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Is, oh, um, the five B risks, there are the reasons why people might get screened. So a lot of them is because their BMI is over 30. So like even if it's 30.1 they get screened, um, if they've had previous gestational diabetes, um they get a screen test, theirs is done earlier. Theirs is done at 16 weeks. Everyone else is done between 24 and 28 weeks. Um, their ethnic origin. So it's usually like South Asian and sort of Africa Caribbean ethnicities, a previous large for gestational age or macrosomic baby and a first degree relative. So mom, dad, brother, sister with diabetes, including if like a sister or mom had gestational diabetes, um, people also will get referred for a glucose tolerance test if at any stage during the pregnancy when they're being um, uh growth scan or getting their measurements done if they become like a really large baby on the 90th 95th sent out. So they're um big babies or if there's polyhedrosis too much fluid that can be a risk or a sign of gestational diabetes. So they'll get screened as well. Um, those, um, are your results for a positive G TT. So above 5.6 for fasting and above 7.8 for two hours after they're kind of different threshold used in Northern Ireland. But that's what passed says, that's what their final says. So that's what I would use. It's easy to remember 5678. for any question that you might get. Um although it is slightly different on the guidelines here, but don't worry about that. Um Management, then this is also a really common question. So if their fasting sugars are above seven, they immediately start insulin. If they're less than seven, they start with diet and exercise. So really strict diet like can't eat chocolate, can really even eat sandwiches, I don't think is too much um sugar release. Um And then they have to check their sugars after or before every meal and um things like that and then it'll get reviewed by the di diabetic team. Then they'll decide if they need Metformin or a step up to insulin risks of DDM. I find this on. So probably there finals don't know. Um Smash. So stillbirth, macrosomia amniotic fluid excess, which is poly shoulder dis associate because of the big babies and hyperglycemia in the neonatal period. Um And then postnatally, sugar control should go back to normal once the baby is born. So in placement last year, a mom said to me like, oh plus baby out chocolate. And so just as soon as they have the baby out, they can resume their normal diet, um, but they do need to get a six week postnatal glucose checked by their GP or their, um, health visit or whatever. Um, just to check that they're not still high and long term wise in for their general health, they have a high risk of type two diabetes. So they probably should be a bit more aware of what they're eating and stuff like that. So, antenatal care, then this is kind of just things that um will be done at every appointment and then a few complications and stuff that can arise. So we got a growth chart in our fourth year. Oy, which I didn't really think would come up, but it did. So just familiar, familiarize yourself with the growth chart. So every woman's is different. Um they'll be done based on their ethnicity, their height, their weight and any previous babies that they've had. So all those lines that you see on the page, those sent lines will be different for every month. So it's not a case of one size fits all. Um So the little X that's on that chart is fundal height. So this is a low risk woman who's just getting their tape measuring done of their tummy and then if there's a circle that is a scan, so that's like a consultant led patient. So the sent lines trend or like a trend of their growth. So they should ideally follow along a sent line like this one roughly is just below the 50th. Um If it's not, if it's going up, um they might get referred for a DDT, like we said, if it's becoming static. So like not moving up as much as it can. After each appointment, they might get referred. Well, they should get referred for a, a scan by consultant. Um and then if it's falling, obviously, that's a concern as well. So, um and they'll get referred for a scan as well. So at the scan, they look at three things. So they look at their amniotic fluid index, which is the AF I So you'll maybe in clinics see them looking at four different quadrants and measuring the amount of fluid um to see if there's too much or too little, they'll look at growth. So that's again, like before the bipyramidal diameters, the head circumference, the abdominal circumference and the feet femur length and then the scanner machine comes up with an estimated weight and then that's got plotted and then the Doppler through the umbilical artery. And I've got we um picture of that to show you what I mean by that in a few slides time. So um small for gestational age and intrauterine growth restriction kind of the same thing. Kind of not so small for gestational age is when the growth is below the 10th. It may just be the baby is small