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In case of treatment failure, these drugs can be given together. Do not stop treatment abruptly. ) are contraindicated. Management of mild pre-eclampsia Before 37 weeks LMP – – – – – Rest and monitoring: BP, weight, oedema, proteinuria at least once a week Measure the fundal height (risk of foetal growth retardation) Normal sodium and caloric intake Do not stop uterine contractions if they occur; let the woman deliver. If diastolic BP ≥ 110 mmHg, attempt to reduce it using oral antihypertensive treatment: methyldopa or atenolol, as above.

Given the risk of haemorrhage and rapid decompensation during delivery, discuss transfusion beforehand with any woman whose haemoglobin is < 7 g/dl, even if anaemia is relatively well-tolerated. As with any transfusion, verify blood group and Rhesus compatibility and perform pre-transfusion donor testing (HIV-1, HIV-2, hepatitis B and C, plus syphilis and malaria in endemic areas). Preventive treatment The demand for iron increases during pregnancy, justifying routine iron supplementation (see page 18).

In all cases, remove the placenta manually, explore the uterine cavity, then give oxytocin. – Transfuse whole blood in cases of intractable postpartum haemorrhage (the absence of clots indicates a clotting disorder). – If haemorrhage persists, consider surgery to stop the bleeding. 37 2 Bleeding during the second half of pregnancy Foetus is alive and viable Labor in progress or Advanced dilation and multipara Prompt vaginal delivery: – – – – – – – amniotomy analgesics ± oxytocin vacuum extractor manual placenta removal uterine exploration oxytocin after placenta removal Haemodynamic monitoring after delivery.

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