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Anti-D – Rh(D) Negative Women
Recommendation 1 Second and Third Trimester (Basic Dose 625 IU) Recommendation 2 Recommendation 3 Good Practice Point Recommendation 5 Recommendation 6 Recommendation 7 Recommendation 8 Recommendation 9 Timing Recommendation Grade First Trimester All Rh(D) negative women (without preformed Anti-D) should be offered 250 IU Anti-D in cases of: – Abortion…
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Anticoagulation in Pregnancy for DVT/PE
First-line Therapy: Low Molecular Weight Heparin (LMWH) Unfractionated Heparin (UFH) Fondaparinux Warfarin Monitoring and Adjustment Peripartum Management Summary
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Preconception Counseling
Medical and Pregnancy History Supplements Nutrition and BMI Optimization Immunizations and Screenings Physical Examinations Lifestyle Modifications Pre-conception Testing Optimizing Health Before Conception Medication Review Counseling and Education Interpregnancy Intervals
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Mastitis
Epidemiology Risk Factors and Prevention Microbiology Clinical Assessment History and Physical Examination Breast Abscess Examination of the Infant and Breastfeeding Investigation Differential Diagnosis Management Ibuprofen or paracetamol for pain early antibiotic therapy is important to prevent abscess formation. Abx = dicloxacillin 500 mg orally, 6-hourly. For 10 days OR…
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UTI in pregnancy
from eTG Asymptomatic Bacteriuria in Pregnancy Acute Cystitis in Pregnancy Acute Pyelonephritis in Pregnancy Recurrent UTI and Bacteriuria in Pregnancy
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Medications in Lactation
Drug M/PAUC % maternal dose Comments Acid-suppressants: Cimetidine 1.7-5.8 5.4-6.7 Avoid in favour of safer alternatives with lower potential for side effects. May accumulate in milk due to active transport. Famotidine 1.5 1.6 Probably safe. Ranitidine 2.8 5.0-7.8 Probably safe when restricted to sporadic doses or a single dose…
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Breast Feeding
Signs of low breast mild supply Increase milk supply Cease breastfeeding Nipple pain
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Endometritis (postpartum)
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Vomiting in pregnancy (including hyperemesis gravidarum)
First line agents (mild symptoms ) Second line agents (moderate symptoms) Third line agents (severe symptoms – PUQE-24 score ≥13)
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Thyroid disease in pregnancy
AFP – Thyroid disease in the perinatal period http://www.racgp.org.au/afp/2012/august/thyroid-disease-in-the-perinatal-period/ Etg therapeutic guidelines – thyroid disorders and pregnancy Hypothyroidism Management Hyperthyroidism Management TSH Measurement Recommendations Iodine Supplementation Isolated Hypothyroxinaemia
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Pelvic instability in pregnancy
Pelvic instability is possibly related to an increase in the hormone relaxin which acts to create laxity in pelvic ligaments as the pelvic girdle adapts to an anticipated pregnancy. There may be a relationship between the levels circulating levels of relaxin and pelvic instability, however conclusive evidence remains forthcoming Most…
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Mental health problems in pregnancy
Risk factors for perinatal depression Antidepressant use during pregnancy b Potential benefits and harms to the patient and fetus associated with psychotropic use during pregnancy [NB1] [NB2] Fetus Patient Potential harms of psychotropic use miscarriagefetal death in utero stillbirthpreterm birthcongenital abnormality [NB3]growth restrictionpoor neonatal adaptationlong-term neurodevelopmental effects [NB4] stress…
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Pre-eclampsia/Hypertension in pregnancy
Diagnosis criteria the organ/system features Hypertension Proteinuria baseline blood long-term health risks Future risks if gestational hypertension Future risks if preeclampsia Future risks if severe preeclampsia, HELLP syndrome or eclampsia Gestational hypertension in future pregnancy Risk ranges from about 1 in 6 (16%) to about 1 in 2 (53%).…
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Epilepsy in pregnancy
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Decreased fetal movements
