Obstetrics

Post pregnancy contraception

This is a new guideline from the FSRH on contraception after pregnancy. There is nothing particularly new about specific methods, but there are a few new interesting points (including a reminder that the COC can be used when breastfeeding from 6 weeks after delivery). Contraceptive options should be discussed antenatally. Ideally the chosen method of…
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RCOG | Ovarian Hyperstimulation Syndrome

This is a new guideline from the RCOG on managing ovarian hyperstimulation syndrome (OHS). Most patients will ultimately be managed in secondary care, but we need to be aware of it, as most women apparently attend the GP first. Two important points if you read no further! Most women present with abdominal pain and distention after…
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RCOG | Chickenpox in pregnancy

This is a new guideline from RCOG on managing chickenpox in pregnancy. It doesn't change our management, but I'm doing a quick summary as I often forget what is classed as significant contact and when immunoglobulin is advised. Why is it important?  Fetal Varicella Syndrome (FVS) can occur if a woman has chickenpox during pregnancy. It's…
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Nice | Antenatal and postnatal mental health

This is an updated guideline from Nice on antenatal and postnatal mental health. There really isn't anything earth shattering in this - most of it we would do anyway. I have highlighted some key points that I hadn't necessarily appreciated. This is not an exhaustive summary, just the things that were new for me. General guidance…
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RCOG | Management of beta thalassaemia in pregnancy

This guideline from RCOG is about the management of beta thalassaemia in pregnancy. I'm not going to go into much detail as it's a rare condition. It is useful to know this guideline is there if you have an affected lady. Pre-pregnancy issues May have trouble conceiving due to endocrine problems High risk pregnancies, so need pre-pregnancy…
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Nice | Vision amniotic leak detector

This guideline advises that the ‘Vision Amniotic Leak Detector’ can be used. This sounds like a rather handy device. The idea is to allow us to reliably exclude amniotic fluid leak as a cause of ‘wetness’ in pregnancy, thus reducing the need for onward referral and also reducing the need for internal examinations. It is a…
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Nice | Tobacco: harm-reduction approaches to smoking

This guideline will really change how we manage smoking cessation. Until now the emphasis has been on getting patients to stop smoking. This guideline recognizes the fact that although the nicotine is the addictive part of the cigarette, it is not the really harmful part. Many patients will be ready to try to stop smoking and…
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Ella-One and breast-feeding

This guideline notes that the advice for using this form of emergency contraception whilst breastfeeding has changed. Women should not breastfeed for 5 days after taking Ella-One. They should express and discard milk in that time to maintain production. Alternatives are Levonelle (with no breast-feeding restriction) and the copper coil (which can be used from…
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