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  <head>
    <title>054-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Antenatal care, pregnancy complications, labour, puerperium">
      <outline text="Two patients, one placental circulation">
        <outline text="Normal adaptations can resemble disease"/>
        <outline text="Minor maternal deterioration threatens placental flow"/>
        <outline text="Management varies with gestation"/>
      </outline>
      <outline text="Confirmation, dating, and booking">
        <outline text="Human chorionic gonadotropin confirms trophoblast only">
          <outline text="Not location or viability"/>
        </outline>
        <outline text="Date by last period and early ultrasound">
          <outline text="Location, number, cardiac activity, crown-rump length"/>
        </outline>
        <outline text="Unknown location: serial assessment">
          <outline text="Until intrauterine, ectopic, or loss is clear"/>
        </outline>
        <outline text="Reconcile teratogenic and essential medicines">
          <outline text="Abrupt withdrawal may exceed exposure risk"/>
        </outline>
        <outline text="Folic acid reduces neural-tube defects"/>
      </outline>
      <outline text="Maternal adaptation and monitoring">
        <outline text="Plasma volume outpaces red-cell mass">
          <outline text="Physiological dilutional anaemia"/>
        </outline>
        <outline text="Cardiac output up, systemic resistance down"/>
        <outline text="Ventilation up, carbon dioxide and bicarbonate down"/>
        <outline text="Filtration up alters creatinine and drug clearance"/>
        <outline text="Clotting shifts toward thrombosis"/>
        <outline text="Reduced reserve for haemorrhage, embolism, infection"/>
        <outline text="Genetic screening is voluntary">
          <outline text="Screening versus diagnosis, false results"/>
          <outline text="Villus sampling and amniocentesis are invasive"/>
        </outline>
      </outline>
      <outline text="Early pregnancy pain and bleeding">
        <outline text="Miscarriage symptoms overlap viable and ectopic">
          <outline text="Assess perfusion, peritonism, hormone, ultrasound"/>
        </outline>
        <outline text="Confirmed loss: expectant, medical, or surgical"/>
        <outline text="Ectopic pregnancy mostly tubal">
          <outline text="Many have no risk factor"/>
          <outline text="Rupture possible at low hormone levels"/>
          <outline text="Unstable: immediate surgery and resuscitation"/>
          <outline text="Stable: methotrexate or observation"/>
        </outline>
        <outline text="Hyperemesis: weight loss, dehydration, ketosis">
          <outline text="Thiamine before substantial carbohydrate"/>
        </outline>
      </outline>
      <outline text="Hypertensive disorders">
        <outline text="Chronic: before pregnancy or early"/>
        <outline text="Gestational: later, no defining organ injury"/>
        <outline text="Pre-eclampsia: new hypertension with organ dysfunction">
          <outline text="Abnormal placentation, endothelial dysfunction, leak"/>
          <outline text="Headache, visual change, epigastric pain: urgent"/>
        </outline>
        <outline text="Antihypertensives reduce severe-pressure harm"/>
        <outline text="Magnesium sulphate prevents eclamptic seizure"/>
        <outline text="Delivery definitive, balanced against prematurity">
          <outline text="Corticosteroids mature fetal lungs"/>
        </outline>
        <outline text="Low-dose aspirin in selected patients"/>
      </outline>
      <outline text="Diabetes in pregnancy">
        <outline text="Placental hormones raise insulin resistance">
          <outline text="Gestational diabetes when beta cells fail to compensate"/>
        </outline>
        <outline text="Pre-existing diabetes: risk from conception"/>
        <outline text="Hyperglycaemia: anomaly, overgrowth, neonatal hypoglycaemia"/>
        <outline text="Insulin needs fall after placental delivery"/>
        <outline text="Retest postpartum for type two risk"/>
      </outline>
      <outline text="Placental and fetal complications">
        <outline text="Praevia: painless bleeding">
          <outline text="No digital examination until location known"/>
        </outline>
        <outline text="Abruption: pain, tenderness, fetal compromise">
          <outline text="Concealed haemorrhage underestimates severity"/>
        </outline>
        <outline text="Rhesus D alloimmunisation">
          <outline text="Anti-D prevents sensitisation"/>
        </outline>
        <outline text="Growth restriction: biometry, fluid, Doppler"/>
        <outline text="Preterm membrane rupture: infection risk">
          <outline text="Fever, tenderness, offensive fluid suggest infection"/>
        </outline>
      </outline>
      <outline text="Labour and birth">
        <outline text="Regular uterine activity with cervical change"/>
        <outline text="Fetal heart patterns guide correction">
          <outline text="Hypotension, excess contractions, cord compression"/>
        </outline>
        <outline text="Delay: contractions, malposition, disproportion"/>
        <outline text="Shoulder dystocia: rehearsed manoeuvres"/>
        <outline text="Cord prolapse: relieve pressure, emergency delivery"/>
        <outline text="Uterine rupture: scarred uterus, laparotomy"/>
      </outline>
      <outline text="Postpartum haemorrhage">
        <outline text="Atony, retained tissue, trauma, coagulopathy"/>
        <outline text="Help, access, warming, quantify loss"/>
        <outline text="Uterotonics and early tranexamic acid"/>
        <outline text="Escalate: balloon, embolisation, hysterectomy"/>
        <outline text="Shock may precede blood-pressure fall"/>
      </outline>
      <outline text="Puerperium and lactation">
        <outline text="Endometritis, mastitis, urinary infection, sepsis"/>
        <outline text="Leg swelling, headache, deficit are warnings">
          <outline text="Thromboembolism, pre-eclampsia, stroke"/>
        </outline>
        <outline text="Prolactin produces, oxytocin ejects milk">
          <outline text="Skin contact, attachment, frequent removal"/>
        </outline>
        <outline text="Mastitis: continue drainage, image abscess"/>
        <outline text="Blues brief, persistent symptoms urgent">
          <outline text="Postpartum psychosis is an emergency"/>
        </outline>
        <outline text="Link complications to lifelong prevention"/>
      </outline>
    </outline>
  </body>
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