BOOK
Obstetrics: Prepare for the MRCOG
Philip N Baker | Alec S. McEwan | Sabaratnam Arulkumaran | Shreelata T Datta | Tahir A Mahmood | Fiona Reid | Mahmood I Shafi | Catherine Aiken
(2015)
Additional Information
Book Details
Abstract
Obstetrics is a new e-book presenting a collection of key articles from Obstetrics, Gynaecology and Reproductive Medicine, mapped by module to the MRCOG Part 2 exam.
As well as mapping to the MRCOG, the Inkling version of this e-book also enables anyone with a short-term interest in a specific area to buy individual articles at a price-point which will give affordable access to all readers (from medical students to GPs and practitioners in related areas, such a genitourinary medicine). Inkling’s app-like quality of user experience on mobiles, tablets and laptops will be an added bonus for learning on the move. As well as being vital preparation for the MRCOG exam, this material is also ideal for life-long learning, CPD and, indeed, preparation for all post-graduate exams in obstetrics (not just MRCOG), including especially the new EBCOG exam in Europe and local college exams in India.[the Middle East and Africa.
The parent journal is a rolling, continuously updated review of obstetrics over a three-year cycle covering all the important topics for the MRCOG Part 2 exam. Its Editorial Board comprises some of Europe’s most influential specialists and includes, among others, the current Presidents of FIGO and EBCOG, as well as the past President of the Royal College of Obstetrics and Gynaecology. The journal’s articles are refreshed, updated, augmented or replaced as appropriate each time the subject is due for revision to provide a concise overview of knowledge and practice core to the curriculum. Each article is written by invited experts and overseen by the relevant subject specialist on the Board. There is a trainee on the Board too, ensuring relevance and accessibility to exam candidates.
- Inkling version gives a highly attractive, app-like user experience, enabling much easier, more pleasurable use of the content on smartphones, tablets and laptops for learning on the move.
- Affordable chapter-level purchase on Inkling version opens out the journal’s authority and expertise to all interested users (medical students, family clinicians, genitourinary specialists and all other related specialties).
- Derived from top-notch authoritative content from the OGRM journal.
- Overseen by a world-class Editorial Board of experts, which includes the Presidents of FIGO, EBCOG and past President of the RCOG.
- A trainee representative on the Editorial Board ensures relevance and accessibility for exam candidates.
- Relevant to all post-graduate exams, including the new EBCOG exam and college exams in India, the Middle East and Africa.
- Highly appropriate content for life-long learning, personal development portfolios and CPD.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Obstetrics: Prepare for the MRCOG | Fm-1 | ||
| Copyright Page | Fm-4 | ||
| Table of Contents | Fm-7 | ||
| Preface | Fm-6 | ||
| About The Obstetrics, Gynaecology and Reproductive Medicine Journal and eBooks | Fm-10 | ||
| Section 1: Fetal | 1 | ||
| Suspected fetal anomalies | 1 | ||
| Introduction | 1 | ||
| Case 1: Diagnosis of maternal type 1 diabetes following diagnosis of fetal structural abnormality at 26 weeks gestation | 1 | ||
| Case 2: Use of free fetal DNA to determine fetal gender in a case of bladder exstrophy | 4 | ||
