Job Aids
for
Maternal and Child
Health Workers
Produced by:
Family Health Division
Department of Health Services
Ministry of Health
Active Management
Prolonged Labor
Fever After Childbirth
Shock
Post-partum Hemorrhage
Pre-eclampsia/Eclampsia
Job Aids - Technical Content Final
1
Active Management of 3rd Stage of Labor
Definition:
A method of delivering the placenta to prevent post- partum hemorrhage. It should be performed
after birth. This procedure includes the following:
Immediate injection of oxytocin after birth
Controlled cord traction
Uterine massage
Supplies/Medications:
Oxytocin 10 IU; sterile needle and syringe.
Draw oxytocin into syringe and set on delivery set.
Container for disposing placenta.
Management:
1. Ensure that the newborn baby is safe and kept warm.
2. Within 1 minute after birth palpate abdomen to exclude second baby.
3. Give oxytocin 10 IU IM (gluteal area) and dispose of the syringe safely.
4. When the uterus becomes rounded or the cord lengthens, hold the clamped cord close to the
perineum with two fingers of the right hand.
5. Place the left hand just above the woman’s pubic bone and gently push the uterus upward
(counter traction).
6. Keep slight tension on the cord and await a strong uterine contraction (should occur within 2-3
minutes). When the uterus becomes rounded and hard, or the cord lengthens, pull the cord
gently downwards. While doing this continue to apply counter pressure on the symphyasis
pubis with the other hand. This procedure is called controlled cord traction.
7. If the placenta does not descend during 30-40 seconds of controlled cord traction do not
continue to pull on the cord:
Gently hold the cord and wait until the uterus contracts again.
Then repeat controlled cord traction with counter traction.
8. As the placenta delivers hold it in 2 hands and gently turn it until the membranes are twisted
(make sure membranes are completely out).
9. Immediately massage the uterus in circular motion until it is contracted.
10. Inspect the placenta and membranes for completeness.
11. Gently clean and examine the vagina and make sure for no laceration, tear and retention of
placenta and membrane. If any portion of the placenta or membrane has been retained, refer
immediately to a higher center.
Procedure after Active Management of Third Stage of Labor:
1. Repeat uterine massage every 15 minutes for the first 2 hours after birth. If the uterus becomes
soft, continue massage until it remains firmly contracted. (Teach the same message to the
woman to massage her uterus).
2. Dispose of the placenta, syringe, and other material appropriately. Wash your hands.
3. Make sure the woman is clean and comfortable, perform newborn care, and assist with
breastfeeding.
Problems: Refer the woman to higher center if:
1. The placenta is not delivered after 30 minutes of delivery.
2. Some portion of the placenta or membrane is retained.
3. Inversion of the uterus.
4. The cord is pulled off.
5. If any tear, laceration in the vagina or if there is continuous bleeding.
Job Aids - Technical Content Final
2
Prolonged/Obstructed Labor
Definition: If a woman has been in active stage of labor (experiencing 3 or more than 3 strong contractions in
10 minutes with each contraction lasting for more than 40 seconds) for more than 8 hours, it is
considered as prolonged labor.
Management:
Ask:
1. The woman’s age, parity, and previous obstetric history.
2. Time of onset of contractions.
3. Any other problems or complaints
Look/examine:
1. Take blood pressure, temperature, pulse, and respiration; note hydration status.
2. Listen to the fetal heart rate (it should be between 120 and 160 beats per minute).
3. Palpate the presenting part abdominally to determine descent.
4. If membranes are ruptured, note the color of the fluid; meconium may signal fetal distress.
5. Monitor the progress of labor. If the woman has been in active labor (3 or more than 3
contractions in 10 minutes, with each contraction lasting for more than 40 seconds) for more
than 8 hours, confirm prolonged labor.
Treat/do:
1. If there are signs of shock, infection, dehydration, or fetal distress, treat immediately and refer
the woman to a higher center.
2. Monitor B/P, pulse, respiration and Fetal Heart Sound
3. If the woman has been in active labor (3 or more than 3 contractions in 10 minutes with each
contraction lasting for more than 40 seconds) for more than 8 hours, refer her to a higher
center.
Job Aids - Technical Content Final
3
Fever after Childbirth
Definition:
When a woman has a fever (temperature 38°C or 100.4°F) that occurs more than 24 hours after
delivery or miscarriage. Most common causes are: breast infection (mastitis or breast abscess);
uterine infection (metritis); urinary tract infection (UTI); and deep vein thrombosis (DVT or
swelling of legs with pain).