and the mom is small and they're just going to be small and there's no concerning underlying features. Um It may also be um concerning. So, um if it is just small, they will get um growth and Doppler done every two weeks and CTT to make sure there's no um fetal distress or any concern features like decelerations or anything. And if that's normal, they just continue with their normal appointment scan scanned and if it's not normal, then um we need to do something about it. So it might be a case of growth restriction rather than just a constitutionally small baby. So in growth restriction can be caused by loads of things. So commonly it's placental problems. So um preeclampsia, diabetes, smoking, drinking, um and then the baby's just not getting enough nutrition. It may also be because the mom is malnourished and then they're getting malnutrition because of that might be due to infections like cytomegalovirus rubella. That's why you screen for those at booking and then it may be a congenital problem. Um So Trisomy Turner syndrome and things like that and they'll be referred to fetal medicine who have very fancy scanners and do very fancy things. Um but not a lot of people get referred there other signs that a baby might be restricted if their movements aren't so good. The mom notices a change in their pattern um of movements if there's reduced amniotic fluid um or if there's uh abnormal Doppler. So I'll explain what I mean by that in a few slides, um or if there's an abnormal CTT, which isn't reassuring. So this is your Doppler. So, um the top one there is normal. So there's like a, a wee line through it there, that's like the baseline. So the Doppler flow that's with each beat of um through the umbilical artery. So it shouldn't come back down to that line if it does, that means it's absent end diastolic flow. So that means there's compromise in the placenta and it's not working as well as it should. So those two, arrows done, um vertically are showing you where there is um absent diastolic flow and then even worse than that is um reversed enddiastolic flow. So that's the bottom picture there, wherever you can see it going below the line. And that means that inside the blood just coursing through like that, it's coming backwards and then going forwards, come back and going forwards. And that means that the baby's not getting good enough blood supply and it obviously then will have ill effect because of that. Um So if there's abnormal Doppler, so either absent or reduced and they need, and they're below 32 weeks, they get a CTG every single day and if any of those are abnormal, they'll plan for delivery. Um It's like a consultant's decision whether to do this or not. So, not something you'd need to decide. Um, but just to be aware of it. Um If it's more than 34 weeks with an abnormal Doppler, then you just deliver. Um I think the rationale between the lower gestation is trying to give the baby more time to develop um in the dummy, but I'm not sure. So don't quote me. Um and if you are looking at preterm delivery, it's worth considering and trying to give steroids and magnesium sulfate for lung development and for neuroprotection. So, hyperemesis, um so this is a specific condition. It's not just vomiting in pregnancy, vomiting in pregnancy is very common. Um And a lot of women will have a hyperemesis is when there's prolonged vomiting, which causes dehydration, which will be seen usually by ketones in urine or by a more than 5% prepregnancy, weight loss loss. Um The P score is like a screening score that can be used to determine if this is hyperemesis or not. Um It's often been linked to a high B HCG. So it's worse in molar pregnancies and twin pregnancies where you have a higher amount of HCG. So, investigations need to do are you need particularly looking at their potassium um urinalysis, as I said, for the ketones, full blood, looking for hematocrit dehydration and then your bone profile and then an ultrasound as well. Usually that's if it's an early pregnancy to see if it is a molar pregnancy and if the pregnancy is viable. Um and then management wise antiemetics. So, in that order PCO M. So prochlorperazine, cyclizine, Ondansetron and metoclopramide, metoclopramide, you can only give for a couple of days. So it's, you, you can't be on it long term. Um A lot of people will be on either cyclizine or Ondansetron. They also need fluid replacement because they're dehydrated and PEX. So like what you give to alcoholics to stop them getting the Wernicke's um, Phop. And if they're gonna be admitted, they need an assessment for low molecular weight heparin because of the dehydration and ted Stockings to stop any clots. So, obstetric cholestasis, this is quite a serious condition if it actually is a true cholestasis. So, um it is due to reduced by loss of flow from the liver. Um, it usually develops after 28 weeks. They don't really know why it's developed some hormonal changes, apparently something to do with the baby, maybe something to do with the mom, maybe, not entirely sure, but