| Case 3: Diagnosis of an autosomal dominant genetic condition following detection of fetal upper limb abnormalities | 5 | ||
| Summary | 7 | ||
| Further reading | 7 | ||
| Fetal anaemia | 8 | ||
| Introduction | 8 | ||
| Case 1 | 9 | ||
| Fetomaternal haemorrhage (FMH) | 9 | ||
| Case 2 | 10 | ||
| Rhesus D isoimmunisation | 12 | ||
| Case 3 | 12 | ||
| Parvovirus B19 infection | 12 | ||
| Further reading | 14 | ||
| Stillbirth in the UK: current trends, investigation and opportunities for prevention | 15 | ||
| Introduction and trends | 15 | ||
| Aetiology | 15 | ||
| Investigations when a stillbirth occurs | 19 | ||
| Interventions to reduce stillbirth rates | 19 | ||
| Conclusion | 21 | ||
| Further reading | 21 | ||
| Advances in fetal therapy | 22 | ||
| Introduction | 22 | ||
| Pharmacotherapy | 22 | ||
| Fetal and neonatal alloimmune thrombocytopenia | 23 | ||
| Twin–twin transfusion syndrome (TTTS) | 23 | ||
| Radiofrequency ablation | 24 | ||
| Diaphragmatic hernia | 24 | ||
| Meningomyelocoele | 25 | ||
| Lower urinary tract obstruction | 25 | ||
| Genomics and free fetal DNA | 25 | ||
| Gene therapy and fetal stem cells | 26 | ||
| Summary | 26 | ||
| Further reading | 26 | ||
| Fetal infection: a pragmatic approach to recognition and management | 28 | ||
| Introduction | 28 | ||
| Case 1 (parvovirus) | 28 | ||
| Case 2 (cytomegalovirus) | 30 | ||
| Further reading | 32 | ||
| Prenatal diagnosis of single gene disorders | 33 | ||
| Introduction | 33 | ||
| Case example | 35 | ||
| Further Reading | 38 | ||
| Ultrasound in antenatal diagnosis of structural abnormalities | 39 | ||
| Introduction | 39 | ||
| Screening | 39 | ||
| Recommended strategy | 40 | ||
| Consent for ultrasound | 40 | ||
| Cost effectiveness of ultrasound | 40 | ||
| Population to be screened | 40 | ||
| Effectiveness of screening | 40 | ||
| First trimester screening for structural abnormalities | 41 | ||
| Structural abnormalities detectable by antenatal ultrasound | 41 | ||
| The use of 3 and 4 dimensional ultrasound in the detection structural abnormalities | 43 | ||
| Complimentary role of fetal MRI in structural abnormalities | 44 | ||
| Training issues | 44 | ||
| Safety of ultrasound | 44 | ||
| Conclusions | 44 | ||
| Further reading | 44 | ||
| Fetal macrosomia | 46 | ||
| Introduction | 46 | ||
| Risk factors | 46 | ||
| Suspected fetal macrosomia | 46 | ||
| Management | 47 | ||
| Summary | 48 | ||
| Further reading | 49 | ||
| Screening for Down syndrome | 50 | ||
| Introduction | 50 | ||
| Definitions | 50 | ||
| A historical perspective | 50 | ||
| National Screening Policy | 51 | ||
| Further improvements | 52 | ||
| The role of later ultrasound scanning in screening for Down syndrome | 53 | ||
| Non-invasive prenatal diagnosis | 54 | ||
| Consent and quality assurance | 54 | ||
| Further reading | 55 | ||
| From the UK NSC website: | 55 | ||
| Antepartum fetal health | 56 | ||
| Introduction | 56 | ||
| Assessment of risk and surveillance strategies | 56 | ||
| Low-risk pregnancy | 56 | ||
| High-risk pregnancy | 57 | ||
| Conclusion | 60 | ||
| Further reading | 60 | ||
| The diagnostic and therapeutic role of ultrasound in obstetrics | 61 | ||
| Introduction | 61 | ||
| Elective use of ultrasound | 61 | ||
| Reactive use of ultrasound | 65 | ||
| Conclusions | 66 | ||
| Further reading | 66 | ||
| Section 2: Maternal | 67 | ||
| Management of HIV infection in pregnancy | 67 | ||
| HIV and women | 67 | ||