Management:
Ask:
1. Delivery date; complications
2. Time of onset of fever
3. Presence and location of pain
4. Presence of foul smelling lochia or discharge
5. Difficulty urinating, urinary frequency
6. Symptoms of cough, cold or flu
7. Breast engorged or normal
Look/examine:
1. Take blood pressure, temperature, pulse and respirations; note hydration status.
2. Breasts: look for reddened area, tenderness: Mastitis
Firm, red, tender breast with fluctuant swelling: Abscess.
3. Abdomen: Tender uterus, foul-smelling lochia or discharge: Metritis.
4. Abdomen (or perineum): Red, draining incision; uterine or perennial tenderness: Wound
infection.
5. Abdomen/back: tenderness above the pubic bone, flank pain: Bladder or kidney infection.
6. Calf muscle: redness, swelling, tenderness: Deep vein thrombosis.
7. General problem, cough, cold, runny nose: viral syndrome
Treat/do:
Condition Medication General Measures
Breast infection
(mastitis)
- Reddened areas seen in
breast, tenderness of
breast
Cap. Amoxycillin 500 mg.
by mouth 3 times/day for 5-7
days; Tab. Paracetamol
500mg by mouth 3 times/day
for 2 days if there is pain
Continue breast-feeding from
both breasts; assist with latch-
on; encourage rest, fluids;
reassurance to mother and
family; follow-up in 2 days
Breast abscess
- Firm, red, tender breast
with fluctuant swelling
Treat as for breast infection
(mastitis) and pain, as above
and refer.
Refer immediately to higher
center for incision and
drainage of abscess; continue
breastfeeding; use cold
compresses; reassurance to
mother and family; follow-up
2 days after surgery.
Uterine infection
(metritis)
- Tender uterus, foul-
smelling lochia or
discharge
Cap. Amoxycillin 500 mg. 8
hourly; PLUS Tab.
Metronidazole 400mg. 8
hourly. Refer with notes.
If necessary, treat for shock;
refer for removal of any
retained placental fragments;
re-evaluate and refer if fever is
still present after 72 hours of
antibiotics. Ensure rest,
hydration and nutrition.
Wound infection (of
abdomen or perineum)
Begin antibiotics as for
uterine infection (metritis) as
If necessary, treat for shock,
refer immediately for
Job Aids - Technical Content Final
4
- Red, draining incision;
uterine or perennial
tenderness
above and refer. evaluation.
Urinary tract infection
(UTI) (Bladder infection
or kidney infection)
- Pain of lower abdomen,
flank pain
Amoxycillin 500mg by
mouth 8 hourly for 3 days;
Encourage plenty of fluids. If
necessary, treat for shock.
Refer to higher center for
evaluation and further
treatment
Deep vein thrombosis
(DVT)
- Calf muscle redness,
swelling, and tenderness
Paracetamol 500mg by
mouth 3 times/day; refer
immediately to higher center
Refer immediately to higher
center; transfer in lying
position with feet elevated.
Cold or flu syndrome
- Headache, cough, runny
nose
Paracetamol 500mg by
mouth 8 hourly for 2 days
Encourage rest, hydration, and
nutrition. Refer if pneumonia
or other serious illness
suspected.
Job Aids - Technical Content Final
5
Treatment of Shock
Definition:
1. Shock is failure of the circulatory system to carry blood and oxygen to the heart, brain, and
other vital organs.
2. It is life threatening and requires immediate and intensive treatment.
3. Pallor; sweatiness; cold, clammy skin; and anxiety, confusion or unconsciousness may be
present.
4. Vital signs change:
a. Systolic blood pressure is usually lower than 90mm Hg.
b. Pulse is usually higher than 110 beats per minute.
c. Respirations are usually shallow and rapid (more than 30/minute).
d. Urine output is usually than 30 ml/hour (¼ cup).
General Management:
1. SHOUT FOR HELP.
2. Monitor vital signs (blood pressure, pulse, respirations, urine output).
3. Turn the woman onto her side to minimize the risk of aspiration if she vomits and to ensure that
an airway is open.