we don't need to know that. So, don't worry. Um So increased bile acids cause itch and it's classically on the palms of their hands and the soles of their feet. So a lot of people will have like generalized itch in pregnancy. But um if it's like a nonspecific itch, not in their palms and soles, it's not likely to be cholestasis. Um But you can prove whether it is or not with um investigations. So they have deranged LFT S and the key for the diagnosis is raised bile acids. So there's like a range of what their bile acid should be at each gestation. If it's above that, then it's called. So it's quite um important that this is recognized because you can have an increased risk of stillbirth. So, um they need to be induced after they become in term. Um and they need to be really vigilant about checking their movements and coming up if their movement is reduced. So the treatment um for it is ursodeoxycholic acid which treats the it or the cause like the high bile acids and then emollients like calamine lotion and antihistamines for the itch um especially might need the antihistamines at nighttime because the itch can be worse then. Um ok, so multiple pregnancy, um these pregnancies are classified um according to how many placentas there are, which is chorion and how many um amniotic sacs there are, which is the amnion. So mono or dye or try if it's triplets. So M CMA means one placenta, one amniotic sac and DCD is two each and you can work out the rest. Um M CMA twins are the highest risk because they're sharing everything. Um and then a key complication to be aware of is twin to twin transfusion. So that's what you can see in the picture there where one twin is really big and one's really small. So there becomes a split in the blood supply from the placenta. Um and one twin gets too much and the other twin gets not enough. So it's not the case that the one that gets loads is he healthy um because they both get affected um badly. So the donor twin gets volume depleted, doesn't get enough blood becomes growth restricted and anemic and the one which gets too much um blood gets overloaded so they can get heart failure, um polycythemia so too much red blood cells and large for gestational age. So you might hear um like eye drops and stuff being mentioned. So that's to do with the heart failure. Um Treatment is um using laser therapy to um cut like the blood vessels to stop the um Duran blood supply, but they don't do that here. You get sent to London for that, but just to be aware of it's an important complication. So or just fetal movement is a really common problem that a lot of people have that they'll present up to be examined or um assessed for. So they um have movement should be felt by 20 weeks and a pattern by 24 weeks. I think that's right. It's either that or 28 weeks. I was meant to check that and I forgot. So, apologies. I'll check this before we send the slides out. Um And then any change in the movement needs to be reported to the midwife or the consultant. Um And everyone will get asked at every appointment how the movements been. Um So the first thing that you do when someone presents with reduced movement is Doppler for the fetal heart. And then um if there's fetal heart, which hopefully there is and usually there is um they get a CTG monitor um of the heartbeat and if there's not, they get an ultrasound to check um immediately. Um So that's just a wee sketch of a CDD. Um They're showing an acceleration, which is a good feature. You want to see them, you don't want to see D aeration and then the photo just showing you what a CDD looks like practically. So you've got your um transducer to look for uterine activity and then the one for the fetal heartbeat and then this doctor see Bravado is how you read CTD. I'll not go into it because I'm sure you've all had teaching on that. So, um just a useful way to remember all the things you need to talk about, but decelerations are bad and accelerations and variability are good. So, rupture of membranes um R OM So you might hear it spoken about which is spontaneous rupture of membranes that can indicate the start of labor. It may not um traumas if they're over 37 weeks because their term um problem is if they're less than 30 weeks, that's premature rupture of the membrane. So, just remembering what term is. Um So if that's a sh uh they're usually given 24 hours to go into labor as long as there's no other concerned features. So things like having a temperature. So you're suspecting an infection. Um they may also be given Oxytocin to and just their labor if they don't go into labor after 24 hours. Um So as I said, prom is premature rupture of membranes at less than 37 weeks. And prep prom is preterm, prelabor rupture of the membranes. So those people um need really close monitoring because that's um a lot of things could go wrong. So, investigations, they need a sterile speculum. You might see the fluid pooling in the um posterior fornix. And then you can do this test called amnesia as well, which detects presence of amniotic fluid