job aids - the health · pdf filejob aids for maternal and child health workers produced by:...

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 postpartum 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.


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.


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


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.


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.


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.


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:


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.

sfo{ ;xof]uL k'l:tsf – clGtd k|fljlws ljifo ;"rL

1

!= k|;j Joyfsf] t]>f] r/0fsf] ;lqmo Aoj:yfkg

kl/efiff M

;lx tl/sfn] ;fn lgsfln ;'Ts]/L kl5 x'g] /Qm>fjnfO{ sd ug]{ Joj:yfkg xf] . of]

k|s[of lzz'sf] hGd kl5 dfq ckgfO{G5 . o;df lgDg s'/fx? ;dfa]z x'G5g\ .

lzz' hGdgf;fy cfdfnfO{ clS;6f]l;g ;'O{ nufpg] .

sG6«f]N8 s8{ 6«ofS;g -;+oldt tj/n] gfnsf] tgfO{ k|s[of_ .

kf7]3/sf] dfln; .

;/;fdfg÷cf}iflw M

!) o"lg6 clS;6f]l;g O{Gh]S;g, / lgd{lns[t l;l/+h -;'O{_

lgd{lns[t l;l/+hdf clS;6f]l;g e/]/ ;kmf 7fpF jf ;'Ts]/L ;fdfu|L /flvPsf]

efF8fdf /fVg] .

Aoj:yfkg M

!= hlGd ;s]sf] lzz'nfO{ ;'/lIft / Gofgf] kf/L /fVg] . cfdfsf] k]6 lj:tf/} 5fd]/

kf7]3/df csf]{ aRrf gePsf] lglZrt ug'{xf];\ .

@= !) o'lg6 clS;6f]l;g ;'O{ lt3|fsf] df+;k]zLdf lbg' xf];\ . l;/LGhnfO{ ;'/lIft

:yfgdf km\ofFSg'xf];\ .

#= lzz'sf] hGdkl5 kf7]3/ 5fdL s8f ePsf] / gfn tGsL s]xL efu aflx/

lg:sLPsf] lgZrLt ug'{;\ . To; kl5 of]gL glhs} gfnnfO{ b'O{ cf}nfn] a]{g';\ .

$= csf]{ xftn] of]gL xf8sf] -l;Dkmofl;; Ko"la;_ dflykl§af6 kf7]3/nfO{ lj:tf/}

dflylt/ ws]Ng'xf];\ -sfpG6/ 6«ofS;g_.

%= gfnnfO{ clnslt tGsfP/ kf7]3/ v'Drg] k|s[ofnfO{ kv{g'xf];\ .

^= ;fn aflx/ lgsfNg gfnnfO{ lj:tf/} tnlt/ tfGg'xf];\ . . o;f] u{bf csf]{ xftn]

kf7]3/nfO{ lj:tf/} dflylt/ ws]Ng] sfd klg hf/Lg} /fVg'xf];\ . -of] k|s[ofnfO{

sG6«f]N8 s8{ 6«ofS;g elgG5 _

&= #) b]lv $) ;]s]G8;Dd gfnnfO{ tnlt/ tfGbf klg ;fn lg:s]g eg] gfnnfO{

tfGg] sfd aGb u/L Ps If0f kv{g' xf];\ .

gfnnfO{ xNsf ;Fu ;dftL /fVg';\ / kf7]3/ k'gM v'Drg] k|s[ofnfO{ kv{g';\ .

kf7]3/ v'Drg yfn]kl5 gfnnfO{ tnlt/ tfGg] / kf7]3/nfO{ lj:tf/}

dflylt/ ws]Ng] k|s[of hf/L /fVg'xf];\ .

*= ;fn aflx/ lg:s]kl5 To;nfO{ b'O{ xftn] ;dfO{ lemNnLx? a]/Lg] u/L 3'dfpb}

aflx/ tfGg'xf];\ .

(= lemNnLnfO{ of]gLaf6 lj:tf/} tfg]/ lgsfNg'xf];\ -;fn tyf lemNnLsf] ;a} c+z

aflx/ lg:s]sf] olsg ug{'xf];\_ .

!)= kf7]3/nfO{ t'?Gt} uf]nfsf/ ?kdf s8f eO{ gv'Dr];Dd dfln; ug'xf];\ .


