Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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To induce labour, the National Institute for Health and Clinical Excellence (NICE) guideline recommend a maximum total dose of 6 mg of prostaglandin E(2) tablet or 4 mg of prostaglandin E(2) gel for women with an unfavourable cervix (3 mg gel for all other women). To determine clinicians' compliance with these recommendations, the data of 1,424 women, who were induced at 10 obstetric units in England, were reviewed. ⋯ Women who received prostaglandin tablets had a 2.5-fold greater likelihood to receive higher-than-recommended maximum total dose (OR: 2.6, 95% CI: 1.8-3.7; p < 0.001) and nine-times more likely to receive double the recommended maximum total dose (OR: 8.7, 95% CI: 2.9-24.4; p < 0.001). In this audit, 1 in 9 women, who underwent induction of labour, received higher than the recommended maximum total dose of vaginal prostaglandin.
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Ante-partum haemorrhage is an important cause of maternal and fetal morbidity and mortality, despite modern improvement in obstetric practice and transfusion service. It is defined as any vaginal bleeding from the 20th week of gestation till delivery. The initial management of ante-partum haemorrhage should concentrate on resuscitation and accurate diagnosis. ⋯ In many cases, it is not possible to make a definite diagnosis, despite all the investigations. Development of ultrasound especially transvaginal scan has helped in the definitive diagnosis and management of placenta praevia. Every unit should have a clear protocol for the management of massive haemorrhage, which should be regularly updated and rehearsed.
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Shoulder dystocia is an obstetric emergency that currently affects 0.6% of all deliveries in the UK. This potentially serious obstetric emergency requires early recognition and prompt involvement of appropriately trained personnel to deliver the baby safely and without delay. Failure to do so may result in significant neonatal and maternal morbidity, with ensuing litigation. ⋯ This can best be accomplished through re-education and re-training of obstetric staff and the updating of Trust management protocols. By promptly acting in accordance with established evidence-based guidelines, we will improve our ability to carefully and competently manage deliveries complicated by shoulder dystocia. However, failing to do so will inevitably have dire repercussions for all.
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Our aim was to test the use of single serum progesterone measurement together with beta hCG in the management of women with pregnancy of unknown location. This was a retrospective study of 126 patients presenting with a clinical picture suggestive of ectopic pregnancy, when ultrasound examination was inconclusive. All the patients had serum progesterone level measured by radioimmunoassay in conjunction with beta hCG. ⋯ High levels of progesterone are reassuring as regards ongoing viable pregnancies and low levels allow a definitive differentiation between viable and non-viable pregnancies. However, low progesterone could not efficiently differentiate between miscarriage and ectopic pregnancy. The use of beta hCG levels in conjunction with serum progesterone is helpful, particularly with serum progesterone levels between 16-80 nmol/l.