4. Keep the woman warm but do not overheat her, as this will reduce circulation to vital organs.
5. Elevate the legs to increase return of blood to the heart.
6. Initiate treatment of the source of shock (hemorrhage, infection, etc.)
Specific Management:
1. Start an IV infusion using cannula. Infuse normal saline or Ringer’s lactate at the rate of 1 liter
in 15-20 minutes.
2. Continue to monitor vital signs and urine output.
3. Do not give fluids or medications by mouth.
4. Prepare for immediate transport to a higher center.
Job Aids - Technical Content Final
6
Management of Vaginal Bleeding After Childbirth
Definition:
Vaginal bleeding in excess of 3 tea glass (1 tea glass=165-200 ml) after childbirth is called
postpartum hemorrhage (PPH). PPH can be of two types:
Immediate PPH occurs in the first 24 hours after birth.
Delayed PPH occurs after 24 hours following birth.
Bleeding may be seen as a sudden gush, or may be seen at a slow rate over several hours. Both
types of bleeding are dangerous.
PPH can happen due to different reasons like:
If the uterus does not contract, or,
Tear or laceration in the uterus or vagina, or,
Retention of placenta
Management:
Ask:
Talk with the woman to assess how she is feeling and her state of consciousness. Teach her to
massage her uterus and assess the amount and frequency of bleeding.
Look/examine:
1. Examine the placenta to assess if there are any missing pieces. Retained placental fragments
may cause postpartum hemorrhage.
2. Feel the uterus to assess whether it is contracted and hard.
3. Take blood pressure, pulse, respiration, and the level of consciousness of the woman.
4. Assess the amount of bleeding, and, examine vagina and perineum to ascertain if there is any
tear or laceration.
Treat/Do
1. Shout for help if sudden heavy bleeding or slow, continuous bleeding is found.
2. If shock is suspected treat immediately (see section 4 for treatment of shock).
3. Massage the uterus to expel blood and blood clots, and to cause contraction of an atonic (boggy,
soft) uterus.
4. Give oxytocin 10 IU IM.
5. If there is any tear or laceration in the vaginal or perineum, refer to higher center for repair.
6. If the placenta is not delivered after 30 minutes of delivery or if some portions of the placenta
has been retained, refer to a higher center for treatment.
7. If bleeding is stabilized observe the woman for 24 hours postpartum. Encourage breast-feeding.
Give iron/folate tablets (enough for 3 months) and encourage plenty of fluids and adequate
nutrition. Teach the danger signs for mother and baby.
8. If bleeding is not controlled, treat the woman for shock (see section 4 for treatment of shock)
and refer to a higher center immediately for further treatment.
Prevention of PPH can occur by performing active management of the third stage on all
women at the time of birth.
All women should be closely observed after childbirth since PPH cannot be predicted.
Job Aids - Technical Content Final
7
Management of Pre-eclampsia/Eclampsia
Definition:
If the diastolic blood pressure of a pregnant woman is 90 mm Hg or more than 90 mm Hg after 20
weeks of gestation, then the condition can be divided into three stages:
1. Mild pre-eclampsia: 20 or more than 20 weeks gestation period
Diastolic blood pressure between 90 and 110 mm Hg
2. Severe pre-eclampsia: 20 or more than 20 weeks gestation period
Diastolic blood pressure more than 110 mm Hg
If a woman in any of the above conditions shows signs of hyperreflexia; headache; clouding of
vision; oliguria (passing less than 2 tea glass of urine in 24 hours); upper abdominal pain (epigastric
pain), then it is an indication that she may have eclampsia, and such a woman should be referred
immediately to a higher center for treatment.
3. Eclampsia occurs when a woman is unconscious with convulsions, and a diastolic blood
pressure of 90 mm Hg or higher after 20 weeks of gestation period.
Management:
Ask:
1. Whether the woman has headache, clouded vision, epigastric pain, or trouble breathing.
2. Whether she has history of convulsions or disease e.g. epilepsy.
Treat/do:
Condition Medication General Measures
Mild Pre-eclampsia
- Diastolic blood pressure
90-110 mm Hg without
any other problems or
complications
Prior to 37 weeks of
gestation:
In this condition, do not give
anticonvulsants,
antihypertensives, sedatives,
tranquilizers, or diuretics.
Follow up twice/week as an
outpatient.
Check fundal height weekly;
if not growing refer to
hospital.
After 37 weeks of gestation
If the blood pressure remains
the same, advise the woman
to deliver at a hospital.
Encourage the woman to eat a
normal diet; do not restrict salt
intake.