| Natural history | 67 | ||
| Mother-to-child-transmission | 67 | ||
| Antenatal testing | 68 | ||
| Methods of MTCT | 68 | ||
| Stigma and mental health conditions in HIV positive pregnant women | 68 | ||
| Sexually Transmitted Infections (STIs) and pregnant women | 69 | ||
| HAART in pregnancy | 69 | ||
| Amniocentesis, cervical suture and invasive procedures | 69 | ||
| Late booking or women presenting in labour who are untested | 70 | ||
| Mode of delivery (see Table 1) | 70 | ||
| Pre-term delivery | 71 | ||
| Treatment to the newborn | 71 | ||
| Breast feeding in HIV positive women | 71 | ||
| Testing of infants | 71 | ||
| Conclusion | 71 | ||
| Further reading | 71 | ||
| Vaccinations in pregnancy | 73 | ||
| Introduction | 73 | ||
| General principles | 73 | ||
| Vaccinations with specific relevance to pregnancy (Table 2) | 74 | ||
| Vaccinations where indications are unchanged in pregnancy (see Table 2) | 77 | ||
| Travel vaccines | 78 | ||
| Relevant potential future vaccines | 78 | ||
| Conclusion | 78 | ||
| Further reading | 78 | ||
| Renal disease in pregnancy | 80 | ||
| Introduction | 80 | ||
| Renal physiology in normal pregnancy | 80 | ||
| Pregnancy in women with chronic kidney disease | 80 | ||
| Dialysis and pregnancy | 84 | ||
| Kidney transplantation and pregnancy | 85 | ||
| Further reading | 86 | ||
| Connective tissue disorders and dermatological disorders in pregnancy | 87 | ||
| Connective tissue disorders in pregnancy | 87 | ||
| Heritable connective tissue disorders | 87 | ||
| Autoimmune connective tissue disorders | 88 | ||
| Dermatological conditions in pregnancy | 91 | ||
| Dermatological conditions not specific to pregnancy | 92 | ||
| Dermatological conditions specific to pregnancy | 94 | ||
| Further reading | 96 | ||
| Prescribing in pregnancy | 97 | ||
| Introduction | 97 | ||
| 1: A framework for prescribing in pregnancy | 97 | ||
| 2: Prescribing for common medical conditions in pregnancy | 101 | ||
| 3: Prescribing for complex medical conditions in pregnancy | 103 | ||
| Further reading | 105 | ||
| Thyroid disorders and other endocrinological disorders in pregnancy | 106 | ||
| Thyroid physiology | 106 | ||
| Hypothyroidism | 106 | ||
| Hyperthyroidism | 107 | ||
| Vitamin D deficiency in pregnancy | 109 | ||
| Hyperparathyroidism | 110 | ||
| Hypoparathyroidism | 110 | ||
| Pituitary disorders in pregnancy | 110 | ||
| Cushing's syndrome | 111 | ||
| Adrenal disease | 112 | ||
| Conclusion | 113 | ||
| Further reading | 113 | ||
| Cardiovascular disease in pregnancy | 115 | ||
| Introduction | 115 | ||
| Cardiovascular physiology | 115 | ||
| Normal cardiovascular examination | 115 | ||
| Cardiac investigations in pregnancy | 116 | ||
| Pre-pregnancy counselling and contraception | 117 | ||
| Ischaemic heart disease | 118 | ||
| Aortic disease | 118 | ||
| Cardiomyopathy | 118 | ||
| Valvular heart disease | 119 | ||
| Prosthetic heart valves | 120 | ||
| Arrhythmias | 120 | ||
| Pulmonary hypertension | 120 | ||
| Congenital heart disease | 121 | ||
| Obstetric care in cardiac patients at delivery | 121 | ||
| Summary | 121 | ||
| References | 121 | ||
| Further reading | 121 | ||
| Hyperemesis, gastrointestinal and liver disorders in pregnancy | 122 | ||
| Overview | 122 | ||
| Pregnancy related gastrointestinal diseases | 122 | ||
| Pregnancy unrelated gastrointestinal diseases | 124 | ||
| Further reading | 126 | ||
| Advanced maternal age | 127 | ||
| Background | 127 | ||