when you're doing your speculum. Um some places do fetal ect and some places use parture. They are to indicate the likelihood of going into labor within like the next 24 hours. And no one should be doing a digital examination because you um risk introducing infection, specifically, the infection you could introduce is chorioamnionitis. So that's infection of the chorion placenta and amnion amniotic blade. Um So to prevent that everyone who is a confirmed trauma or prep prom or prom gets erythromycin for 10 days or until their labor starts, they also need regular monitoring of the um baby with ultrasounds and CTG monitoring of their temperature. So they might be sent home like if they um rupture their membranes at like 30 weeks and they're stable and the baby's ok, they might be sent home and just brought back regularly like a couple of times a week to have their white blood cells and their CRP checked to check for any temperature and then an assessment of baby as well. Um And then might be given steroids if their preterm meconium stained Lyor is um a bad thing. Um Usually, so it's indicating fetal distress during labor. So that means that the baby is all stressed out, loses control of its anal sphincter and it passes its medium in the amniotic fluid. So the Lyor is another name for amniotic fluid and it gets um then inhaled by the baby and that can cause um meconium aspiration and respiratory distress. So, pains need to be at delivery if that's the case. If whenever the woman's in li you can see this discolored like or coming out of them. That's bad. So um like or should be like a clear color. Um And if there is any sort of change to that, then um needs actions. But if it's something like a light green yellow color, they they might continue labor as normal. Um But the more dark it gets or if there's fetal distress on a CTG or particularly if it's black and medium was like a black color. So it was a pure meconium, then they need to deliver directly. I usually will be a section. So, preterm labor is labor for 37 weeks. Um If the really is in labor. There's not much you can do about it. You can try and give Nifedipine as tocolysis, tocolysis just means to stop contractions and delay delivery. Um But often it doesn't work. Um So in that case, steroids need to be given to the baby. Um as long as the parents consent. So they need ideally two doses of betamethasone, which is two doses of 12 mg given I am usually into the bum of the mum and 24 hours apart. So two doses over 48 hours that matures fetal lungs and um helps it to produce surfactant. So, decrease risk of respiratory distress, magnesium sulfate also is helpful. Um It's neuroprotective and it should be given within 12 hours of birth. So it can be hard to time that well. Um but try their best and then other than labor, there may be other causes for abdominal pain. So you may have a differential of preterm labor in someone who's like 35 weeks, but it may be one of these other things. So I'll go into essential eruption later. Um uterine rupture is quite uncommon but it is just what it says in uterus ruptures and you got extreme abdominal pain of a sudden onset pelvic girdle pain is quite common and that's just like ligaments and stuff whenever since stretching. Um and quite a lot of people will get that particularly bad in certain positions like sitting in a car. Um gallstones remember, um, your fs for, um, gallstones. So women, um, are likely to get gallstones. So, don't forget that as a differential appendicitis because anyone can still get appendicitis and a uti which again are common in pregnancy and they treated so antiparent hemorrhage. So this is bleeding, um, after 24 weeks, if it's bleeding, before 24 weeks, this is a threatened miscarriage. They're different. Um, so I divide it into painless and painful bleeding, so, painless bleeding, um, since to previous. So that's when you have a low lying placenta which is covering the, um they're high risk of hemorrhage, but they won't have any pain. Um to diagnose it generally, it'll be seen on the anomaly scan. They check for whether the placenta is attached to and then if it's low lying, they'll get another, um, check done of its position at about 32 weeks. Um But if someone hasn't had that again, you can do transvaginal ultrasound. Um just to be aware if they've had a previous scar in their uterus like ac section. Um You need to rule out placenta accreta um because that is when the placenta is invaded into the tissues and that can be even worse. Um And then they can't labor naturally. They need to have a section because um they will just bleed out otherwise vasa previa is kind of similar but also very different to placenta. Previa is the mom's vassals because it's placental. Um Vasa previa is, it's still potential blood, but it's the baby's blood if that makes sense. So, um that's when the cord is covering the walls and whenever the membranes rupture, you get bleeding. Um So it's the two come in combination with each other and you get fetal distress, it's because the baby