Algorithms for Obstetrics and Gynaecology by Sambit Mukhopadhyay, Edward Morris, Sabaratnam Arulkumaran

By Sambit Mukhopadhyay, Edward Morris, Sabaratnam Arulkumaran

Algorithms in Obstetrics and Gynaecology offers the center wisdom had to take on all occasions in obstetrics and gynaecology, in a based type. All algorithms are designed to help swift determination making within the such a lot clinically appropriate events to minimise the hazards of a terrible consequence. a number of scientific difficulties are lined from universal non-life-threatening emergencies akin to hyperemesis in being pregnant, to life-threatening acute occasions corresponding to ectopic being pregnant, acute fetal misery or maternal cave in.

Each subject is gifted as both an set of rules, a care pathway, or desk of key info and has been conscientiously based to make sure a logical development of notion to assist anticipation, early prognosis and recommended and acceptable administration. Accompanying key studying issues spotlight the fundamental details from the subject. according to present nationwide instructions and scientific proof, the algorithms and care pathways can be utilized as a competent and useful source for everyday perform in obstetrics and gynaecology.

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Pdf>. Care pathway for the management of constipation Constipation Slow-transit constipation Obstructive constipation • Increase fibre content of diet and fluid intake • Avoid commercial sources of fibre which can affect colonic bacteria • Refer to dietician The use of laxatives should be restricted to severe cases Osmotic laxatives Preferred to stimulatory laxatives Stimulatory laxatives • Irritant suppositories can be used to overcome minor obstruction • Enemas should be restricted to management of elderly, infirm and immobile patients, and those with neurological disorders • Surgery should be considered for those with anatomical lesions • Pelvic floor dysfunction is treated with biofeedback therapy 40 Urinary tract symptoms in pregnancy Non-urgent obstetrics Key learning points Common urinary symptoms are often related to physiological changes in pregnancy Repeated urinary infections can be a sign of underlying renal disease Routine antenatal urinalysis is important to detect UTI and pre-eclampsia.

8% of 16–24 year olds report taking ectasy in the previous year in 2010–11. General principles about treatment of substance misuse See Care pathway. Further reading Home Office Statistical Bulletin (2011). Drug misuse declared: findings from the 2010/11 British Crime Survey, England and Wales. pdf>. Substance misuse in pregnancy Specific pregnancy issues 20 National Institute for Health and Clinical Excellence (2010). Pregnancy and complex social factors: a model for service provision for pregnant women with complex social factors.

It is important to identify whether these symptoms are reflections of normal physiological changes in pregnancy or whether they represent an underlying pathology. 5 cm during pregnancy ● Increase in volume of up to 30% Dilation of renal pelvices (hydronephrosis) and dilatation of the ureters (hydroureter) ● Causes: o High progesterone levels reduce ureteric tone, peristalsis, and contraction pressure o Mechanical compression at the pelvic brim—right side > left side o Uterine enlargement causes elongation and lateral displacement of ureters ● Occurs in up to 80% of pregnancies ● Commonly asymptomatic ● Right side is affected more than the left ● Results in increased volume of urine in the collecting system (200–300 mL) o Reservoir of urine o Increased risk of pyelonephritis and UTI Bladder changes ● Progesterone-induced bladder wall relaxation can increase capacity ● Compression from enlarging uterus causes displacement and reduced capacity Intermittent vesicoureteric reflux ● Causes: o Incompetence of the vesicoureteral valve o Increased intravesical pressure o Decreased intraureteral pressure Biochemical changes—fall in serum creatinine and urea due to increased renal plasma flow.

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