2

!!= of]gLnfO{ xNsf;+u ;kmf ug'{xf];\ / of]gLdf 3fpm jf RofltPsf] 5÷5}g tyf

;fn jf lemNnLsf] s'g} c+z 5'6]sf] 5 ls eg]/ /fd|/L lg/LIf0f ug{'xf];\ .

!@= lzz' hGd]sf] klxnf] @ 306f;Dd k|To]s !% ldg]6df kf7]3/sf] dfln; ug]{

k|s[of hf/L /fVg'xf];\ . olb kf7]3/sf] df+zk];L v's'nf] ePsf] kfO{Pdf kf7]3/

s8f geO{Gh]n;Dd dfln; ub}{ ug{'xf];\ . -% b]lv !) ldg]6sf] km/sdf cfkm\gf]

kf7]3/ dfln; u/L /xg ;'Ts]/LnfO{ ;d]t dfln; ug]{ t/Lsf l;sfO{ lbg'xf];\_ .

!#= ;'Ts]/LnfO{ ;kmf u/L cf/fd ;Fu a:g d2t ug'{ xf];\ . gjhft lzz'sf] t'?Gt}

ug'{ kg]{ :ofxf/ u/L :tgkfg u/fpg ;'Ts]/LnfO{ ;xof]u ug'{ xf];\ .

!$= ;fn, k|of]u ePsf] l;/LGh / cGo a:t'x? pko'Qm 7fpFdf la;h{g ug'{ xf];\ /

cfkm\gf] xft w'g'xf];\ .

;d:ofsf] klxrfg M

lgDg cj:yfdf ;'Ts]/LnfO{ a9L ;'ljwf ePsf] :jf:Yo ;+:yfdf l;kmf/Lz ;fy k7fpg'

kb{5 .

!= lzz' hGd]sf] cfwf 306f ;Dddf klg ;fn aflx/ glg:s]df .

@= kf7]3/ pN6]df -e+8f/ kms]{df_ .

#= gfn leq} k;]df jf gfn r'l§Pdf .

$= of]gL leq 3fp ePdf jf of]gL RofltPsf] ePdf jf nuftf/ /Qm>fj

e}O{ /x]df .

@= nfdf] k|;j Aoyf

kl/efiff M

olb dlxnfnfO{ ;qmLo k|;j Aoyf -!) ldg]6df # eGbf al9 k6s kf7]3/ v'Dr]sf] /

Ps k6s v'Drbf $) ;]s]08 eGbf nfdf] cjlw ;Dd /xg]_ nfu]sf] * 306f eGbfal9

ePdf o:tf] ca:yfnfO{ nfdf] k|;j Aoyf elgG5 .

Aoa:yfkg M

;f]Wg] M

!= dlxnfsf] pd]/, ue{jlt ePsf] k6s, ljut / jt{dfg k|;"ltsf] ljj/0f .

@= Joyf nfUg z'? ePsf] ;do .

#= s'g} cGo ;d:of jf u'gf;f] .

x]g]{÷5fDg]÷hfFRg] M

!= dlxnfsf] /Qmrfk, tfkqmd, gf8L / Zjf;sf] ult hfFRg'xf];\ / hn

ljlgof]hgsf] l:yltsf] n]vfhf]vf ug'{;\ .

@= ue{sf] aRrfsf] d'6'sf] w8\sg ;'Gg'xf];\ -of] w8\sg k|lt ldg]6 !@) b]lv !^)

k6s x'g' kb{5_


3

#= k]6 5fd]/ ue{sf] aRrfsf] s'g rflx c+u tnlt/ kms]{sf] 5 kQf nufpg'xf];\ .

$= lemNnL km'6L;s]sf] eP kfgLsf] /+u x]g'{xf];\ . olb kfgLdf lbzf h:tf]

xl/of]/sfnf] /+u ldl;P/ cfPsf] 5 eg] ue{sf] aRrfnfO{ sl7g ePsf] eGg]

hgfpF5 .

pkrf/÷sfo{ M

!= dlxnfsf] /Qmrfk, gf8L, Zjf; ult / ue{sf] aRRffsf] d'6'sf] w8\sgsf]

n]vfhf]vf ug]{ .

