No specific diagnostic criteria for AAP – only ~50% diagnosed preoperatively; maintain a high index of suspicion for persistent abdominal pain, displaced cervix, failed induction, oligohydramnios.
ART alone is NOT an indication for aspirin or a GTT – base decisions on standard risk-factor assessment only.
VTE risk: 5-fold ↑ in pregnancy, 20–60-fold ↑ in first 3 months postpartum; absolute rate ~1:1000 pregnancies.
Confirm every high-chance expanded cffDNA result with amniocentesis (not CVS) — overcomes confined placental mosaicism.
Chorionicity by 11+0–13+6 weeks; scan MCDA 2-weekly from 16 wks, DCDA 4-weekly from 20 wks.
Prior stillbirth: pooled OR 4.8 for recurrent stillbirth (2.5% vs 0.4%) – comparable to or greater than diabetes/hypertension as a risk factor.
Escalate: oxygen requirement, RR ≥20/min or HR ≥110 bpm → urgent MDT (RCOG). Target sats 94–98%.
DV starts or escalates in pregnancy in one-third of cases (MBRRACE-UK); fetal mortality ~16/1000 affected pregnancies.
Maternal age alone: 30% DR at 5% FPR.
Threshold-of-viability delivery decisions require MDT consensus (neonatal + obstetric team) with fully informed parents.
MOMS trial (n=183): prenatal vs postnatal repair – VP shunt 44% vs 84%; hindbrain herniation at 12mo 64% vs 96%; independent walking at 30mo 44.8% vs 23.9%.
Giant omphalocele = >5 cm diameter or >50% liver in sac – risk of pulmonary hypoplasia; consider ELCS to ↓dystocia/trauma.
MCA-PSV action line for considering fetal blood sampling: 1.5 MoM for gestation.
Background fetal radiation over pregnancy ≈ 1 mGy; <50 mGy at any gestation = negligible risk – do not delay indicated imaging.
No specific UK guideline for LGA in non-diabetic women — be explicit about uncertainty. NICE LGA = >95th centile; RCOG macrosomia = >4500 g.
Take an index sample (IgM + IgG) after reported exposure; if both negative repeat at 4 weeks. Always test the stored booking sample (IgM, IgG, avidity) when index IgM is positive.
Oligohydramnios: AFI ≤5 cm, SDVP <2 cm. Polyhydramnios: SDVP >8 cm or AFI ≥24 cm.
Physiological changes of normal pregnancy (hyperventilation/respiratory alkalosis, vasodilatation) mimic early sepsis and delay diagnosis; pregnant women are less able to buffer sepsis-related metabolic acidosis.
Chronic maternal corticosteroid use does NOT replace a standard fluorinated ACS course if preterm delivery threatens at 24–34 weeks.
Chemical feticide (KCl) = independent chorionicity ONLY – contraindicated in monochorionic pregnancies (shared circulation risk)
HF diagnosis needs ≥2 fluid compartments; organ-fluid findings (e.g. hydronephrosis, ventriculomegaly) do not count.
Chorioangioma: ~1% of placentas; ‘giant’ (>4cm) in 1 in 3500–9000 births – complications mainly with tumours >4cm.
HRE = adenomyosis, ART conception, or surgically treated peritoneal/deep infiltrating endometriosis – manage in consultant-led high-risk clinic; no national/international guidance exists.
NAS occurs in 55–95% of opioid-exposed infants; substitution therapy reduces but does not eliminate this risk.
Puerperal psychosis: 1–2/1000 births; psychiatric emergency – NICE mandates assessment within 4 hours of referral for sudden-onset psychosis.
Commonest cause of a retrospectively false positive NIPT result = confined placental mosaicism (CPM)
Imaging is a screening tool, not a diagnostic test — never perform hysterectomy on antenatal suspicion alone.
Manage in a specialised regional PAS centre with full MDT (NHS England mandate since 2020); deliver electively around 34–36+6 weeks.
PGT-A history: FISH/cleavage-stage biopsy (1990s–2010) was found harmful (9-RCT meta-analysis) → superseded by CCS (aCGH/qPCR/SNP/NGS) on TE biopsy, which shows benefit.
BMI <18.5 kg/m² = underweight; NICE weight-management guidance excludes this group – paucity of evidence-based guidance.
FSAs affect 3–5% of pregnancies; ~50% have a genetic/chromosomal cause.
Ultrasound-indicated cerclage: ≥1 previous sPTB/STM + CL <25 mm before 24 weeks. History-indicated: ≥3 previous sPTB/STM. TAC: previous failed cerclage with delivery <28 weeks.
Smoker baseline carboxyhaemoglobin 4% (3–8%) vs non-smoker 1%; heavy smoker up to 15% – CO left-shifts O₂–Hb curve.
Twins: 3× perinatal mortality vs singletons; 50% deliver <37 weeks, ~20% <34 weeks (Scotland)
Fall in blood pressure is a late sign of hypovolaemic shock in pregnancy – earliest signs are mild tachycardia, tachypnoea, narrowed pulse pressure, agitation.