| Introduction | 127 | ||
| Antenatal risks | 127 | ||
| Intrapartum risks | 131 | ||
| Advantages of later childbearing | 131 | ||
| Conclusion | 131 | ||
| Further reading | 132 | ||
| Abdominal pain in pregnancy: a rational approach to management | 133 | ||
| Case history | 133 | ||
| Rational approach to ‘abdominal pain’ in pregnancy | 133 | ||
| Effect of pregnancy on the diagnosis of underlying pathology | 134 | ||
| Common ‘pathological’ causes of abdominal pain during pregnancy and their management | 135 | ||
| Common obstetric conditions during late pregnancy that may present with ‘acute abdominal pain’ | 135 | ||
| Conditions associated with, but not caused by pregnancy | 137 | ||
| Abdominal pain due to gynaecological conditions | 138 | ||
| Conclusion | 140 | ||
| Further reading | 140 | ||
| Pre-existing type I and type II diabetes in pregnancy | 141 | ||
| Introduction | 141 | ||
| Physiological adaptations during pregnancy | 141 | ||
| Pre-pregnancy counselling | 141 | ||
| Lifestyle modifications | 142 | ||
| Review of medication | 142 | ||
| Management of diabetic complications during pregnancy | 142 | ||
| Diabetic medication during pregnancy | 143 | ||
| Management of pre-existing diabetic complications | 144 | ||
| Antenatal management | 144 | ||
| Conclusions | 146 | ||
| Further reading | 146 | ||
| Gestational diabetes | 147 | ||
| Introduction | 147 | ||
| Epidemiology | 147 | ||
| Pathogenesis | 147 | ||
| Diagnostic criteria | 147 | ||
| Perinatal complications (Box 2) | 148 | ||
| Rationale for treatment | 148 | ||
| Screening | 149 | ||
| Management | 150 | ||
| Acceptability of treatment | 151 | ||
| Obstetric considerations | 151 | ||
| Neonatal care | 152 | ||
| Long-term risks for women | 152 | ||
| Long-term risks for baby | 152 | ||
| Conclusions | 152 | ||
| Further reading | 152 | ||
| Substance misuse in pregnancy | 154 | ||
| Introduction | 154 | ||
| Case 1 (booking) | 154 | ||
| Case 2 (booking) | 155 | ||
| Case 2 (antenatal care) | 156 | ||
| Case 2 (antenatal care) | 157 | ||
| Case 1 (intrapartum care) | 157 | ||
| Case 2 (intrapartum care) | 157 | ||
| Case 1 (post-natal care) | 158 | ||
| Case 2 (post-natal care) | 158 | ||
| Further reading | 158 | ||
| Neurological disease in pregnancy | 160 | ||
| Epilepsy | 160 | ||
| Headache | 161 | ||
| Cerebrovascular disorders | 163 | ||
| Multiple sclerosis | 163 | ||
| Myasthenia gravis | 163 | ||
| Cerebral tumours | 164 | ||
| Myotonic dystrophy | 164 | ||
| Bell's palsy | 164 | ||
| Entrapment neuropathies | 164 | ||
| Further reading | 165 | ||
| Cancer in pregnancy | 166 | ||
| Introduction | 166 | ||
| Investigations and imaging in pregnancy | 166 | ||
| Management | 166 | ||
| Treatment | 166 | ||
| Organ pathology | 168 | ||
| Summary | 172 | ||
| Further reading | 172 | ||
| An obstetrician's guide to perinatal psychiatry | 173 | ||
| Introduction | 173 | ||
| Case 1 | 173 | ||
| Epidemiology of mental illnesses in pregnancy and post-partum | 173 | ||
| Obstetrician's role in identification of women who require referral to mental health services | 173 | ||
| Case 2 | 174 | ||
| Risk of relapse post-partum | 174 | ||
| Case vignette 3 | 174 | ||
| Post-partum psychosis | 174 | ||
| Management of pregnant women with mental illnesses | 175 | ||
| Medication in pregnancy | 175 | ||
| Medication during lactation | 176 | ||
| Other interventions | 176 | ||
| Mental Health Act and Mental Capacity Act | 176 | ||
