Obstetrics

Sepsis following pregnancy

This guideline from the RCOG covers management of post-natal sepsis (i.e. in the first 6/52 after delivery). Causes of sepsis following pregnancy In women presenting with infection postnatally, especially consider the following possible causes: UTI Endometritis Cellulitis (eg around cannulas or caesarean section scars) Mastitis Necrotising fasciitis (beware excruciating pain with little outward sign of…
Read more

Sign | Management of perinatal mood disorders

This is a useful resource if you have a woman who falls pregnant on medication used for depression. Things that I think are useful to remember are: Screening perinatal mood disorders There is no good screening test for problems. Mood should be asked about at booking then at the 6 week and 3 month checks. Postnatally,…
Read more

Antepartum Haemorrhage

Most of this guideline is aimed at secondary care. From our point of view: Any bleeding, including spotting needs evaluation in secondary care, even if painless. Beware cervical lesions as a cause, especially in women with a history of abnormal smears – if in doubt refer to colposcopy. Placenta Praevia – don’t do a VE, speculum…
Read more

Multiple pregnancy

Most of this is directed at secondary care. Things that may impact on us: Anaemia Do a FBC at 20 to 24/40, then again at the normal 28/40. This is because multiple pregnancies carry a higher risk of anaemia and folate deficiency. Aspirin for pre-eclampsia Multiple pregnancy is a risk factor for pre-eclampsia. Therefore, if…
Read more

Caesarean Section

The technical bits of guidance on caesarian section are directed at secondary care. There are 3 elements that really affect us. The first is that all pregnant women should be given information about caesarean-section (CS), given that 25% of women will go on to have one. The second element is in the after-care. Heavy bleeding…
Read more

Obstetric cholestasis

This is a good overview of the condition. Remember – it is a diagnosis of exclusion. Features: Pruritus without a rash (except excoriation). It is often worse at night and affects palms and soles too. Cholestatic symptoms (pale stool / dark urine / jaundice) Deranged LFT (transaminases / gamma-GT – bilirubin and bile acids may also be…
Read more

Rhesus D prophylaxis in pregnancy

This guideline is very relevant to us. Nothing has really changed, but it reiterates best practice. It applies to non-sensitised women (ie who don’t have anti-D antibodies on their booking bloods): When would we need to give it? Most of the time (eg terminations / evacuation of products etc), anti-D will be given in secondary…
Read more

RCOG | Breast cancer and pregnancy

A lot of this is aimed at specialists. There are some useful bits about preconception counselling in a woman who’s had breast cancer and also advice about breast feeding. The most useful things are: New presentation of breast lump – ensure you refer women as you would if they weren’t pregnant. Women can have treatment…
Read more

Maternal collapse

There is a good algorithm that you can print out on page 22. Remember that in BLS for a pregnant woman, you need a tilt to the left of 15°. This can be achieved by getting someone to put their knees under her right side. Remember that after 20/40, perimortem fetal delivery can save the…
Read more