Making Best Practice, Every Day Practice
Abnormal proliferation of placental tissue inside the uterus leads to a spectrum of rare benign and malignant lesions that include molar pregnancy and together constitute gestational trophoblastic disease (GTD). GTD can be challenging to diagnose, and primary healthcare professionals should be aware of its signs and symptoms to ensure prompt and appropriate referral.
The majority of pregnancies progress successfully, but some result in a miscarriage or in an ectopic pregnancy. About two-thirds of the related maternal deaths are associated with substandard care due to late or missed diagnosis. Recent NICE guidelines aim to improve outcomes for women, and this article provides practical information on how the new recommendations impact on day-to-day practice in primary care.
After the second trimester, it is generally assumed that a pregnancy will end with the joy of a newborn baby. But the reality is that each year in the UK, one in every 200 – or around 4,000 – babies die in the third trimester before, or during, labour. This is one of the highest rates of stillbirth among high-income countries, and each death has profound effects on the woman, her family and health services.
Early detection and timely intervention have reduced maternal deaths from ectopic pregnancy, but women continue to die. New guidelines from the National Institute for Health and Clinical Excellence (NICE) aim to ensure that all health professionals are alert to the possibility of ectopic pregnancy and avoid missed opportunities for diagnosis.
In the UK, under the Abortion Act 1967, an abortion (termination of pregnancy; TOP) can only be carried out by a hospital or a specialised licensed clinic.
Nausea and vomiting in pregnancy (NVP) are regarded as a ‘normal’ phenomenon of early pregnancy, and so their impact is under-appreciated and under-researched. The condition can, however, be so serious that women need admission for fluid replacement. GPs and practice nurses looking after women with NVP need to be aware of its potential severity and be willing to offer safe and effective therapy.
In the UK about half of women of reproductive age are either overweight or obese. Obesity is known to adversely affect female fertility, as well as the health of mothers and their children. But even modest weight loss can restore fertility and improve a woman’s chances of a successful pregnancy.
Despite NICE guidelines, long-acting reversible contraceptives (LARCs) remain little used in the UK, but this looks set to change with their inclusion in this year’s new Quality and Outcomes Framework contraception indicators. The author reviews the currently available LARCs, and discusses how to tailor choice to the needs and preferences of each woman.
Between 0.2 and 4% of all pregnancies in western industrialised countries are complicated by cardiovascular disease (CVD), and the number of patients who develop cardiac problems during pregnancy is increasing. Knowledge of the risks associated with CVD during pregnancy and their management is of pivotal importance for advising patients before pregnancy.
It is exceedingly uncommon for a woman in the UK to die during pregnancy, with maternal mortality in the region of one death per 10,000 maternities1. Although there have been very significant improvements in antenatal care, such as a marked reduction in the number of deaths due to thromboembolic disease, other areas are trailing behind. One such area is cardiac disease – now the leading cause of maternal death in the UK. These relatively rare deaths also mask the much larger issues of maternal, fetal and perinatal morbidity. The most recent Confidential Enquiries into Maternal Death and the new European Society of Cardiology guidelines summarised in this issue of the PCCJ highlight the major clinical issues and attempt to provide consensus opinion regarding optimal care in what is a relatively evidence-sparse field.
The care of pre-existing diabetes during pregnancy is complex and the remit of secondary care, but much can be done by primary care staff to ensure that pregnant women and their babies are safely on the right track by the time pregnancy is confirmed. In this article, we explore how to provide women with pre-existing diabetes with detailed and accurate preconceptual advice. Work needs to begin before contraception is discontinued to significantly reduce the risks for both mother and baby. In women with gestational diabetes, practice nurses can also be proactive postnatally, preventing progression to type 2 diabetes.
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