Preparing for Safe Delivery Learning Objectives At the

Preparing for Safe Delivery

Learning Objectives At the end of the sessions, learners will be able to: • List the items of personal protective equipment (PPE) to be worn by the provider to conduct normal delivery • List the seven trays as per Go. I’s recommendation (depending upon level of facility) and three additional trays/kits, and their contents to be kept ready in LR • Describe the importance of pre-filled syringe with 10 IU Oxytocin kept ready before delivery by the side of delivery tray 2

Trays/Kits to be Kept in Labour Room 7 Trays (as per Go. I’s MNH Toolkit): • Delivery tray Additional trays/kits: • Episiotomy tray • Examination Tray • Medicine tray • PPH Management • Emergency drug tray Kit • Severe PE/E • Baby tray Management Kit • MVA tray • PPIUCD tray 3

Delivery Tray • • • Sterile Gloves Speculum, Urinary catheter -1 each Bowl for antiseptic lotion- 1 Sponge holding forceps-1 Gauze pieces, Cotton swabs Sterile perineal pads-2 Artery forceps-2 Scissor- 1 Kidney tray- 1 Cord clamp-1 4

Episiotomy Tray • Inj. Xylocaine 2% • 10 ml disposable syringe with needle • Episiotomy scissor, Artery forceps • Allis forceps, Sponge holding forceps, Toothed forceps • Thumb forceps, Kidney tray, Needle holder • Needle (round body and cutting) • Chromic catgut no. 0, Gauze pieces, Cotton swabs, Antiseptic lotion, Gloves 5

Baby Tray • Two pre-warmed towels/sheets for wrapping the baby (Baby should be received in a pre-warmed towel. Do not use metallic tray for receiving baby. ) • Mucus extractor, cotton swabs • Nasogastric tube, Gloves • Bag and mask, Sterilized thread/cord clamp, Needle (26 gauze) and syringe (1 ml) • Inj. Vitamin K, needle and syringe 6

Medicine Tray* • Inj. Oxytocin 10 IU (to be kept in fridge), Inj. Gentamicin, Inj. Vit K, Inj. Betamethason, Inj. Hydralazine • Cap Ampicillin 500 mg, Tab. Metronidazole 400 mg, Tab Paracetamol, Tab Ibuprofen, Tab B complex, Tab. Misoprostol 200 micrograms, Tab. Nifedipine, Tab. Methyldopa • IV fluids - Ringer lactate, Normal Saline, Magnifying glass (*Nevirapin and other HIV drugs only for ICTC and ART Centres) 7

Emergency Drug Tray** • Inj. Oxytocin (to be kept in fridge), Inj. Magnesium sulphate 50%, Inj. Calcium gluconate-10%, Inj. Dexamethasone, Inj. Ampicillin, Inj. Gentamicin, Inj. Metronidazole, Inj. Lignocaine-2%, Inj. Adrenaline, Inj. Hydrocortisone Succinate • Inj. Diazepam, Inj. Pheneraminemaleate, Inj. Carboprost (to be kept in fridge), Inj. Pentazocin chloride, Inj. Promethazine, Inj. Betamethasone (to be kept in fridge), Inj. Hydralazine • IV fluids- Ringer lactate, normal saline, IV sets with 16 -gauge needle at least two, IV Cannula, Vials for blood collection • Syringes and needles, Tab. Nifedipine, Tab. Methyldopa, Suction catheter, Mouth gag. • Ceftraixone (3 rd generation cephalosporin for L 3 facility) (**only for L 2, L 3 facilities) 8

MVA/EVA and PPIUCD Tray MVA/EVA Tray: • Gloves, speculum, anterior vaginal wall retractor, posterior vaginal wall retractor, sponge holding forceps • MVA syringe and cannulas, MTP cannulas • Small bowl of antiseptic lotion, sanitary pads, pads /cotton swabs, disposable syringe and needle, sterilized gauze/pads, urinary catheter PPIUCD Tray • Cu IUCD 380 A/ Cu IUCD 375 in a sterile package • PPIUCD Insertion Forceps, sims speculum, sponge holding forceps, bowl with swabs Only for L 3 facilities with PPIUCD trained provider) • Misoprostol tablet 9

Examination Tray • SS tray • Knee hammer • Bowl with cotton swabs • MCP cards • Sterile gloves • Blood and urine collection vials, alcohol swabs • Antiseptic solution bottle • Measuring tape • Stethoscope/ Foetoscope • RDKs (to be kept in refrigerator) • Uristix bottle • BP apparatus • Thermometer 10

PPH Management Kit • Wide bore cannula (number 16/18)- at least 2 • IV set, IV fluids (NS, RL), Syringes (10 m. L, 5 m. L, 2 m. L), Blood and urine collection vials • Inj. Oxytocin (to be kept in refrigerator), Tab. Misoprostol, Inj. Methylergometrine, Inj. Carboprost (to be kept in refrigerator) • Bowl with cotton swabs, Alcohol/spirit swabs, Antiseptic solution bottle, Adhesive tape, Suture material, Dry cotton swabs • Self-retaining catheter, Urobag, Syringe & distilled water for inflation • Long elbow-length sterile gloves, Sterile gloves • For Condom Tamponade: SS tray with lid, Sims speculum, SS bowl with swabs, Sponge holders, Suture material, Scissors, Foley’s catheter (16 no. ), Condoms, IV set, 500 m. L NS, PPE *Ensure availability of functional oxygen source with attachments, functional suction machine and functional BP apparatus and stethoscope. 11

Severe PE/E Management Kit • Mouth gag, Suction catheter • IV cannula, IV set, IV fluids (RL), Syringes (20 m. L, 10 m. L, 5 m. L) • Antihypertensive drugs (Labetalol- Tab & Inj. , Tab. Nifedipine) • Inj. Magnesium sulfate- at least 20 ampoules (1 amp = 1 gm) • 2% xylocaine, Alcohol swabs, Adhesive tape, Antiseptic solution bottle, Blood and urine collection vials • Self-retaining catheter, Urobag, Syringe & distilled water for inflation, dry cotton swabs • Sterile gloves, knee hammer, Inj. Calcium Gluconate *Ensure availability of functional oxygen source with attachments, functional suction machine and functional BP apparatus and stethoscope. 12

Pre-filled Oxytocin Syringe • Pre filled 10 IU oxytocin syringe (by the side of delivery tray) helps in ü Ensuring that the mother receives Inj Oxytocin 10 I. U. immediately after delivery ü Reducing confusion and need for health worker to step away from mother to pick and fill Oxytocin syringe 13

Key Messages • • For safe delivery PPE should be worn by providers to prevent infection • All seven trays must be kept ready in LR as recommended in Go. I’s MNH tool kit. • Always keep pre-filled syringe with 10 IU oxytocin by the side of delivery tray. This helps providers to ensure that mother receives it within one minute of delivery of baby 14