High Blood Pressure

Perinatal Institute Reviews: Hypertension in Pregnancy
http://www.perinatal.nhs.uk/reviews/

This explains definitions, diagnosis and management of hypertension and proteinuria in pregnancy.

Kröner C, Turnbull D, Wilkinson C.
Antenatal day care units versus hospital admission for women with complicated pregnancy (Cochrane Review).
In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software, Abstract.

The one trial of sufficient quality to be included in this review (involving only 54 women), concluded that antenatal day care of women with non proteinuric hypertension in pregnancy reduces in patient stay and induction of labour rate.

Eclampsia
RCOG GreenTop Guidelines: Eclampsia
http://www.rcog.org.uk/guidelines.asp?PageID=106&GuidelineID=9
Evidence based management recommendations.

Diabetes

Perinatal Institute Reviews: Diabetes in Pregnancy
http://www.perinatal.nhs.uk/reviews/

This is the most common pre existing medical condition in pregnancy. The review examines complications and management with emphasis on the two current main issues, prepregnancy care and adverse outcome in Type 2 diabetics.

Cholestasis

Any woman presenting with itching in pregnancy should have their liver function and bile acids checked. Bile acids may be the first and only results to become abnormal. If these are normal but itching persists they should be repeated at regular intervals. Further details on diagnosis, management and ongoing research at:

Perinatal Institute Reviews: Cholestasis in Pregnancy
http://www.perinatal.nhs.uk/reviews

Thrombosis

This remains the leading direct cause of maternal death in the United Kingdom.

Why Mothers Die 1997-1999. The fifth report of the Confidential Enquiries into Maternal Deaths in the United Kingdom
RCOG Press December 2001
http://www.cemach.org.uk

Includes key recommendations for prevention, diagnosis and management.

There were 31 deaths from pulmonary embolism and of those 13 were antepartum (8 in the first trimester). There has been a reduction in deaths after Caesarean section following guidelines in the 1994-96 Confidential Enquiry. Guidelines for thromboprophylaxis following vaginal delivery are included in the current report.

Royal College of Obstetricians and Gynaecologists.
Throboembolic Disease in Pregnancy and the Puerperium: Acute Management. Guideline No 28. London RCOG; 2001.
http://www.rcog.org.uk/guidelines.asp?PageID=106&GuidelineID=20
Provides further information on acute management.

Placenta praevia

RCOG Green Top Guidelines: Placenta praevia
http://www.rcog.org.uk/guidelines.asp?PageID=106&GuidelineID=17

SROM

Department of Health Communication
Induction of Labour 2001
http://www.rcog.org.uk/resources/pdf/rcog_induction_of_labour.pdf

Evidenced based guidelines on induction of labour including management following SROM at term.

Pregnancy Complications

Perinatal Institute Reviews: Antenatal Corticosteroids.

This remains a leading cause of perinatal morbidity and mortality.

Two doses of betamethasone 12mg im 12 hours apart should be given to women between 24-36 weeks gestation in threatened or suspected preterm labour or risk of delivery. This course should not be repeated unless part of a randomised controlled trial. For details see http://www.perinatal.nhs.uk/reviews

Breech

Tocolysis:
RCOG GreenTop Guidelines in progress

To date tocolytic agents have NOT been shown to significantly improve neonatal mortality. They should therefore be used to delay labour in order to administer betamethasone and/or transfer to a hospital with appropriate neonatal facilities, if required. They should not be used if there is any contraindication to pregnancy prolongation and the side effects of individual agents should be considered.

RCOG GreenTop Guidelines
The Management of Breech Presentation
http://www.rcog.org.uk/guidelines.asp?PageID=106&GuidelineID=19

All women with breech presentation at term, without contraindication to vaginal delivery, should be offered ECV by experienced personnel. If this is refused or unsuccessful, current evidence supports that caesarean section is the safest mode of delivery for breech presentation at term. The review details the evidence for this and the recommendations if caesarean section is refused or there is insufficient time. In addition, preterm and multiple pregnancy evidence is presented.

Multiple Pregnancy

Taylor MJO, Fisk NM.
Multiple pregnancy
The Obstetrician and Gynaecologist 2000; 2(4); 4-10.

A review of twin complications, antepartum and intrapartum management including the importance of chorionicity determination.

Carroll SGM, Soothill PW, Abdel-Fattah SA, Porter H, Montague I, Kyle PM.
Prediction of chorionicity in twin pregnancies at 10-14 weeks of gestation.
BJOG 2002; 109: 182-187, Abstract.

Chorionicity should be defined between 11-14 weeks, when the most recent evidence suggests that it can be correctly identified 99% of the time.

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