LEQUIPMENT, SUPPLIES, DRUGS AND LABORATORY TESTS
L2. EQUIPMENT, SUPPLIES, DRUGS AND TESTS FOR ROUTINE AND EMERGENCY PREGNANCY AND POSTPARTUM CARE
Hand washing
Clean water supply
Soap
Nail brush or stick
Clean towels
Waste
Bucket for soiled pads and swabs
Receptacle for soiled linens
Container for sharps disposal
Sterilization
Instrument sterilizer
Jar for forceps
Supplies
Gloves:
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utility
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sterile or highly disinfected
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long sterile for manual removal of placenta
Urinary catheter
Syringes and needles
IV tubing
Suture material for tear or episiotomy repair
Antiseptic solution (iodophors or chlorhexidine)
Spirit (70% alcohol)
Swabs
Bleach (chlorine base compound)
Impregnated bednet
Condoms
Alcohol-based handrub
Tests
Syphilis testing (e.g. RPR)
Proteinuria dip sticks
Container for catching urine
HIV testing kit (2 types)
Haemoglobin testing kit
Rapid diagnostic tests or Light microscopy
Drugs
Oxytocin
Ergometrine
Misoprostol
Magnesium sulphate
Calcium gluconate
Diazepam
Hydralazine
Ampicillin
Gentamicin
Metronidazole
Benzathine penicillin
Cloxacillin
Amoxycillin
Ceftriaxone
Trimethoprim + sulfamethoxazole
Clotrimazole vaginal pessary
Erythromycin
Ciprofloxacin
Tetracycline or doxycycline
Artesunate/Artemether
Quinine
Lignocaine 2% or 1%
Adrenaline
Ringer lactate
Normal saline 0.9%
Glucose 50% solution
Water for injection
Paracetamol
Gentian violet
Iron/folic acid tablet
Low-dose aspirin
Calcium tablets
Mebendazole
Sulphadoxine-pyrimethamine
Nevirapine (infant)
Zidovudine (AZT) (infant)
Once-daily fixed-dose combination of ARVs recommended as first-line ART according to national guidelines
Betamethasone or Dexamethasone
L3. EQUIPMENT, SUPPLIES AND DRUGS FOR CHILDBIRTH CARE
Warm and clean room
Delivery bed: a bed that supports the woman in a semi-sitting or lying in a lateral position, with removable stirrups (only for repairing the perineum or instrumental delivery)
Clean bed linen
Curtains if more than one bed
Clean surface (for alternative delivery position)
Work surface for resuscitation of newborn near delivery beds
Light source
Heat source
Room thermometer
Hand washing
Clean water supply
Soap
Nail brush or stick
Clean towels
Waste
Container for sharps disposal
Receptacle for soiled linens
Bucket for soiled pads and swabs
Bowl and plastic bag for placenta
Sterilization
Instrument sterilizer
Jar for forceps
Equipment
Blood pressure machine and stethoscope
Body thermometer
Fetal stethoscope
Baby scale
Self inflating bag and mask - neonatal size
Suction apparatus with suction tube
Infant stethoscope
Delivery instruments (sterile)
Scissors
Needle holder
Artery forceps or clamp
Dissecting forceps
Sponge forceps
Vaginal speculum
Supplies
Gloves:
- →
utility
- →
sterile or highly disinfected
- →
long sterile for manual removal of placenta
- →
Long plastic apron
Urinary catheter
Syringes and needles
IV tubing
Suture material for tear or episiotomy repair
Antiseptic solution (iodophors orchlorhexidine)
Spirit (70% alcohol)
Swabs
Bleach (chlorine-base compound)
Clean (plastic) sheet to place under mother
Sanitary pads
Clean towels for drying and wrapping the baby
Cord ties (sterile)
Blanket for the baby
Baby feeding cup
Impregnated bednet
Alcohol-based handrub
2 ml and 1 ml syringes (for giving ARV to babies)
Drugs
Oxytocin
Ergometrine
Misoprostol
Magnesium sulphate
Calcium gluconate
Diazepam
Hydralazine
Ampicillin
Gentamicin
Metronidazole
Benzathine penicillin
Lignocaine
Adrenaline
Ringer lactate
Normal saline 0.9%
Water for injection
Eye antimicrobial (1% silver nitrate or 2.5% povidone iodine)
Tetracycline 1% eye ointment
Vitamin A
Izoniazid
Nevirapine (infant)
Zidovudine (AZT) (infant)
Once-daily fixed-dose combination of ARVs recommended as first-line ART according to national guidelines
Contraceptives
(see Decision-making tool for family planning providers and clients)
Test
Syphilis testing (e.g. RPR)
Proteinuria dip sticks
Container for catching urine
HIV testing kits (2 types)
Haemoglobin testing kit
L4. LABORATORY TESTS
Check urine for protein
Label a clean container.
Give woman the clean container and explain where she can urinate.
