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BEFORE BIRTH

BEFORE BIRTH

  • INSTRUCTIONS

    1. Answer the questions below by selecting the most appropriate response.
    2. Add photos and notes by clicking on the paperclip icon
    3. To add a Corrective Measure click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority, and due date
    4. Complete audit by providing digital signature
    5. Share your report by exporting as PDF, Word, Excel or Web Link

1 -- On Admission

  • Check your facility’s criteria

  • Does mother need referral?

  • Start plotting when cervix ≥4 cm, then cervix should dilate ≥1 cm/hr
    • Every 30 min: plot HR, contractions, fetal HR
    • Every 2 hrs: plot temperature
    • Every 4 hrs: plot BP

  • Partograph started?

  • Ask for allergies before administration of any medication
    Give antibiotics to mother if any of:
    • Mother’s temperature ≥38°C
    • History of foul-smelling vaginal discharge
    • Rupture of membranes >18 hrs

    Give magnesium sulfate to mother if any of:
    • Diastolic BP ≥110 mmHg and 3+ proteinuria
    • Diastolic BP ≥90 mmHg, 2+ proteinuria,
    and any: severe headache, visual disturbance, epigastric pain

    Give antihypertensive medication to mother if systolic BP >160 mmHg
    • Goal: keep BP <150/100 mmHg

  • Does mother need to start Antibiotics?

  • Does mother need to start Magnesium sulfate and antihypertensive treatment?

  • Confirm supplies are available to clean hands and wear gloves for each vaginal exam.

  • Encourage birth companion to be present at birth.

  • Call for help if any of:

    • Bleeding
    • Severe abdominal pain
    • Severe headache or visual disturbance
    • Unable to urinate
    • Urge to push

  • Confirm that mother or companion will call for help during labour if needed.

  • This checklist is not intended to be comprehensive and should not replace the case notes or partograph. Additions and modifications to fit local practice are encouraged.

    For more information on recommended use of the checklist, please refer to the “WHO Safe Childbirth Checklist Implementation Guide” at: www.who.int/patientsafety.

  • Completed By

2 -- Just Before Pushing (Or Before Caesarean)

  • Ask for allergies before administration of any medication

    Give antibiotics to mother if any of:
    • Mother’s temperature ≥38 °C
    • History of foul-smelling vaginal discharge
    • Rupture of membranes >18 hrs
    • Caesarean section

    Give magnesium sulfate to mother if any of:
    • Diastolic BP ≥110 mmHg and 3+ proteinuria
    • Diastolic BP ≥90 mmHg, 2+ proteinuria,
    and any: severe headache, visual disturbance, epigastric pain

    Give antihypertensive medication to mother if systolic BP >160 mmHg
    • Goal: keep BP <150/100 mmHg

  • Does mother need to start Antibiotics?

  • Does mother need to start Magnesium sulfate and antihypertensive treatment?

  • Confirm essential supplies are at bedside and prepare for delivery:

For mother

  • Prepare to care for mother immediately after birth:

    Confirm single baby only (not multiple birth)
    1. Give oxytocin within 1 minute after birth
    2. Deliver placenta 1-3 minutes after birth
    3. Massage uterus after placenta is delivered
    4. Confirm uterus is contracted

  • Gloves

  • Alcohol-based handrub or soap and clean water

  • Oxytocin 10 units in syringe

For baby

  • Prepare to care for baby immediately after birth:

    1. Dry baby, keep warm
    2. If not breathing, stimulate and clear airway
    3. If still not breathing:

    • clamp and cut cord
    • clean airway if necessary
    • ventilate with bag-and-mask
    • shout for help

  • Clean towel

  • Tie or cord clamp

  • Sterile blade to cut cord

  • Suction device

  • Bag-and-mask

  • Assistant identified and ready to help at birth if needed.

  • This checklist is not intended to be comprehensive and should not replace the case notes or partograph. Additions and modifications to fit local practice are encouraged.

    For more information on recommended use of the checklist, please refer to the “WHO Safe Childbirth Checklist Implementation Guide” at: www.who.int/patientsafety.

