By Geoffrey Chamberlain
This fourth version of this ABC has been completely up to date and revised with new pictures and illustrations.
This ABC addresses the various present such a lot arguable concerns similar to the position of the midwife and GP, want for decentralisation of administration, domestic births and screening and may be priceless to GPs, scientific scholars, midwives, nurses and trainee obstetricians.
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All tissue is sent to the laboratory for examination of its neoplastic potential. After an evacuation all women should be registered for follow up at one of the supraregional trophoblast disease centres, where human chorionic gonadotrophin concentrations in urine or blood can be measured. If these are high at six weeks chemotherapy is recommended to prevent subsequent malignancy. 12 After evacuation of a hydatidiform mole the human chorionic gonadotrophin concentration remains high. Methotrexate and folinic acid were given on nine occasions, the treatment being associated with a reduction in hormone concentration 41 ABC of Antenatal Care Other causes of vaginal bleeding Bleeding may come from local problems in the vagina or cervix.
Cervical incompetence The cervix may have some weakness which could be associated with a spontaneous miscarriage in the mid-trimester (13–27 weeks). This can be either congenital or acquired after overstretching at a previous dilatation and curettage or birth. The unsupported membranes bulge into the cervical canal through the internal os and rupture early, which causes the abortive process. The incompetence may be diagnosed before pregnancy by a hysterogram (a radiological examination of the uterine cavity) or in pregnancy by ultrasonography.
Doctors would do well to refer women asking for either procedure to a department of obstetrics that performs both and will give impartial and balanced advice in each individual case. In many centres both tests show similar risk rates. Trisomy 21 (Down’s syndrome) is much commoner in women over 35, but still half of the babies with this condition are born to women under that age. Although the risks to mothers under 35 are less, the overall number of babies born is much greater. To negate this, simple screening is required since both CVS and amniocentesis are unsuitable, invasive procedures A the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated; B the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman; C the pregnancy has NOT exceeded its 24th week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman; D the pregnancy has NOT exceeded its 24th week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of any existing child(ren) of the family of the pregnant woman; E there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.