Teach woman how to collect a clean-catch urine sample. Ask her to:
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Clean vulva with water
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Spread labia with fingers
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Urinate freely (urine should not dribble over vulva; this will ruin sample)
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Catch the middle part of the stream of urine in the cup. Remove container before urine stops.
Analyse urine for protein using either dipstick or boiling method.
DIPSTICK METHOD
Dip coated end of paper dipstick in urine sample.
Shake off excess by tapping against side of container.
Wait specified time (see dipstick instructions).
Compare with colour chart on label. Colours range from yellow (negative) through yellow-green and green-blue for positive.
BOILING METHOD
Put urine in test tube and boil top half. Boiled part may become cloudy. After boiling allow the test tube to stand. A thick precipitate at the bottom of the tube indicates protein.
Add 2-3 drops of 2-3% acetic acid after boiling the urine (even if urine is not cloudy)
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If the urine remains cloudy, protein is present in the urine.
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If cloudy urine becomes clear, protein is not present.
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If boiled urine was not cloudy to begin with, but becomes cloudy when acetic acid is added, protein is present.
Check blood for malaria parasites
Blood for the test is commonly obtained from a finger-prick.
The two methods in routine use for parasitological diagnosis are light microscopy and rapid diagnostic tests (RDTs).
The choice between RDTs and microscopy depends on local context, including the skills available, patient case-load, epidemiology of malaria and the possible use of microscopy for the diagnosis of other diseases.
L5. PERFORM RAPID PLASMAREAGIN (RPR) TEST FOR SYPHILIS
Perform rapid plasmareagin (RPR) test for syphilis
Seek consent.
Explain procedure.
Use a sterile needle and syringe. Draw up 5 ml blood from a vein. Put in a clear test tube.
Let test tube sit 20 minutes to allow serum to separate (or centrifuge 3-5 minutes at 2000-3000-rpm). In the separated sample, serum will be on top.
Use sampling pipette to withdraw some of the serum.
Take care not to include any red blood cells from the lower part of the separated sample.
Hold the pipette vertically over a test card circle. Squeeze teat to allow one drop (50-μl) of serum to fall onto a circle. Spread the drop to fill the circle using a toothpick or other clean spreader.
Important: Several samples may be tested on one card. Be careful not to contaminate the remaining test circles. Use a clean spreader for every sample. Carefully label each sample with a patient's name or number.
Attach dispensing needle to a syringe. Shake antigen.
1Draw up enough antigen for the number of tests to be done (one drop per test).
Holding the syringe vertically, allow exactly one drop of antigen (20-μl) to fall onto each test sample.
DO NOT stir.
Rotate the test card smoothly on the palm of the hand for 8 minutes.
2(Or rotate on a mechanical rotator.)
Interpreting results
Non-reactive (no clumping or only slight roughness) – Negative for syphilis
Reactive (highly visible clumping) – Positive for syphilis
Weakly reactive (minimal clumping) – Positive for syphilis
NOTE: Weakly reactive can also be more finely granulated and difficult to see than in this illsutration.
L6. PERFORM RAPID HIV TEST (TYPE OF TEST USED DEPENDS ON THE NATIONAL POLICY)
Use rapid HIV testing with same-day results using rapid diagnostic tests (RDTs) in antenatal care. If the laboratory testing is the policy for antenatal care you may use RDTs for the pregnant woman who comes to ANC late in pregnancy, the woman who only comes in labour or has not received her HIV results prior to labour.
Explain the procedure and seek consent according to the national policy.
Use test kits recommended by the national and/or international bodies and follow the instructions of the HIV rapid test selected.
Prepare your worksheet, label the test, and indicate the test batch number and expiry date. Check that expiry time has not lapsed.
Wear gloves when drawing blood and follow standard safety precautions for waste disposal.
Inform the woman for how long to wait at the clinic for her test result (same day or they will have to come again).
Draw blood for all tests at the same time (tests for Hb, syphilis and HIV can often be coupled at the same time).
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Use a sterile needle and syringe when drawing blood from a vein.
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Use a lancet when doing a finger prick.
Perform the test following manufacturer's instructions.
Interpret the results as per the instructions of the HIV rapid test selected.
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If the first test result is negative, no further testing is done. Record the result as – HIV-negative.
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If the first test result is positive, perform a second HIV rapid test using a different test kit.
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If the second test is also positive, record the result as - HIV-positive.
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If the first test result is positive and second test result is negative, repeat the testing.
Do a finger prick and repeat both tests.
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If both tests are positive or both are negative, record accordingly.
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If tests show different results, use another test, or record the results as inconclusive. Repeat the tests after 2 weeks or refer the woman to hospital for a confirmatory test.
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Send the results to the health worker. Respect confidentiality A2.
Record all results in the logbook.
- 1
Make sure antigen was refrigerated (not frozen) and has not expired.
- 2
Room temperature should be 73°-85°F (22.8°-29.3°C).
