms
- Flat or concave nails
Severe anemia
- 7 Hemoglobin g/dl or
less
- Hct 20% or less
- Symptoms and signs of
severe anemia
- Swelling
-
Heart failure due to anemia
Cough
- Wheezing
- Swelling of the lower
extremities
- Enlarged liver
- Swelling of the neck
veins
- Diastolic murmurs, and/
- Heart
rhythm Heart failure due to disease
or
disturbances
- Rough systolic noise
with palpable tremor
- enlarged heart
- Wheezing
-
Cyanosis (cyanosis)
- Cough
- Swelling of the lower
extremities
- Enlarged liver
- Swelling of the neck
veins
- Shortness of breath
- High temperature
-
Cough with phlegm
- Chest pain
- Seal
lung
Hoarseness
- Rapid breathing
- Rattling / whistles
- Shortness of breath
- Cough
-
- Rattling / whistles
Noisy breathing
tissue Pneumonia
- Shortness of breath
- Wheezing
- Hypertension
- Cough with frothy sputum
Bronchial asthma
Pulmonary edema associated
with preelampsia
- Proteinuria
Treatment severe anemia
- If necessary, a blood transfusion
- Use of blood components;
- Enter 40 mg of furosemide in / after the transfusion of each unit of blood.
- If it is assumed the presence of malignant malaria, keep a woman, both with severe
malaria.
- Give ferrous sulfate or iron fumerat 120mg orally PLUS folic acid 400mkg orally once a
day for 6 months during pregnancy. Continue treatment for 3 months after delivery.
In areas endemic helminthic infestation (camshaft-st - 20% or more), assign one of the
following anthelmintic treatments:
- 400mg albendazole 100ig orally once or 2 times daily for 3 days;
- OR levamisole 2.5 mg per 1 kg weight orally one time a day for 3 days;
- OR mebendazole 500mg orally 100 mg once or 2 times daily for 3 days;
If helminth infections are highly endemic (camshaft-st - 20% or more), repeat the
anthelmintic treatment 12 weeks after the first course.
- Heart failure
Heart failure, which developed due to anemia
Blood transfusion is needed in almost all cases, when heart failure is caused by anemia
- Use of blood components;
- Enter 40 mg of furosemide in / after the transfusion of each unit of blood.
Heart failure caused by diseases of the heart
Treat acute heart failure. Used medications may include:
- Morphine 10 mg / m once;
- Or 40 mg of furosemide in / Repeat if necessary;
- OR digoksin0,5mg / m once;
- OR 0.3 mg nitroglycerin sublingual, again after 15 minutes if necessary
Refer the woman to a hospital tertiary level, if necessary.
Assistance in case of heart failure that developed during childbirth
- Place the woman on her left side.
- Limit transfusion liquids to reduce the risk of circulatory overload and strictly enroll
fluid balance in the card up.
- Ensure adequate analgesia
- If required oxytocin use solution of higher concentration and a lower pour its speed to
maintain fluid balance (e.g., the concentration may be doubled if the injection speed is
reduced to half a minute).
Note: Do not give ergometrine.
- Avoid prolonged attempts during the phase of expulsion, if possible.
- If necessary, reduce the burden on women during childbirth, perform an episiotomy and
complete birth vacuum extraction or forceps fetus.
- Ensure active management of third stage of labor.
The presence of heart failure is not an indication for cesarean section.
Tactics assist in the case of HF, which developed during cesarean section
- Use local infiltration anesthesia with sedation retaining consciousness. Avoid spinal
anesthesia.
- Perform extraction baby and the placenta.
pneumonia
Inflammation in the lungs affects the lung parenchyma, which is poorly tolerated by
pregnant women.
- To confirm the diagnosis of pneumonia may require radiological examination of the chest.
- Give erythromycin 500 mg orally 4 times a day for 7 days.
- Assign a steam inhalation.
Consider the possibility of tuberculosis in women in those areas where it is distributed.
bronchial asthma
Bronchial asthma complicates 3-4% of pregnancies. Pregnancy is associated with
worsening of symptoms in one-third of women suffering from bronchial asthma.
- If bronchoconstriction use bronchodilators (e.g. 4mg salbutamol orally every 4 hours or
aerosol 250mkg every 15 minutes until three doses).
- If there is no effect of the bronchodilators, if necessary, use corticosteroids such as
hydrocortisone / in 2 mg / kg body weight every 4 hours.
- If there are signs of infection (bronchitis), give ampicillin 2 g / every 6 hours.
- Avoid destination prostaglandins. For the prevention and treatment of postpartum
hemorrhage, use of oxytocin 10Ed. / m or ergometrine 0, 2 mg / m.
- After the relief of acute, continue treatment with inhaled bronchodilators and inhaled
corticosteroids for the prevention of recurrent exacerbations.