Counsel the woman and her
family about the danger signs
of severe pre-eclampsia and
eclampsia, and advise that they
should seek immediate
treatment should they sight a
danger sign.
Place the woman on her left
side to reduce the danger of
aspiration of secretions.
The treatment for severe pre-eclampsia and eclampsia are the same as given below:
Job Aids - Technical Content Final
8
Severe Pre-eclampsia
- Diastolic blood pressure
110 mm Hg or more with
headache, clouding of
vision, epigastric pain,
oliguria
Eclampsia - Unconsciousness with
convulsions and fits and
blood pressure 90 or more
than 90 mm Hg
Give 10 mg. Diazepam
injection IM
If diastolic blood pressure is
more than 110 mm Hg, give
5 mg. Nifedipine orally
Observe and record vital
signs and fetal heart rate.
Record urinary output.
If blood pressure remains
above 110 mm Hg even after
10 minutes then repeat 5 mg.
Nifedipine under the tongue.
After providing obstetric first
aid, refer the woman to a
hospital with documentation of
observations, medications and
vital signs (accompany the
woman if possible); Advise the
family not to leave the woman
unattended; Reassure the
woman and the family and
inform them about the
condition; If the condition of
the woman stabilizes after
treatment, counsel the family
to be prepared to take her to a
hospital for treatment; Place
the woman on her left side to
reduce the danger of aspiration
of secretions.
Note: Do not administer Nifedipine, unless diastolic blood pressure is greater than 110 mm
Hg.
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cj:yf pkrf/ ;fdfGo x]/rfx
:tg ;+qmd0f -:tg
;'lGgg', /ftf] b]lvg',
5'bf b'Vg'_
%–& lbg ;Dd lbgsf]
# k6s %))
ldlnu|fdsf]
Pdf]lS;l;nLg SofK;'n
vfg lbg], b'v]sf] 5
eg] @ lbg ;Dd
lbgsf] # k6s %))
ld=u|f=sf]
Kof/fl;6fdf]n rSsL
cf}iflw vfg lbg] .
lzz'nfO{ b'j} :tgaf6 :tgkfg
u/fO{ /fVg nufpg], :tgnfO{ cf8
lbg] lsl;dn] n'uf nufpg ;Nnfx
lbg], emf]nLnf] kbfy{ v'jfO{ cf/fd
ug{ k|f]T;fxg ug]{, ;'Ts]/L / pgsf]
kl/jf/nfO{ cfZj:t kfg]{, @–# lbg
kl5 hFrfpg cfpg cg'/f]w ug]{ .
:tg kfs]sf]
– :tg /ftf], b'Vg],
vfDbf sdnf]
8Nnf] e]l6Pdf
dfly pNn]lvt pkrf/
z'? ul/ al9 ;'ljwf
ePsf] :jf:Yo ;+:yfdf
l;kmf/Lz ;fy k7fpg]
.
:tg lr/kmf/ u/L kLk lgsfNg
al9 ;'ljwf ;DkGg :jf:Yo
;+:yfdf l;kmf/Lz ;fy k7fpg],
:tgkfg u/fO{ /fVg nufpg],
rL;f] kfgL kl§ nufpg], ;'Ts]/L /
pgsf] kl/jf/nfO{ cfZj:t kfg]{,
lr/kmf/ u/]sf] @–# lbg kl5
hFrfp+g cfpg cg'/f]w ug]{ . Kff7]3/ ;+qmd0f
– tNnf] k]6 5fDbf
b'Vg', b'u{lGwt
of]gL>fj x'g'
k|To]s * 306fdf
%)) ld=u|f= sf]
Pdf]lS;l;nLg SofK;'n
/ $)) ld=u|f=sf]
d]6«f]lg8fhf]n rSsL
cr]tg -zs_ ePsf] cfef;
ePdf pkrf/ ug]{, ;fnsf] s'g}
efu leq} c8\lsPsf] eP ;f]
lgsfNg al9 ;'ljwf ePsf] :jf:Yo
;+:yfdf l;kmf/Lz ;fy k7fpg], /
sfo{ ;xof]uL k'l:tsf – clGtd k|fljlws ljifo ;"rL
5
cf}iflw vfg lbg] .
al9 ;'ljwf ePsf]
:jf:Yo ;+:yfdf
l;kmf/Lz ;fy k7fpg] .
