Pregnancy

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  Management of nausea and vomiting in pregnancy
This is the most common troublesome symptom of early pregnancy and affects 50–90% of pregnant women with variable severity. The vast majority are able to manage with simple lifestyle advice, but a minority warrant further investigation, monitoring and treatment.
  Obstetric anal sphincter injury
This review considers the difficult issue of obstetric anal sphincter injury – only one third of our affected patients will discuss this with us voluntarily! It can be read in conjunction with the section on management of faecal incontinence found in the chapter on gastroenterology.
  Management of miscarriage
Miscarriage is common and a source of significant distress for some of our patients. As GPs we are often the first point of contact for women who fear they may be miscarrying and we provide aftercare.
  Proton pump inhibitors in pregnancy
We commonly prescribe PPIs to patients of childbearing age and dyspepsia is a very common symptom in pregnancy for which we might be tempted to prescribe a PPI if more simple measures fail. But how safe are these drugs for pregnant women and in the pre-conception period?
  Hypertension in pregnancy
These guidelines introduce several new concepts that we will see become a routine part of antenatal care. There has been a lot in the press recently about the fragmentation of maternity services and the benefits of GPs being more involved. It would be worthwhile discussing these guidelines with your community midwife colleagues!
  Ectopic pregnancy
This is one of those 'not to miss' diagnoses – I think most of us would consider the diagnosis in women of child-bearing age presenting with abdominal pain and vaginal bleeding, but one-third of the women who died from ectopic pregnancy in the UK were initially misdiagnosed as having a gastrointestinal problem.