is losing its blood. So you'll get decelerations on the CT D. Um Often it can be picked up um unter, but it also may not be. So if there is rupture of membrane bleeding and fetal distress all happening at the same time in labor, they need an emergency section. If it's known about, that's great. They can have an elective section but they can't labor normally. Um So painful bleeding and placental abruption. That's when the placenta comes away from the wall of the uterus. Um The classically in questions will have a woody uterus and tender uterus, but it may also be concealed, meaning that there's no active bleeding, but there's a lot of blood which is poling in the abdomen, which is also causing pain. So, just be aware of that, that's a plus uh concealed abruption. So they get some sort of pain in the abdomen, shock and fetal distress and they need sectioned as well. And then uterine rupture usually happens during labor when the contractions trigger the uterus to rupture. Um risk of that are having a previous section. So, obviously, there's a weakness in the uterus itself. Um um There will be feel distress with this as well and they need a section. So labor then your stages of labor. Um First stage is like the bit that takes a while. So that's from when you're getting a basement, which is like thinning out of the cervix and dilation of the cervix and needs to get that number of 10 centimeters. The latent face can take ages um like days and that's to get from 0 to 4 centimeters. It can be very pronged. Um They say it's meant to progress at half a centimeter an hour. But um I don't know if that's really very accurate, but that's their aim. Um because some people can be up and down, up and down for days. Um thinking they're in labor, but they're kind of in the early stages of latent labor. Um And then active first stage is from 4 to 10 centimeters, which should happen at one centimeter an hour. Second stage is when the baby is born. Um And it may be delayed. Um And then a delayed in second stage can be an indication to go for a section because the baby can get distressed. So if they're pushing for more than two hours, if there's first um birth or more than an hour, if they've had a couple of births before, that's what multi power means. So, parity is more than one. They try to aim for 34 contractions in 10 minutes each lasting for 60 seconds. That's what they call established labor. And then third stage is delivery, placenta. Physiological can take up to 60 minutes. Um But most people get active management of the third stage, which is up to 30 minutes past the placenta. That's when you get cord, um, controlled cord traction and they give Oxytocin as well. That's to just help with the contractions um and reduce the risk of A PPH. So you'll know from peds as well. They try to do delay cord clamping. Um And that's before, after the second stage, before the third stage. So just, just to give the baby all that blood that it can get and then common reasons for failure to progress are your three ps. So the passage, so if the head could fallow and pelvic, so the mom are disproportionate, so bad position or whatever. Um or like if it's just a really narrow um canal and then it's kind of in combination with the passenger, if there's mal presentation and it's just never gonna get through with the different angles of the head. Um And then par is incoordinate contractions. Those are the common reasons for failure to progress which may need um section or instrumental delivery, induction of labor. Then you have the bishop score is worked out for everybody. So it's mostly to do with the cervix. So position, consistency of basement and dilation and then the station of the fetal head. So if it's more than eight, they're favorable. And if it's less than eight, they're not favorable and their cervix needs some stuff done to, to make it favorable. Um So that's when you would use your Prostaglandins. So they might use a pessary, they might use a gel or a balloon, um, catheter, which is literally just a foley catheter with, with loads of like water in it to make it bigger and then that's meant to irritate the cervix and cause it to dilate. Um They may use that if you can't use prostaglandin. So they've had a previous section or if they power of more than three or equal to three and then artificial rupture membranes, that's an AM, that's when they get like this little hook and they just break the membranes. Um That should also cause prostaglandin release which triggers contractions to happen. And usually you get that with an Oxytocin infusion. You know, say you only use that if the cervix is dilating like all because of course, you're not gonna get in to break the waters if you can't. Um if the service isn't dilating and also there's no point in breaking the waters um and giving Oxytocin for it to cause contractions. If it's contracting against closed off um complications, then of uh inductional. So hyper stimulation, that's what when you have more than five contractions to remember their aiming for 3 to 4 