By Sambit Mukhopadhyay, Edward Morris, Sabaratnam Arulkumaran
Algorithms in Obstetrics and Gynaecology provides the middle wisdom had to take on all occasions in obstetrics and gynaecology, in a based model. All algorithms are designed to aid speedy determination making within the such a lot clinically appropriate occasions to minimise the dangers of a bad final result. a number medical difficulties are lined from universal non-life-threatening emergencies resembling 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 rigorously based to make sure a logical development of inspiration to assist anticipation, early prognosis and recommended and applicable administration. Accompanying key studying issues spotlight the fundamental details from the subject. in accordance with present nationwide instructions and medical facts, the algorithms and care pathways can be utilized as a competent and functional source for day after day perform in obstetrics and gynaecology.
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The management of twin and triplet pregnancies in the antenatal period. NICE clinical guideline 129. pdf>. 23 Multiple pregnancy Screening for Down’s syndrome Algorithm for multiple pregnancy Multiple pregnancy diagnosed Establish chorionicity at 11–14 weeks Monochorionic Dichorionic Offer screening for Down’s syndrome using combined test. Discuss increased risks of pre-eclampsia, growth restriction, preterm labour Offer screening for Down’s syndrome using combined test. Discuss increased risks of pre-eclampsia, growth restriction, preterm labour Scan 2-weekly from 16 weeks for: Twin-twin transfusion syndrome Intrauterine growth restriction Fetal anomaly (18–20 weeks) Presentation (34–36 weeks) Scan 4-weekly from 20 weeks for: Intrauterine growth restriction Fetal anomaly (18–20 weeks) Presentation (36 weeks) Aim to deliver 36–37 weeks Aim to deliver 37–38 weeks Triplets/more Refer to fetal medicine unit Key learning points Discharge in pregnancy may be physiological or infective Sexually transmitted disease (STD) must be excluded Consider membrane rupture.
Further reading Aerospace Medical Association Medical Guidelines Task Force (2003). Medical Guidelines for Airline Travel, 2nd ed. Aviation, Space, and Environmental Medicine, 74 (5 Suppl), A1–19. American College of Obstetricians and Gynecologists (2011). Travel during pregnancy. Available at:
6/100 000 births by 1990 A dose of 500 IU of anti-D immunoglobulin will bind to fetal Rh antigens and neutralize up to 4 mL of Rh-positive fetal blood, preventing maternal sensitization Rh antigen and erthyrocyte antibody status is assessed at booking, and non-sensitized Rh-negative women are offered immunoprophylaxis (women who are already sensitized will not benefit) Following negative repeat erythrocyte antibody testing, an IM injection of immunoglobulin (collected from Rh-negative donors) is given at 28 weeks’ gestation Rh-negative women are also offered additional immunoprophylaxis after potential sensitizing events— anything which could involve FMH, including childbirth (where the baby is Rh-positive), trauma, APH, stillbirth, miscarriage or ectopic pregnancy, manual removal of placenta, and invasive procedures such as amniocentesis and CVS Regimens vary from country to country (minimum 250 IU before 20 weeks and 500 IU after 20 weeks) 250 IU at 28 weeks in the UK Anti-D should be given as soon as possible within 72 h of the event After delivery, the baby’s Rh status should be established by a cord blood sample.
Algorithms for Obstetrics and Gynaecology by Sambit Mukhopadhyay, Edward Morris, Sabaratnam Arulkumaran