Obs

• GDM and DM → offer IOL or ELCS between 37+0w and 38+6w (no later than 40+6w). Monitor capillary blood glucose every hour during labour. Discontinue blood glucose lowering treatment immediately after birth.
• Simple Analgesia of Choice throughout Pregnancy → paracetamol.
• IOL → prostaglandin pessary (24 hrs) > prostaglandin gel (6 hrly) > ARM > syntocinon infusion.
• Placenta Praevia → if woman presents with bleeding, first steps are to admit to antenatal ward, take FBC and G&S, and CTG monitoring. Then can do TVUSS to assess location of placenta.
• RA and MS (Th1-Mediated) → reduce in severity during pregnancy, as immune system shifts away from Th1 mediated responses to Th2.
• Anti-Epileptics in Pregnancy → may need higher dose due to increased renal and hepatic clearance of drugs during pregnancy. These changes reverse quickly post-partum, so AED should be reviewed within 10 days post-partum to adjust dose again.
• VBAC → 75% chance of success. 0.5% chance of uterine rupture (1% if syntocinon is used). Best indicator of successful VBAC is previous vaginal birth, previous VBAC makes odds of another successful one 85-90%.
• HIV in Pregnancy → require further testing for hepatitis C. If co-existent hepatitis C, require caesarean section with intrapartum IV zidovudine.
• Multiple Pregnancy → time at which zygote devides determines chorionicity and amnionicity. <day 4: DCDA, day 4-8: MCDA, day 8-12: MCMA, >day 13: conjoined.
• Glycosuria in Pregnancy → any woman with 2+ on one occasion or 1+ on two occasions should be assessed (OGTT).
• Erb’s Palsy → C5, C6 injury. Self-resolving, refer to physiotherapy.
• GBS → if previous baby has had GBS infection, offer intrapartum benzylpenicillin. If have previously been infected but child was not infected, then may have testing late in pregnancy.
• TOP → oral mifepristone (progesterone receptor antagonist to end the pregnancy) followed by vaginal/sublingual misoprostol (prostaglandin E1 analogue to expel the pregnancy) 36-48 hrs later.
• Pueperal Pyrexia → temperature of >38 within 14 days of delivery. Endometritis is mouse common cause, patient needs to be admitted to hospital for IV antibiotics (clindamycin and gentamicin).
• Breastfeeding → anti-epileptics (eg. lamotrigine) are safe to use.
• Cerebral Venous Sinus Thrombosis → headache and varying neurology post-partum. Ix: MRI. Mx: IV unfractionated heparin, followed by thrombolysis, followed by 3-6m of anticoagulation.
• Undiagnosed Breech in Labour → if still in first stage, category 2 c-section (within 75 mins). If in second stage, adopt an all-fours position for vaginal birth.
• Endometritis → risk is greatly increased by c-section compared to normal delivery.
• VZV (Chickenpox) → if mother affected 4 weeks before or 1 week after birth, baby should be given VZIG prophylaxis.