Pdf]lS;l;nLg v'jfPsf] &@
306f;Dd klg Hj/f] cfO{ /x]df
d"Nof+sg u/L al9 ;'ljwf ePsf]
:jf:Yo ;+:yfdf l;kmf/Lz ;fy
k7fpg] . ;'Ts]/LnfO{ oy]i6
emf]nLo Pj+ kf}li6s vfgf vfg /
cf/fd lng ;Nnfx lbg] .
3fp kfSg' -k]6sf]
cyjf of]gLsf]_
–3fp /ftf] ePdf,
5'bf b'Vg] ePdf
cyjf kLk au]df
Kff7]3/ ;+qmd0fdf
lbOg] Pdf]lS;l;nLg
cf}ifl3 z'? u/L al9
;'ljwf ePsf] :jf:Yo
;+:yfdf l;kmf/Lz ;fy
k7fpg] .
cr]tg -zs_ ePsf] cfef;
ePdf pkrf/ ug]{ / d"Nof+sgsf]
nflu al9 ;'ljwf ePsf] :jf:Yo
;+:yfdf l;kmf/Lz ;fy k7fpg] .
d'qgnL ;+qmd0fM # lbg;Dd k|To]s *
306fdf %))
ld=u|f=sf]
Pdf]lS;l;nLg vfg
lbg] .
k|;:t emf]n ePsf] vfgf v'jfpg]
. cr]tg -zs_ ePsf] cfef;
ePdf pkrf/ ug]{ . yk pkrf/sf]
nflu al9 ;'ljwf ePsf] :jf:Yo
;+:yfdf l;kmf/Lz ;fy k7fpg] .
lk8f}+nfsf] dfz+k]zL
;'lGgg', /ftf] x'g',
b'Vg' -gzfdf /ut
hldg'_
lbgsf] # k6s %))
ld=u|f=sf]
Kof/fl;6fdf]n vfg
lbg] / al9 ;'ljwf
ePsf] :jf:Yo ;+:yfdf
l;kmf/Lz ;fy k7fpg]
.
cljnDj al9 ;'ljwf ePsf]
:jf:Yo ;+:yfdf l;kmf/Lz ;fy
k7fpg], o;/L k7fpFbf v'§f cln
dfly p7fO{ ;'tfP/ nfg] Aoj:yf
ldnfpg] .
6fpsf] b'Vg] /
kftnf] l;+ufg auL
vf]sL nfUg] -?3f
vf]sLsf] k|sf]k_
@ lbg;Dd k|To]s *
306fdf %))
ld=u|f=sf]
Kof/fl;6fdf]n vfg lbg] .
;'Ts]/Ln] k|;:t emf]nLnf] Pa+
kf}li6s vfgf vfg / cf/fd
kfPsf] olsg ug]{ . lgdf]lgof jf
cGo s'g} s8f /f]u nfu]sf]
cfz+sf ePdf al9 ;'ljwf ePsf]
:jf:Yo ;+:yfdf l;kmf/Lz ;fy
k7fpg] .
sfo{ ;xof]uL k'l:tsf – clGtd k|fljlws ljifo ;"rL
6
$= cr]tg -zs_ sf] pkrf/
kl/efiff M
xfd|f] z/L/sf] /Qm;+rf/ k|0ffnLn] d'6', dl:tis / z/L/sf cGo dxTjk"0f{ c+ux?df
clS;lhg o"St /utsf] kof{Kt cfk"lt{ ug{ g;Sg'nfO{ g} cr]tg -zs_ elgG5 . of]
k|f0f wfts ePsf]n] o;sf] t'?Gt / /fd|f];Fu pkrf/ ug{ h?/L 5 . cg'xf/ kx]+lng',
lr6\ lr6\ kl;gf cfpg', 5fnf lr;f] Pj+ Rofk Rofk x'g' lrlGtt, r]tgf 36\g] jf
a]xf]; x'g' h:tf zssf nIf0fx? x'g\ .
z/L/sf dxTjk"0f{ ;"rsx?df km/s kb{5g\ M
-s_ l;:6f]lns /Qmrfk () ldln ld6/ eGbf sd x'G5 .
-v_ gf8Lsf] ult k|lt ldg]6 !!) k6s eGbf a9L x'G5 .
