By Geoffrey Chamberlain
(BMJ e-book) textual content has been up-to-date all through and redesigned within the present ABC structure. Covers association of care, common antenatal administration, fetal wellness, paintings in being pregnant, raised blood strain, preterm exertions, a number of being pregnant, audit of start, and extra. earlier version: c1993. Softcover.
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(BMJ publication) textual content has been up to date all through and redesigned within the present ABC structure. Covers association of care, general antenatal administration, fetal well being, paintings in being pregnant, raised blood strain, preterm hard work, a number of being pregnant, audit of delivery, and extra. past variation: c1993. Softcover.
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3 Rising risk of Down’s syndrome with increase in nuchal skin fold oedema (from Nicholaides et al. 2 • • • • • 26 Ultrasound soft markers of Down’s syndrome Dilated renal pelves Nuchal translucency/thickness Choroid plexus cysts Echogenic bowel Short femur Detection and management of congenital abnormalities Testing in mid-pregnancy 200 Structural abnormalities 180 Sacral meningocele Thoracic spine Thorax 160 α Fetoprotein (µg/l) Open neural tube defects such as anencephaly and open spina bifida allow ␣ fetoprotein to escape from cerebro-spinal fluid into the amniotic fluid, whence it is absorbed into the maternal blood, producing higher than normal concentrations.
The results of such minimally invasive management are as good as those of more conservative surgery, with the time spent in hospital and the emotional effects on the woman’s life being much reduced. B A B Any woman treated for an ectopic pregnancy should be warned of the increased chances of a recurrence. The increased risk is said to be seven times above background. 9 Tubal ectopic pregnancy. (A) Laparoscopic injection of methotrexate, a fetocidal substance. (B) Clamping and cutting out of the affected part of the tube at open surgery Vaginal bleeding in early pregnancy Gestational trophoblastic disease Causes Chromosomal changes in the fertilised oocyte lead to degeneration of the stem blood vessels in the villi in very early pregnancy, so producing a vast overgrowth of swollen villae (vesicles) inside the uterus.
They may bleed on stimulation. Carcinoma of the cervix is rare but important in women of childbearing age. It may cause bleeding on stimulation and examination with a speculum reveals the cause. If there is any doubt a biopsy must be performed under anaesthesia even when a woman is pregnant. A general maternal disease such as blood dysplasia, von Willebrand’s disease, or leukaemia may cause symptoms in rare cases. Lesions of the cervix or vagina may cause bleeding in early pregnancy. References 1 Westergaard J, Teisner B, Sinosich M et al.