| Referral to Social Care | 176 | ||
| Case 4 | 176 | ||
| Conclusion | 177 | ||
| Further reading | 177 | ||
| Sickle cell disease in pregnancy | 178 | ||
| Introduction | 178 | ||
| Background | 178 | ||
| Definition | 178 | ||
| Pathophysiology | 178 | ||
| Erythrocyte changes | 178 | ||
| Clinical features | 179 | ||
| Impact on maternal and fetal outcome | 179 | ||
| Screening | 179 | ||
| Management | 180 | ||
| Case study | 186 | ||
| Conclusion | 186 | ||
| Further reading | 186 | ||
| Respiratory disease in pregnancy | 188 | ||
| Introduction | 188 | ||
| Asthma | 188 | ||
| Respiratory tract infections | 191 | ||
| Cystic fibrosis | 194 | ||
| Bronchiectasis | 194 | ||
| Pulmonary arterial hypertension | 194 | ||
| Cystic fibrosis lung transplant recipients | 195 | ||
| Restrictive & fibrotic lung diseases | 195 | ||
| Conclusion | 195 | ||
| Further reading | 196 | ||
| Bleeding disorders in pregnancy | 197 | ||
| Introduction | 197 | ||
| Thrombocytopenia in pregnancy | 197 | ||
| Thrombotic microangiopathies | 200 | ||
| Inherited coagulation factor deficiencies | 201 | ||
| Further reading | 203 | ||
| The implications of obesity on pregnancy outcome | 205 | ||
| Miscarriage | 205 | ||
| Gestational diabetes | 205 | ||
| Fetal risks | 207 | ||
| Labour and delivery | 207 | ||
| Further reading | 207 | ||
| Urogynaecological complications in pregnancy: an overview | 209 | ||
| Physiological changes to the urinary tract during pregnancy | 209 | ||
| Urinary tract infection in pregnancy | 209 | ||
| Urolithiasis | 210 | ||
| Urological injury at caesarean section | 211 | ||
| Urinary retention | 212 | ||
| Urological cancer in pregnancy | 212 | ||
| Further reading | 212 | ||
| Venous thromboembolism in pregnancy | 214 | ||
| Introduction | 214 | ||
| The scale of the problem | 214 | ||
| Physiological changes in the coagulation system during pregnancy | 214 | ||
| Risk factors for venous thromboembolism in pregnancy | 214 | ||
| Prevention of venous thromboembolism in pregnancy | 215 | ||
| Conclusion | 217 | ||
| Further reading | 217 | ||
| Section 3: General obstetrics: (antenatal, intrapartum and postnatal) | 225 | ||
| Routine antenatal management at the booking clinic | 225 | ||
| Introduction | 225 | ||
| The first antenatal booking visit | 225 | ||
| Identification of risk factors | 225 | ||
| Antenatal care and education | 226 | ||
| Antenatal care and lifestyle | 226 | ||
| Advice on diet and use of supplements before and during pregnancy | 226 | ||
| Minor ailments of pregnancy | 228 | ||
| Clinical examination | 228 | ||
| Routine (booking) blood tests | 229 | ||
| Screening for haematological disorders | 230 | ||
| Screening for infections | 230 | ||
| Screening for fetal anomalies | 231 | ||
| Further reading | 232 | ||
| Routine antenatal management later in pregnancy | 233 | ||
| Introduction | 233 | ||
| Why provide antenatal care? | 233 | ||
| What pattern of care is effective? | 233 | ||
| Screening for clinical problems | 234 | ||
| BMI should be reassessed in the third trimester in overweight women | 238 | ||
| Maternal request for a Caesarean section | 238 | ||
| Further reading | 238 | ||
| Common symptoms and signs during pregnancy | 240 | ||
| Introduction | 240 | ||
| Physiological adaptations during pregnancy | 240 | ||
| Conclusion | 243 | ||
| Further reading | 243 | ||
| Antenatal management of teenage pregnancy | 245 | ||
| Introduction | 245 | ||
| Teenage Pregnancy Strategy and beyond | 245 | ||