@= dlxnf cr]tg -zs_ ePsf], ;+qmd0f, z/L/df kfgLsf] sld jf ue{sf]

aRrfnfO{ sl7g ePsf] cfef; ePdf t'?Gt pkrf/ ug]{ jf al9 ;'ljwf ePsf]

:jf:Yo ;+:yfdf k7fpg] Aoj:yf ug]{ .

#= ;qmLo k|;j Aoyf nfu]sf] cf7 306f eGbf al9 eof] eg] pQm dlxnfnfO{ al9

;'ljwf ePsf] :jf:Yo ;+:yfdf l;kmf/Lz ;fy k7fpg] Aoj:yf ug]{ .

#= ;'Ts]/L cj:yfsf] Hj/f]

kl/efiff M

;'Ts]/L jf ue{ktg ePsf] @$ 306f kl5 dlxnfsf] z/L/sf] tfkqmd #* l8u|L

;]lN;o; jf !))=$ l8u|L km/]gxfO6 eGbf 3]/} eof] eg] ;'Ts]/L cj:yfsf] Hj/f]

elgG5 . Hj/f] cfpgfsf] k|d'v sf/0f x'g\M :tgdf ;+qmd0f x'g', kf7]3/df ;+qmd0f x'g',

d'q gnLdf ;+qmd0f x'g' cyjf gzf leq /ut hDg' .

Joj:yfkg M

;f]Wg] M

!= ;'Ts]/L ePsf] ldlt / cGo s'g} ;d:ofx? 5 ls 5}g .

@= Hj/f] cfpg z'? ePsf] ;do .

#= z/L/sf] s'g} laz]if c+u b'v]sf] 5 ls 5}g .

$= b'u{lGwt of]gL>fj eO{ /x]sf] 5 ls 5}g .

%= lk;fj km]g{ sl7gfO{ ePsf] 5 ls 5}g, / lk;fj slt ;dosf] cGt/df eO

/xsf] 5 .

^= ?3f vf]sLsf] nIf0fx? 5 ls 5}g .

&= :tg ;fdfGo 5 ls uflgPsf] 5 <


!= dlxnfsf] /Qmrfk, tfkqmd, gf8L / Zjf;sf] ult hfFRg'xf];\ / hn

ljlgof]hgsf] l:ylt l6Kg'xf];\ . cr]tg -zs_ ePsf] nIf0f b]lvPdf t'?Gt

cr]tgsf] k|fylds pkrf/ u/L al9 ;'ljwf ePsf] :jf:Yo ;+:yfdf l;kmf/Lz

;fy k7fpg] Aoj:yf ug'{xf];\ .


4

@= :tg M :tg /ftf] ePdf, :tg ;'lGgPsf] / 5'bf v]/L b'Vg] 5 eg] :tgsf]

;+qmd0f ePsf] elg z+sf ug]{ . :tg ;'lGgPsf] / sdnf] 8Nnf] ePsf] ePdf

:tg kfs]sf] z+sf ug]{ .

#= k]6 M kf7]3/ 5fDbf b'Vg] / b'u{lGwt of]gL>fj ePdf kf7]3/sf] ;+qmd0f ePsf]

z+sf ug]{] .

$= ck/]zg u/]sf] k]6sf] 3fp cyjf of]gLsf] 3fp /ftf] ePdf, 5'Fbf b'v]df, kLk

au]df 3fpdf ;+qmd0f ePsf] z+sf ug]{ .

%= tNnf] k]6sf] d'lg cyjf sDd/ b'v]df d"q gnL ;DaGwL ;+qmd0f ePsf] z+sf

ug]{ .

^= lk8f}nfsf] df+zk]zL /ftf], ;'lGgPsf] / e]§fPsf] g;f 5'bf b'v]df g;f leq /ut

hd]sf] elg z+sf ug]{ .

&= ;fdfGo ;d:ofM kftnf] l;+ufg auL ?3fvf]sLsf] nIf0f eP ;fwf/0f

?3fvf]sLsf] z+sf ug]{ .

pkrf/÷sfo{ M

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], /


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]


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]


k7fpg] .


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];\ .


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];\ .


!= 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];\ .


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 .


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]

.

job aids - the health · pdf filejob aids for maternal and child health workers produced by:...

Documents