contractions in 10 minutes. And that's when your contractions last more than two minutes. So they need their Oxytocin stopped to stop the stimulation for the contractions. You can use taco lets like I think they usually used to, to um consider fluids and then mom their left lateral to get the most blood supply to the baby and they may, may need sections. So that's a failed induction if that happens. Um PPH, then there was, I think an OS it on this, not for our finals, but last year's finals. Um So primary PPH is if it's within 24 hours of labor and secondary is up to 12 weeks. Postnatally, vaginal birth is more than 500 mils and a section is more than 1000 mils. Um Again, like we said, Oxytocin in the third stage decreases the risk of this. Um and then your causes your forte and you need to know those the most common one is uterine. So her tone, they all get bundle massage, the massage at the top of their uterus and Oxytocin to stimulate the contractions and increase the tone tissue is routine placenta or the membrane. So you need to check and the midwife do check if the placenta is complete. Um If the thought is that it's due to tissue, they may need to go to cure for a manual removal. Um And that's literally just what it sounds like. They just stick their hands and then try and take the placenta out and then trauma. Um See if there's been any tears repair that if it's needed and thrombin if they have a clotting disorder. So a preexisting one if they have a family history of one. and then I've just written there about tears because it's kind of related. So 1st, 2nd, 3rd and 4th degree tears. So I can remember it goes S MSM so, so professionally and then peroneal muscle and then anal sphincter and then rectal mucosa, obviously fourth is the worst um management then of uh PPH. So you'll see ABCD with circulation first, if there's like loads of blood loss and then uterine massage and then you can use Oxytocin ergometrine um IM and then you can put up the Oxytocin infusion, then move on to carboprost, miSOPROStol. Remember you can only use miSOPROStol after the baby is out because it's, it's bad. Otherwise, t TriC stomach acid and then bimanual compression, which is when you have one hand in on one hand palpate in the uterus. Um And then if no lab work, you have to go to the theater. So theater um you'll do intrauterine balloons, um A beta lynch suture, which is when they just tie off a big suture around to try and increase the tone, a uterine artery embolization to stop the amount of blood that can come out. And then last resort and definitive management is a hysterectomy. Um Things to consider major hemorrhage protocol. So that's when you get 1 to 1 to 1 of blood cells, fresh frozen plasma and platelets and you need wide more cannulas at least two senior help. So, an obstetrician senior midwife, an test um it useful to put in a catheter because if their cat or, or if their bladders fill, it can stop the uterus contraction because obviously they're ly in a similar position and they may have a risk of ti that wee picture is from queens. Um That's how they kind of estimate blood loss. Um So a kidney dash is 500 mils which is a PPH of a vaginal birth. And then a PPH on the bed is um with it, I think it says g um if it's on the bed that's after a section and then if it goes onto the floor, that's even worse, it's more than 1000. So, obstetric emergencies then um shoulder dystocia um as I said, common in diabetics um or macrosomic babies. So that's when the anterior shoulder. So the shoulder coming first is stuck behind the synthesis pubis. Um that can cause pressure in the brachial plexus, which remember is up in the top of your arm. So it can cause herbs, palsy, which is compress due to compression of C five C six, um fetal distress because their heads kind of out, but it's not really. So they're kind of getting um like a stimulus to breathe in their room, but they're kind of not and they can get very distressed. Um Fourth degree chairs, although sometimes people will get an Omy, which is a cut and the perineum to try and increase the size um of the opening for the baby to come out and then a pph as well. Um So management first still use super pressure to try and maneuver the wee shoulder out. Um They may need an Aecio mcroberts remover which is when they moved mom's legs into position and then ac section. So, um if that happens, it's like an emergency and they have to call obstetricians and midwives and at least, and all that jazz and pes in case the baby's distressed um cord prolapse as well, then is another emergency happens during labor. Risks of that if they have an abnormal lie. So if the baby is not lying, um what's that longitudinally? If they're light like transverse or blink, um then there's more room for the cord to move around and it can get stuck and lower where it shouldn't be. So that's it coming out through this. Um Also an increased risk if they are a strong or a prep because you have less sort of fluid to keep the cord up where it should be or after an artificial