Perineal Tears

• Grade 1 → superficial damage, no muscle involvement. No repair required.
• Grade 2 → injury to perineal muscle, no anal sphincter inolvement. Repair on ward by experienced midwife or clinician.
• Grade 3 → involves anal sphincter complex. Repair in theatre by clinician.
  • 3a → <50% EAS.
  • 3b → >50% EAS.
  • 3c → IAS.
• Grade 4 → involves anal sphincter complex (EAS and IAS) and rectal mucosa. Repair in theatre by clinician.

Physiological Changes in Pregnancy

• Increase in cardiac output. (Drop in CO occurs immediately after delivery).
• Increase in tidal volume. Causes increased minute ventilation (this increased respiratory workload results in a feeling of breathlessness). Decrease in total lung capacity.
• Decrease in platelet count (gestational thrombocytopenia = occurs late in pregnancy).
• Increase in basal metabolic rate.
• Increase in GFR → redcued serum urea, reduced serum creatinine, increased urinary protein loss.

Medications C/I in Breastfeeding → lithium, aspirin, methotrexate, benzodiazepines, amiodarone, sulphonamides, tetracyclines, chloramphenicol, ciprofloxacin, carbimazole.

Puerperal Pyrexia → temperature of >38ºC in the first 14 days following delivery. Causes: endometritis (most common), UTI, wound infection, mastitis, VTE.

EDD → add one year and seven days to the first day of the LMP and subtract three months. (if period >28 days, add extra days on).

Shoulder Dystocia