By Kelly, Claire; Clifford, Amie; Yau, Christopher; Hallam, Sally
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Extra resources for Obstetrics, gynaecology and women's health on the move
Placental abruption (see Chapter 7, Complications in labour) MICRO-facts Women with risk factors will have regular blood pressure monitoring and urinalysis. = Investigations: = Obstetrics = Maternal: – Diagnosis: k urinalysis; k urine cultures: to exclude infection; k proteinÁcreatinine ratio; k 24 hour urine collection for protein; k BP. – Checking for complications: k full blood count: to assess platelet levels and haematocrit; k urea and electrolytes: to assess renal function; urea levels should normally go down in pregnancy; k serum uric acid levels: may be owing to renal damage; uric acid levels tend to increase with gestation; k liver function tests (LFTs): to assess liver function; alkaline phosphatase is always raised in pregnancy; k lactate dehydrogenase: will be in haemolysis.
Some obstetricians do serial ultrasound scans and weekly or twiceweekly Doppler scans. = Management: = Induction of labour at 37 weeks’ gestation is usually recommended owing to the unpredictable nature of the disease. = Ursodeoxycholic acid: – may help relieve itching but is not licensed for use in pregnancy. = Water-soluble vitamin K: – cholestasis can reduce vitamin K absorption, increasing the risk of postpartum haemorrhage. = Prognosis: = Pruritus and abnormal LFTs should resolve post-delivery.
Haemorrhoids: = modify diet; = haemorrhoid creams if needed. Symphysis pubis dysfunction: = this is pain in the pubic and sacroiliac joints; = treatment: – analgesia; – physiotherapy. Itching: = commonly benign, but can be due to obstetric cholestasis (see Chapter 3, Medical problems in pregnancy). Ankle oedema: = commonly benign: advise raising the legs; = if sudden onset, exclude pre-eclampsia. Abdominal pain: = commonly benign, but do not forget surgical causes for the acute abdomen. 6 Common symptoms in pregnancy 21 = Vaginal candidiasis: = more common in pregnancy; oral treatment is contraindicated; use imidazole pessaries.
Obstetrics, gynaecology and women's health on the move by Kelly, Claire; Clifford, Amie; Yau, Christopher; Hallam, Sally