Vertical transmission risk: primary 100% · early latent 40% · late latent 10%; can cross placenta from 14 weeks.
Fetal tachycardia = HR >200 bpm; bradycardia = HR <100 bpm consistently.
NSAIDs only before 28 weeks, shortest course — late use risks oligohydramnios (5×) and ductus arteriosus constriction (0.5%). Analgesic aspirin >300 mg/day in late pregnancy not advised.
ACS benefit is time-limited: only clear benefit if delivery occurs within 7 days of administration – accurate prediction of preterm birth risk is essential.
vAMA = maternal age ≥45 years at delivery; 78% conceive via ART, 91% of these via egg donation.
SA loss implicated in ≥50% of serious safety events (HIE, maternal deaths)
Skin incisions: never use monopolar electrosurgery – causes blistering/poor healing.
IH incidence after open gynae surgery: 3.5–16.9%; 4× more re-admissions, 5× longer stay, 3× higher cost after IH post- hysterectomy.
Fluid overload = deficit > 1000 ml (hypotonic) or > 2500 ml (isotonic); suggested action limits 750 ml / 1500 ml (GPP)
Only true contraindication to cystoscopy: untreated UTI (BAUS)
SOSURE = Survey/sigmoid → Ovarian mobilisation → Suspension → Ureterolysis → Rectovaginal/pararectal entry → Excision (flexible framework, not rigid order)
Outpatient hysteroscopy failure rate 4.2%; internal os stenosis accounts for 61.7% and external os stenosis 23.3% of failed entries.
VCD by route: laparoscopic 4.9% > abdominal 0.29% > vaginal 0.12%.
No preoperative test definitively excludes leiomyosarcoma – must be stated explicitly during consent for LM/morcellation.
Manchester repair = cervical amputation + anterior approximation of cardinal ligaments (Donald 1908, modified by Fothergill); for 2nd/3rd-degree prolapse in women wishing to retain the uterus.
Incidence of neuropathy post-gynae surgery: 1.1–1.9%; femoral nerve commonest (≥11%)
Non-obstetric surgery needed in 0.5–2% of pregnancies; appendicectomy is the commonest procedure (6.5% of cases in a 6.5-million-gestation study)
Warfarin: stop 5 days preop (all risk levels); bridge with treatment-dose LMWH only if high thrombotic risk (Box 1)
Critical window for adhesion formation and barrier-agent efficacy = 3–5 days (peritoneal re-epithelialisation time)
Vessel seal limits: ABD 7 mm · UD 5 mm (Harmonic Ace+7 = 7 mm) · Thunderbeat 7 mm · CO₂ laser 1 mm · plasma = small vessels only.
Surgical smoke = 95% water + 5% chemicals/debris; up to 80 chemicals incl. benzene (a known carcinogen, recommended exposure nil)
TOP is the commonest cause of uterine perforation; risk doubles in the 2nd trimester vs 1st trimester.
Urinary tract injury = commonest major laparoscopic complication; 91× higher litigation risk than other complications.
75% of vascular injuries occur at Veress/primary trocar entry; major injury mortality 8–23%.
Insufflation pressure 6–10 mmHg (laparoscopy 12–16); Alexis® O-Retractor or GelPOINT® V-Path platform seals the vaginal cuff.
Epidural catastrophic complication risk: 1.8/100,000 (paraplegia/death); hypotension requiring intervention RR 7.13 vs RSC/PCA.
Full text unavailable – these notes reflect the abstract only; verify all detail against the original TOG article before exam use.
Caprini score ≥9 → 10.7% VTE risk, LMWH for 30 days; lap surgery scores 1pt (<45min) or 2pt (>45min).
SSI onset: superficial/deep ≤30 days (no implant) or ≤1 year (implant) after surgery.
HAT = 50–60% of all VTE; unprophylaxed major abdominal surgery DVT 17–40%.
Term is "supporting information", not "supporting evidence".
PDSA = Plan, Do, Study, Act – the core structured QI cycle; repeat as many times as needed to embed change.
A statistically flawed study is an ethically flawed study.
Self-regulated learning = Cognition + Metacognition + Motivation.
Feedback loop completes only when the learner acts to change practice — not simply when information is given.
Limitation: 3 years from injury/date of knowledge; child → from 18th birthday; no limit if lacking capacity; death → 3 years from death.
Caldicott = 7 principles (confidentiality); GDPR = 6 data protection principles (handling + right to erasure). Both embedded in law.
Standard is now the reasonable patient, not the reasonable doctor — Bolam/Sidaway no longer governs consent.
NHS Resolution’s 4 core services: claims management, practitioner performance advice, primary care appeals, safety & learning.
Harden & Crosby teacher roles: information provider, role model, facilitator, assessor, curriculum/course planner, resource creator.
Capacity presumed from 16 yrs (s1(2)); rebut on the balance of probabilities (s2(4))
WPBA introduced by RCOG in 2007 on PMETB recommendation.
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