  • Completed By

AFTER BIRTH

AFTER BIRTH

3 -- Soon After Birth (Within 1 Hour)

  • Is mother bleeding abnormally?<br>

  • If bleeding abnormally:

    • Massage uterus
    • Consider more uterotonic
    • Start IV fluids and keep mother warm
    • Treat cause: uterine atony, retained placenta/fragments, vaginal tear,
    uterine rupture

  • Ask for allergies before administration of any medication

    Give antibiotics to mother if placenta manually removed or if
    mother’s temperature ≥38 °C and any of:
    • Chills
    • Foul-smelling vaginal discharge
    If the mother has a third or fourth degree of perineal tear give antibiotics
    to prevent infection

    Give magnesium sulfate to mother if any of:
    • Diastolic BP ≥110 mmHg and 3+ proteinuria
    • Diastolic BP ≥90 mmHg, 2+ proteinuria, and any: severe headache, visual disturbance, epigastric pain

    Give antihypertensive medication to mother if systolic BP >160 mmHg
    • Goal: keep BP <150/100 mmHg

  • Does mother need to start Antibiotics?

  • Does mother need to start Magnesium sulfate and antihypertensive treatment?

  • Check your facility’s criteria

  • Does baby need Referral?

  • Give baby antibiotics if antibiotics given to mother for treatment of maternal infection during childbirth or if baby has any of:

    • Respiratory rate >60/min or <30/min
    • Chest in-drawing, grunting, or convulsions
    • Poor movement on stimulation
    • Baby’s temperature <35 °C (and not rising after warming) or baby’s temperature ≥38 °C

  • Does baby need Antibiotics?

  • Arrange special care/monitoring for baby if any:

    • More than 1 month early
    • Birth weight <2500 grams
    • Needs antibiotics
    • Required resuscitation

  • Does baby need Special care and monitoring?

  • Started breastfeeding and skin-to-skin contact (if mother and baby are well).

  • Confirm mother / companion will call for help if danger signs present.

  • Responsibility for the interpretation and use of the material in this checklist lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. For more information visit www.who.int/patientsafety.

  • Completed By

4 -- Before Discharge

  • Confirm stay at facility for 24 hours after delivery

  • Ask for allergies before administration of any medication

    Give antibiotics to mother if any of:
    • Mother’s temperature ≥38 °C
    • Foul-smelling vaginal discharge

  • Does mother need to start antibiotics?

  • Give magnesium sulfate to mother if any of:
    • Diastolic BP ≥110 mmHg and 3+ proteinuria
    • Diastolic BP ≥90 mmHg, 2+ proteinuria, and any: severe headache, visual disturbance, epigastric pain

    Give antihypertensive medication to mother if systolic BP >160 mmHg
    • Goal: keep BP <150/100 mmHg

  • Is mother’s blood pressure normal?

  • If pulse >110 beats per minute and blood pressure <90 mmHg
    • Start IV and keep mother warm
    • Treat cause (hypovolemic shock)

  • Is mother bleeding abnormally?<br>

  • Give antibiotics to baby if any of:
    • Respiratory rate >60/min or <30/min
    • Chest in-drawing, grunting, or convulsions
    • Poor movement on stimulation
    • Baby’s temperature <35°C (and not rising after warming) or baby’s temperature ≥38°C
    • Stopped breastfeeding well
    • Umbilicus redness extending to skin or draining pus

  • Does baby need Antibiotics?

  • Is baby feeding well?

  • Discuss and offer family planning options to mother.

  • Arrange follow-up and confirm mother / companion will seek help if danger signs appear after discharge.

Danger Signs

  • Mother has any of:
    • Bleeding
    • Severe abdominal pain
    • Severe headache or visual disturbance
    • Breathing difficulty
    • Fever or chills
    • Difficulty emptying bladder
    • Epigastric pain

    Baby has any of:
    • Fast/difficult breathing
    • Fever
    • Unusually cold
    • Stops feeding well
    • Less activity than normal
    • Whole body becomes yellow

  • Responsibility for the interpretation and use of the material in this checklist lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. For more information visit www.who.int/patientsafety

  • Completed By

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