-u_ Zjf; k|s[of xn'sf t/ l56f] x'G5 -k|lt ldg]6 #) eGbf a9L_
-3_ lk;fj sd dfqfdf x'G5 . -Ps 306fdf #) ld=nL= jf rf}yfO{+ sk eGbf
sd dfq_
;fdfGo Joj:yfkg M
!= ;xof]usf] nflu af]nfpg' xf];\ .
@ z/L/sf] dxTjk"0f{ nIf0fx?sf] -efO6n ;fO{g_ cg'udg ug'xf];\ -/Qmrfk, gf8L,
Zjf;k|Zjf;, lk;fj km]/]sf] kl/df0f_ .
#= ;'Ts]/Ln] s]xL u/L afGtf u/Lg\ eg] g lg::ffl;o"g\ / pgsf] Zjf; gnL v'nf
/xf];\ eg]/ pgnfO{ sf]N6] kf/L ;'tfpg'xf];\ .
$= ;'Ts]/LnfO{ Gofgf] kf/L /fVg'xf];\ t/ w]/} ttfpg] xf]Og . w]/} tfltPdf z/L/sf
dxTjk"0f{ c+ux?df /Qm ;+rfng sd x'G5 .
%= d'6'df ;xh t/Lsfn] /ut kms{gsf] nflu dlxnfsf] v'§f cln pFrf kf/L
lbg'xf];\ .
^= zs x'g'sf] sf/0f kQf nufO{ pkrf/ z'? ug'{{xf];\ . h:t}, /Qm>fj, ;+qmd0f,
OToflb .
ljz]if Joj:yfkg M
!= gzfaf6 cfO{ le Sofg'nf /flv !%–@) ldg]6df g} ! ln6/ ;nfO{g kfgL jf
/L+u/ NofS6]6 lbg z'? u/L xfNg'xf];\ .
@= klxnf] Ps 306f leq @ ln6/ ;nfO{g kfgL lbg'xf];\ .
#= z/L/sf dxTjk"0f{ nIf0fx?sf] cg'udg u/L /xg'xf];\ / lk;fjsf] kl/df0f klg
l6Kg'xf];\ .
$= d'vaf6 s'g} emf]n jf cf}iflw gv'jfpg'xf];\ .
%= al9 ;'ljwf ePsf] :jf:Yo ;+:yfdf l;kmf/Lz ;fy cljnDa k7fpg tof/L
ug'{xf];\ .
sfo{ ;xof]uL k'l:tsf – clGtd k|fljlws ljifo ;"rL
7
%= ;'Ts]/L kl5sf] /Qm>fjsf] Aoj:yfkg
kl/efiff M
lzz' hGd]kl5 # lrof lunf; -! lrof lunf; a/fa/ !^% b]lv@)) ldnL ln6/_
eGbf a9L /Qm>fj ePdf ;'Ts]/L kl5sf] /Qm>fj elgG5 . ;'Ts]/L kl5sf] ;Qm>fj
b'O[ k|sf/df af8\g ;lsG5 M
;'Ts]/L kl5sf] tTsfn x'g] /Qm>fj eGgfn] lzz' hGd]sf] @$ 306f leq} x'G5 .
;'Ts]/L kl5sf] l9nf] x'g]] /Qm>fj eGgfn] lzz' hGd]sf] @$ 306f kl5dfq x'G5 .
/Qm>fj cs:dft w]/} x\jfn x\jfn klg x'g ;S5 cyjf cln cln ul/ la:tf/};+u
l9nf] ultdf klg x'g ;S5 . To;}n] b'j} cj:yfsf] /Qm>fjnfO{ vt/f k"0f{ dflgG5 .
Joj:yfkg M
;f]Wg] M
dlxnfnfO{ s:tf] cg'ej e} /x]sf] 5 / pGsf] r]tgfsf] l:ylt kQf nufpg pgLl;t
s'/f ug'{xf];\ . pgnfO{ kf7]3/ dfln; ug{ l;sfpg'xf];\ / /Qm>fjsf] af/]df hfgsf/L
lng' xf];\ .
x]g]{÷5fDg]÷hfFRg] M
!= k|To]s lzz'sf] hGdkl5 ;fnsf] s'g} efu leq 5'6]sf] 5 ls elg ;fnsf] /fd|/L
lg/LIf0f ug'{xf];\ . ;fnsf] s'g} c+z leq 5'6]df ;'Ts]/L kl5 /Qm>fj e} /xG5 .