rupture of the membranes. So this will present as either you can see the cord um like if you're looking on speculum or a vaginal examination or maybe fetal distress because if you think about that, if every time the baby contracts its head pushing on its cord, which is its blood supply. So it's restricting its own blood supply. Um, management. The most important thing to do is not to touch the cord. Um, you put the mom on all fours, you can cover it with like a wet towel, but they need to go to theater right away. Um, so amniotic fluid embolism is the risk for the mom. Um, it's basically like same sort of pathology as a pe, but it's not a clot, it's due to amniotic fluid. Um So it causes shortness of breath, hypoxia hypertension, so shock and it can cause cardiac arrest and it occurs during around the time of or shortly after delivery. Um And yeah, very serious and needs um senior help. So just a quick couple of points on postnatal care. Um, mastitis is quite common. Mom should be encouraged to continue to breastfeed, it won't hurt the baby. Um and it will help to sort of flush out the ducts and things. If it's not resolving, they might need antibiotics. Skin soft tissue infection is usually flu cloxacillin as long as they're not allergic. Um, everyone should get their six week postnatal check done by their GP and that's for the moms. Obviously the babies get their um midwife check and then they get their other baby check as well. Um Mental health things. Um Just to be aware, three different kind of categories. Baby boys is mild. Um And there's no sort of issues with attachment to the baby or forming relationships with them or anything. Um They might just feel very tired, stressed and a bit flat that's normal and they can be reassured. But with a close eye, um, postnatal depression then is a bit more serious and there may be just classical depression um issues. Um a poor bond with the baby, they might need an SSRI or CBT and then psychosis. Um that sort of happens in the first couple of weeks or two months of postnatally. Um Those moms may harm themselves or harm their baby, don't bond very well with their baby and may need or should get um treated in a mother and baby unit. Although there is not one in Northern Ireland, um routine products of conception, then that is if the whole placenta isn't complete and you get a little bit of placental tissue left behind in the uterus, um that gets called endometritis. So just an infection of endometrium. It's basically the same as pelvic inflammatory disease, but it's not due to like an sti it's due to the routine products. Those moms are given miSOPROStol to try and encourage the um products out and antibiotics as well. And then they get an interval scan. I think it's like 10 days or two weeks after they've been given my and antibiotics to check if it's resolved. So they'll maybe present with like passing a lot of blood clots, feeling unwell, abdominal pain, that kind of thing. Um So just then to chat through acies about what could be asked, I'm not going to like, go through everything that's in an obstetric history because you can all read your, um, a up. But, um, basically they should always be asked about fetal movement, bleeding, ruptures of membranes. So if they've noticed any bleeding, any abnormal fluid, if they have any pain in their tummy and then those preeclampsia um symptoms, and then everyone should always be asked about their mental health and if they feel safe at home, um again, pregnant examination, there's a great bit an os. So, so use that um just things to remember their fundal height, you're meant to use a tape measure facing downwards. So as not to like cheat and reassure yourself if it's not reassuring. So the number in centimeters should be their gestation plus or minus two. And if it's not, they get referred, um then things to just get slick with knowing what the differences of them are. As the babies lie, their presentation, their position and their engagement. There's just if you, if you can sound good doing that, then you'll impress the examiner and then you auscultate over the anterior shoulder of the baby and remember to feel the mom's pulse as well because you don't want to um be falsely reassuring someone if you think it's a baby's heartbeat, but it's actually a very anxious mom. So their heartbeat might be similar to what their baby's heartbeat should be. Um other points then just kind of come up quite long questions. So HIV positive moms usually need a Cesarean birth but can have vaginal birth if their viral load is low. External cephalic version is used for breach presentations at either 36 weeks if there's first pregnancy or 37. If it's more than um one pregnancy or birth before, that's just because there's a little bit more room in there for it to move um breach up until that point is fine. They don't really worry because it can turn itself back around, but sort of after that point, it's less likely to turn lithium. So used for bipolar can cause cardiac anomalies. So specifically Epstein, normally in