| Risk factors for teenage pregnancy | 245 | ||
| Antenatal care | 245 | ||
| Engaging teenagers in maternity care | 249 | ||
| Conclusion | 250 | ||
| Further reading | 250 | ||
| Therapeutic strategies for the prevention and treatment of pre-eclampsia and intrauterine growth restriction | 251 | ||
| Introduction | 251 | ||
| Case 1. Intrauterine growth restriction – therapies for prevention | 251 | ||
| Intrauterine growth restriction – therapies for treatment | 252 | ||
| Intrauterine growth restriction – potential new strategies for prevention or treatment | 253 | ||
| Case 2. Pre-eclampsia – therapies for prevention | 253 | ||
| Case 3. Pre-eclampsia – therapies for treatment | 254 | ||
| Pre-eclampsia – potential new strategies for prevention or treatment | 255 | ||
| Conclusion | 256 | ||
| Further reading | 256 | ||
| Twin pregnancy | 257 | ||
| Introduction | 257 | ||
| Zygosity and chorionicity | 257 | ||
| First trimester screening | 257 | ||
| Anomaly screening | 257 | ||
| Management of twins discordant for fetal anomaly | 258 | ||
| Abnormalities specific to twins | 258 | ||
| Anomalies confined to monochorionic gestations | 259 | ||
| Twin reversed arterial perfusion sequence (TRAP) | 260 | ||
| Monochorionic, monoamniotic twins | 260 | ||
| Conjoined twins | 261 | ||
| Antenatal management | 261 | ||
| Conclusions | 262 | ||
| Further reading | 262 | ||
| Prolonged pregnancy | 263 | ||
| Definition | 263 | ||
| Incidence | 263 | ||
| Calculation of gestational age | 263 | ||
| Risk factors | 263 | ||
| Aetiology, pathophysiology, and clinical risks | 264 | ||
| Management | 264 | ||
| Planned delivery | 265 | ||
| Expectant management | 265 | ||
| Economic considerations | 266 | ||
| Intrapartum management | 266 | ||
| Conclusion | 266 | ||
| Further reading | 266 | ||
| Antepartum haemorrhage | 268 | ||
| Introduction | 268 | ||
| Case 1 | 268 | ||
| Case 2 | 269 | ||
| Discussion | 270 | ||
| Antenatal management | 270 | ||
| Imaging evaluation | 271 | ||
| Use of blood and blood components | 271 | ||
| Further reading | 272 | ||
| Current challenges in pregnancy-related mortality | 273 | ||
| Introduction | 273 | ||
| Definitions | 273 | ||
| Measures of maternal mortality | 273 | ||
| Limitations in calculating maternal mortality and cause of death | 274 | ||
| Current estimates of maternal mortality | 274 | ||
| Trends in maternal mortality | 274 | ||
| The aetiologies of maternal mortality | 274 | ||
| Reducing maternal mortality | 277 | ||
| Conclusion | 280 | ||
| Further reading | 280 | ||
| Management of a woman with a previous preterm birth | 281 | ||
| Introduction | 281 | ||
| Case history – part 1 | 281 | ||
| Case history – part 2 | 283 | ||
| Conclusion | 285 | ||
| Further reading | 286 | ||
| Induction of labour | 287 | ||
| Introduction | 287 | ||
| Physiology of labour | 287 | ||
| Prevention of induction of labour | 288 | ||
| Indications for induction of labour | 288 | ||
| Contraindications to induction of labour | 288 | ||
| Timing of induction of labour | 288 | ||
| Methods of induction of labour | 289 | ||
| Induction of labour in women with previous caesarean sections | 291 | ||
| Monitoring and pain relief associated with induction of labour | 292 | ||
| Conclusion | 292 | ||
| Further reading | 292 | ||
| Management of preterm labour | 294 | ||
| Introduction | 294 | ||
| Incidence of preterm birth | 294 | ||
| Causes of preterm birth | 294 | ||