@= k|To]s lzz'sf] hGdkl5 dlxnfsf] /Qmrfk , gf8L / Zjf;sf] ult gfKg] tyf
leq ePsf] /ut / /utsf 8Nnfx? lgsfNg kf7]3/sf] dfln; ug]{ ug'{xf];\ .
lzz'hGd]sf] klxnf] @ 306f;Dd k|lt !% ldg]6df /Qm>fjsf] l:ylt x]g'{xf];\ .
To;kl5sf] @ 306f k|lt cfwf cfwf 306fdf / To;kl5 lzz' hGd]sf] ^
306f;Dd k|lt 306fdf /Qm>fjsf] cg'udg ug]{ ug'{xf];\ .
pkrf/÷sfo{ M
!= cs:dft w]/} /Qm>fj jf lj:tf/} t/ nuftf/ /Qm>fj ePdf ;xof]usf] nflu
s/fpg'xf];\ .
@= cr]tg -zs_ ePsf] cfz+sf ePdf cljnDa pkrf/ ug'{xf];\ . -zssf] pkrf/
ljlw x]g'xf];\ _
#= /ut / /utsf] 8Nnfx? lgsfNg tyf kf7]3/sf] v's'nf] dfz+k]zLnfO{ v'Drg
lbg kf7]3/sf] dfln; ug'{xf];\ .
$= dlxnfsf] df+zk]zLdf !) o"lg6 clS;6f]l;g ;'O{ nufpg'xf];\ .
%= g;faf6 ;nfO{g kfgL lbg yfNg'xf];\ .
sfo{ ;xof]uL k'l:tsf – clGtd k|fljlws ljifo ;"rL
8
^= of]gL -k]l/lgod_df 3fp eP gePsf] hfFr ug'{xf];\ / 3fp l;nfO{ ug{ cfjZos
ePdf al9 ;'ljwf ePsf] :jf:Yo ;+:yfdf l;kmf/Lz ;fy k7fpg'xf];\ .
&= ;fn em/], gem/]sf] / em/]sf] ;fnsf] k"0f{ c+z eP gePsf] hfFRg'xf];\ .
*= /Qm>fj lgoGq0f ePdf klg o:tf ;'Ts]/LnfO{ @$ 306f;Dd cfkm\gf]
lgu/fgLdf /fVg'xf];\ . :tgkfg u/fpg k|f]T;fxg ug{'xf];\ . # dlxgfnfO{ k'Ug]
cfO/g÷kmf]n]6 rSsL lbg'xf];\ . k|;:t emf]nLnf] / kf}li6s vfgf vfg k|f]T;fxg
ug'{xf];\ . cfdf / lzz'nfO{ x'g;Sg] vt/fsf nIf0fx? atfO{ lbg'xf];\ .
^= uef{j:yfdf x'g] lk|–PSnfDkl;of/ PSnfDkl;of sf] Aoj:yfkg
kl/efiff M
lk|–PSnfDkl;of
ue{wf/0fsf] @) xKtfkl5 olb ue{jtL dlxnfsf] /Qmrfk hfRbf 8fO{:6f]lns rfk ()
b]lv !!) ldld kfO{Pdf To;kl5 $ 306fsf] km/sdf klg g3l6 () b]lv !!) ldld
g} kfO{Pdf To:tf] cj:yfnfO{ xNsf lk|–PSnfDkl;of elgG5 .
uDeL/ lk|–PSnfDkl;of
ue{wf/0fsf] @) xKtfkl5 olb ue{jtL dlxnfsf] 8fO{:6f]lns /Qmrfk lnbf Ps jf b'O{
k6s;Dd klg !!) ldld eGbf a9L ePsf] kfO{Pdf To:tf] cj:yfnfO{ uDeL/ lk|
PSnfDkl;of elgG5 . o:tf] cj:yfdf dlxnfsf] 6fpFsf] b'Vg], cfFvf 3ldnf] x'g], Hofb}
sd lk;fj x'g] -@$ 306fdf @ lrof lunfF; eGbf sd dfq lk;fj cfpg'_, dflyNnf]
k]6 b'Vg] (Epigastric pain) x'G5 .
PSnfDkl;of
ue{wf/0fsf] @) xKtfkl5 ue{jtL dlxnf a]xf]; eO{ sDk cfPdf / pgsf] 8fO{:6f]lns
/Qmrfk () ldld eGbf a9L ePdf o:tf] cj:yfnfO{ PSnfDkl;of elgG5 . o;sf]
nIf0fx? uDeL/ lk|–PSnfDkl;ofsf] h:t} x'G5g\ .