AFP: Decreased fetal movements- A practical approach in primary care setting http://www.racgp.org.au/afp/2014/november/decreased-fetal-movements-a-practical-approach-in-a-primary-care-setting/ Pregnancy factors and outcomes associated with decreased fetal movements Pregnancy factors associated with DFM Outcomes associated with DFM Fetal growth restrictionSmall for gestational agePlacental insufficiencyOligohydramniosThreatened preterm labourFetomaternal transfusionIntrauterine infections Congenital malformationPreterm birthPerinatal brain injuryDisturbed neurodevelopmentLow birth weightLow Apgar…
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PUPPP – pruritic urticarial papules and plaques of pregnancy
Rx
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Cholestasis of pregnancy
BMJs Best Practice – search Cholestasis of pregnancy Diagnosis of cholestasis in pregnancy is confirmed by: Clinical features Investigations Fetal surveillance Treatment of maternal pruritis
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Low back pain, pelvic pain in pregnancy
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Anaemia in pregnancy
AJGP Anaemia in pregnancy – https://www1.racgp.org.au/ajgp/2019/march/anaemia definition known risk factors Interpretation of pathology results Treatment recommendations of iron deficiency Supplement name Iron content Elemental iron content Ferro-Grad C Ferrous sulfate 325 mg 105 mg Ferro-Gradumet Ferrous sulfate 325 mg 105 mg Maltofer tablets Iron polymaltose 370 mg 100 mg Maltofer syrup…
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Gestational Diabetes
Classification Diagnosis Screening: 2nd Trimester – 24-28 weeks gestation Screening : 1st Trimester if multiple RFs for early diagnosis: if Bariatric Surgery HbA1c vs GTT Risks from GDM Maternal risks of GDM Fetal/ neonatal risks of GDM Mx Medications Follow-up
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Miscarriage
Definitions of Miscarriage: Risk Factors for Early Pregnancy Loss Epidemiology History and Physical Examination: Management of Miscarriage MIST Trial Findings: Recurrent pregnancy loss (RPL) Pregnancy loss by maternal age Maternal age (years) Rate of pregnancy loss (%) 20–24 11 25–29 12 30–34 15 35–39 25 40–44 51 >45 93 Common causes:…
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Placenta praevia
Placenta abruption Placenta acccreta Vasa previa
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Ectopic pregnancy
Risk Factors Clinical presentation If medical or expectant:
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Bleeding in pregnancy
First trimester vaginal bleeding Bleeding in second half of pregnancy (antepartum bleeding) Third term EPL irrespective of pregnancy location or management option. Determining viability and location of pregnancy
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Preterm Labour
Risk factors: – Previous preterm abnormality – Bacterial vaginosis – UTI/ STI – Gestational diabetes – Hypertensive disorders of pregnancy – Cervical incompetence (previous cone biopsy) – Intrauterine infection – Multiple pregnancy – Use of ART – Uterine abnormalities – Polyhydramnios/ oligohydramnios – Placental abruption/ previa – Interpregnancy duration of…
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postpartum
6 weeks BABY CHECK MOTHER Contraceptive options Contraceptive type Notes Contraindications Options for all women, including those breastfeeding Levonorgestrel intrauterine device Lasts up to five yearsFrequent spotting or bleeding in the first 3–5 months is common; thereafter, the device significantly reduces menstrual bleedingHigh level of effectivenessCan be inserted <48 hours postpartum/immediately…
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Antenatal care
First Visit (Booking Visit) History and Assessment Physical Examination Initial Investigations Supplement Recommendations Lifestyle and Dietary Advice Pre-pregnancy BMI (kg/m2) Rate of weight gain 2nd and 3rs trimester (kg/week) Recommended total weight gain range (kg) <18.5 underweight 0.51 12.5 to 18 18.5 to 24.9 normal weight 0.42 11.5 to 16 25.0…
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Preconception care
Here’s a refined version of your document with improved structure and clarity: Smoking and Substance Use Cessation Smoking Cessation Alcohol Cessation Recreational Drug Cessation Caffeine Reduction Folic Acid Supplementation Timing and Dosage Iodine Supplementation Nutrition and Weight Assessment Immunization Review Medication Review Teratogenic Medications to Avoid/Review: Health and Chronic Condition…