| Prediction – in the general population and those at increased risk | 294 | ||
| Therapeutic interventions to prevent PTL in those at high risk | 295 | ||
| Diagnosis of PTL | 297 | ||
| Treatment of PTL | 297 | ||
| Further reading | 300 | ||
| Mechanisms and management of normal labour | 301 | ||
| Physiology of normal labour | 301 | ||
| Normal labour | 302 | ||
| Mechanisms of normal labour | 303 | ||
| Other mechanisms | 303 | ||
| Management of labour | 304 | ||
| Assessing maternal well-being | 304 | ||
| Assessing fetal well-being | 304 | ||
| Assessing progress of labour | 304 | ||
| Management of suspected delay in normal labour | 304 | ||
| Pain relief | 305 | ||
| Posture in labour | 305 | ||
| Further reading | 305 | ||
| Prioritization on the labour suite | 307 | ||
| General principles | 307 | ||
| Consultant presence on labour suite | 308 | ||
| Simulation training | 308 | ||
| Prioritizing (triage) the workload | 308 | ||
| Use of resources and managing challenging situations | 309 | ||
| Example of a labour suite board (Table 1) | 309 | ||
| Further reading | 311 | ||
| Intrapartum fetal surveillance | 312 | ||
| Introduction | 312 | ||
| Case 1 | 312 | ||
| Patterns of hypoxia resulting in birth injury | 313 | ||
| Case 2 | 314 | ||
| Case 3 | 317 | ||
| CTG monitoring, medico-legal issues and best practice recommendations | 319 | ||
| Best practice recommendations and risk management issues related to EFM | 319 | ||
| Patient identity | 319 | ||
| Maternal pulsations | 319 | ||
| Poor quality of the trace | 320 | ||
| Misinterpretation of CTGs | 320 | ||
| Inappropriate action with suspicious or pathological CTG | 320 | ||
| Role of adjuvant tests | 320 | ||
| Overall clinical picture and pattern evolution of CTG | 320 | ||
| Diagnosis to decision to deliver interval | 321 | ||
| Teamwork and communicating findings | 321 | ||
| Storage of CTG | 321 | ||
| Training in CTG interpretation | 321 | ||
| Audit and risk management | 321 | ||
| Conclusion | 321 | ||
| Further reading | 321 | ||
| Meconium in labour | 323 | ||
| Introduction | 323 | ||
| Formation and composition of meconium | 323 | ||
| Normal maturation of fetal gastrointestinal tract | 323 | ||
| Grading of meconium | 324 | ||
| Intrapartum management | 324 | ||
| Meconium in the term fetus | 324 | ||
| Meconium in the pre-term fetus | 325 | ||
| Complications of meconium-stained amniotic fluid | 325 | ||
| Meconium aspiration syndrome | 325 | ||
| Infection | 327 | ||
| Prevention of meconium aspiration syndrome | 327 | ||
| Amnioinfusion | 327 | ||
| Induction of labour at 41 weeks | 328 | ||
| Other potential methods | 328 | ||
| Conclusion | 328 | ||
| Further reading | 328 | ||
| Malpositions and malpresentations of the fetal head | 329 | ||
| Introduction | 329 | ||
| Fetal head presentations and positions – definitions and mechanisms of labour | 329 | ||
| Aetiology of malpresentations and malpositions of fetal head | 329 | ||
| Clinical presentation and diagnosis | 330 | ||
| Signs of obstructed labour | 331 | ||
| Obstetric outcomes associated with malpositions or malpresentations of the fetal head | 331 | ||
| Occipitoposterior position (OP) | 332 | ||
| Causes | 332 | ||
| Mechanism of labour | 332 | ||
| Diagnosis | 333 | ||
| Prevention | 333 | ||
| Management | 333 | ||
| Role of ultrasound assessment of the fetal head position at instrumental delivery | 334 | ||
| Occipitotransverse position | 334 | ||
| Face presentation | 334 |