Joj:yfkg M
;f]Wg] M
!= dlxnfnfO{ 6fpsf] b'Vg], cfFvf 3ldnf] b]Vg]], dflyNnf] k]6 b'Vg] jf ;f; km]g{
ufx|f] ePsf] 5 ls elg ;f]Wg'xf];\ .
;'Ts]/L kl5sf] /Qm>fj x'g af6 aRgsf] nflu ;a} dlxnfnfO{ lzz' hGdfpFbf
;'Ts]/L Joyfsf] t]>f] r/0fsf] ;qmLo Joj:yfkg x'g lgtfGt h?/L 5 .
lzz' hGd]kl5 ;a} ;'Ts]/LnfO{ /fd|f] lgu/fgLdf /fVg' k5{ lsgeg] ;'Ts]/L kl5
x'g] /Qm>fj s;nfO{ x'G5 s;nfO{ x'b}g elg eGg ;lsGb}g .
sfo{ ;xof]uL k'l:tsf – clGtd k|fljlws ljifo ;"rL
9
@= dlxnfnfO{ klxnf klg sDk cfpg] jf cGo s'g} /f]u -ljz]if u/L 5f/] /f]u_
lyof] lyPg eGg] af/] ;f]Wg'xf];\ .
pkrf/÷sfo{ M
!= ue{wf/0fsf] #& xKtf gk'u];Dd xNsf lk|–PSnfDkl;ofsf] nIf0fx? oyfjt
/x]df jf ;fdfGo ePdf lgDg k|s[of ckgfpg] .
s= xKtfsf] b'O{ k6s hFrfpg cfpg cg'/f]w ug]{ .
v= ue{jtL dlxnf / pgsf] kl/jf/nfO{ uDeL/ lk|–PSnfDkl;of /
PSnfDkl;ofsf] nIf0fx? af/]df k/fdz{ lbg] .
u= afofF sf]N6] k/L ;'Tg] / a9L cf/fd ug{ k|f]T;fxg ug]{ .
3= ;fdfGo vfglkg ug]{ / g"gsf] dfqf 36fO{ /fVg kb}{g .
8=
k|To]s xKtf kf7]3/sf] pFrfO{ gfKg] / pFrfO{ ga9]df c:ktfn hfg
cg'/f]w ug{] .
r= sDk gx'g], /Qmrfk sd ug]{, lgb|f nfUg], a9L lk;fj nfUg] s'g} klg
cf}iflw glbg] / o:tf] cj:yfsf] dlxnfnfO{ lgoldt hfFr ug{ ;Dej
gePdf c:ktfn egf{ x'g pTk|]l/t ug]{ .
@= ue{wf/0fsf] #& xKtf kl5 klg xNsf lk|–PSnfDkl;of sfod} /x]df o:tf
dlxnfnfO{ lzz' hGdfpg c:ktfn egf{ x'g pTk|]l/t ug]{ .
#= uDeL/ lk|–PSnfDkl;of / PSnfDkl;of cj:yfdfM
s= o:tf cj:yfsf dlxnfnfO{ cfkm"n] hfFr ubf{ kfO{Psf ;Dk"0f{ ljj/0fx?,
u/LPsf] pkrf/ Pa+ dxTjk"0f{ nIf0fx?sf] hfgsf/L ;lxt cljnDa
c:ktfn k7fpg] Aoj:yf ug]{ .
v= c:ktfn k7fpg' cl3 dlxnfsf] df+zk]zLdf !) ld=u|f= 8fOhLkfd ;"O{
nufpg] .
u= /\ofn/jfGtf af6 lg:;fl;g glbg dlxnfnfO{ afofF sf]N6] kf/L ;'tfpg] /
lghnfO{ PSn} g5f]8\g] .
3= kLl8t dlxnfsf] 8fO:6f]lns /Qmrfk !!) ldld eGbf a9L /xL /x]df
d'vaf6 % ldnL u|fd lgkm]l8lkOg cf}iflw v'jfO{ lbg] .
8= k|To]s cfwf 306fdf dxTjk"0f{ nIf0fx? efO{6n ;fO{g Pj+ ue{sf]
aRrfsf] d'6'sf] w8\sg x]/L l6kf]6 ug]{ . lk;fjsf] kl/df0fsf] n]vf /fVg]
.