the baby, um magnesium sulfate, although it's very good used for um preeclampsia or eclampsia treatment can also cause respiratory depression. So they need to be monitored for that and you should not be given anyone a nonsteroidal in pregnancy can cause cardiac problems in the baby. And even in labor, it can't be used, can't be used to postnatal. So, um going through acies from previous years, um as I said, we had a growth chart and we kind of had a like a gyne um examination in our finals this year. So, not really obstetrics. Um but things I have asked before is like PV, bleeding again, that could be gyne as well. Um bimanual and a speculum which also could be Gyne could be pregnancy, um preeclampsia history, PPH ABCD, E as I said, um growth chart, um genetic counseling, um preconception counseling and then data interpretation. So they could give you like a new start with BP high and then they could give you like a urine dip and the blood test and you'd have to decide what it is, um that kind of thing. So I have just a couple of MCQ S. So either if you want to write in the chat or on the, I don't know what the chat is. So it might be easier. Oh, here's the chat. So if you want to say what you think the answer is, um, so this is about Down syndrome screening. Don't worry if you don't get it right. And the answers are all on the slides as well. Any takers for the answer, I'll just tell you the answer then. So c is the answer for this one. That's the kind of thing you just need to learn. So there's no real easy way about it. Um And then this is your reasons for having a glucose tolerance test. So if anyone wants to type in, I'll give you a minute and then if not, I'll just tell you an answer. I someone said c no, it's not say their age isn't really a factor in their risk for diabetes. It's more a risk factor for clots and preeclampsia. So, in this case, it's their dad having diabetes. So, first degree relative with diabetes. So this one is about your folic acid. So, a lady with celiac disease BMI of 29 and anemia. What folic acid should she be on? Yeah, perfect. Someone's saying d so it is 5 g because she has celiac disease. Um, someone with a BP of 100 and 55/98 without proteinuria feels while otherwise no medications outside of pregnancy. What is the diagnosis? Perfect. So d so more than 20 weeks. So it's not essential hypertension and she doesn't, doesn't take any medications outside of pregnancy indicating that she's not on any antihypertensives already. Um, no proteinuria. So that rules out your preeclampsia, which by default, then rules out your health because it's a manifestation of bad preeclampsia and then it's not normal, um, to have an increased BP of that um, high in pregnancy. In fact, usually your BP dips a little bit when you're pregnant. Um, so next one, someone who's trying to conceive, who's on salbutamol, beclomethasone inhalers for asthma, valproate for epilepsy and paracetamol and codeine for chronic back pain. Which of the medications could be teratogenic. Yeah. Perfect. Everyone's in e par, as we said before, neural defects. Um, so if someone's coming up to be assessed, um, for reduced movements at 35 weeks, what's the first thing you should do? Yeah, perfect. Or the um, Doppler of the fetal heart that's right. Um Someone saying be as well, but before you do a CTG, you just listen in first. Um you would do a CTG provided there is a heartbeat there just to look for any fetal distress. But Doppler is easier to do and it's what's done first. So I don't think there's too many more left. Um, a 31 year old lady is 34 weeks pregnant has really bad abdominal pain, fetal movements have been normal until the pain started. No vaginal bleeding, but the pain is getting worse. Her uterus is tender firm and woody on palpation. High BP was recorded at our last appointment. What is likely diagnosis? Yeah. Uh Phenolic B is right. Um So again, this is like a wee buzzword, woody um uterus on palpation is um basically always placental eruption for your questions. Anyway. Um Also having a high BP is a risk factor for placental erruption. So that all makes sense. So that would be um so someone has one half liter blood loss two hours after their general delivery. What is the definitive management of this? Yeah. Got D coming in there, which is right. Hysterectomy is the definitive management. So, um all the other ones would be used first and then a hysterectomy if it can't be controlled as definitive management of a postpartum hemorrhage. So that is me that's all done. Um You'll get these slides, I'll fix that wee bit about um movements and patterns and things. I just didn't wanna get it wrong before I send it to you. Um And then again, if you have any questions, feel free to send me the email. Um Anyone, any questions at the moment? Thank you very much. Uh A um that was very, very good. Uh So, well, I've majority that recorded so we'll upload that onto the portal and also if you could tell me on your side that. Mhm. No problems. So, thank you very, very much. All right. No worries.