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  <head>
    <title>054-02 Maternal adaptation, placental physiology, obstetric emergencies, and postpartum transition</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Maternal adaptation, placenta, emergencies, postpartum">
      <outline text="Adaptation and maternal resuscitation">
        <outline text="Adaptations mimic disease">
          <outline text="Non-pregnant normal creatinine may mean impairment"/>
          <outline text="Modest bleeding turns dangerous as compensation fails"/>
        </outline>
        <outline text="Maternal resuscitation is fetal resuscitation">
          <outline text="Left uterine displacement eases aortocaval compression"/>
          <outline text="Compressions and defibrillation not delayed"/>
          <outline text="Early preparation for emergency delivery"/>
        </outline>
        <outline text="Search causes in parallel, keep resuscitating"/>
      </outline>
      <outline text="Organ system adaptation">
        <outline text="Dilutional anaemia despite rising red-cell mass"/>
        <outline text="Supine vena cava compression, relieved laterally"/>
        <outline text="Progesterone drives ventilation">
          <outline text="Non-pregnant normal carbon dioxide: hypoventilation"/>
        </outline>
        <outline text="Functional residual capacity falls">
          <outline text="Little oxygen reserve during apnoea"/>
        </outline>
        <outline text="Filtration up lowers urea and creatinine">
          <outline text="Glycosuria does not diagnose diabetes"/>
        </outline>
        <outline text="Hypercoagulability">
          <outline text="Protects against delivery bleeding"/>
          <outline text="Raises venous thrombosis, especially postpartum"/>
        </outline>
      </outline>
      <outline text="Placental physiology">
        <outline text="Exchange and endocrine organ"/>
        <outline text="Spiral arteries remodel to low resistance">
          <outline text="Failed remodelling causes placental ischaemia"/>
          <outline text="Antiangiogenic signals injure endothelium"/>
          <outline text="Pre-eclampsia, growth restriction, abruption"/>
        </outline>
        <outline text="High maternal pressure, poor placental flow"/>
      </outline>
      <outline text="Early pregnancy">
        <outline text="Positive gonadotropin: activity, not location"/>
        <outline text="Discriminatory thresholds are not absolute"/>
        <outline text="Ectopic rupture at low or falling levels">
          <outline text="Shoulder-tip pain, syncope, shock: surgery"/>
        </outline>
        <outline text="Hyperemesis: exclude multiple and molar pregnancy"/>
        <outline text="Vomiting depletes thiamine">
          <outline text="Carbohydrate first risks Wernicke encephalopathy"/>
        </outline>
      </outline>
      <outline text="Pre-eclampsia, HELLP, and eclampsia">
        <outline text="Multisystem placental endothelial disease">
          <outline text="Diagnosable without proteinuria"/>
        </outline>
        <outline text="Warnings: headache, vision, epigastric pain, reflexes"/>
        <outline text="Severe hypertension treated urgently">
          <outline text="Prevents maternal intracranial haemorrhage"/>
        </outline>
        <outline text="Magnesium sulphate for eclamptic seizure">
          <outline text="Monitor reflexes, breathing, urine; calcium antidote"/>
        </outline>
        <outline text="Cautious fluid: leak risks pulmonary oedema"/>
        <outline text="Delivery removes placenta, timing balanced"/>
        <outline text="HELLP: haemolysis, liver enzymes, low platelets"/>
        <outline text="Eclampsia before, during, or after birth"/>
        <outline text="Lifelong cardiovascular risk"/>
      </outline>
      <outline text="Gestational diabetes">
        <outline text="Insulin resistance exceeds beta-cell reserve"/>
        <outline text="Maternal glucose drives fetal insulin">
          <outline text="Growth and fat deposition"/>
          <outline text="Neonatal hypoglycaemia after birth"/>
        </outline>
        <outline text="Insulin need falls after placental delivery"/>
        <outline text="Postpartum testing for persistent diabetes"/>
      </outline>
      <outline text="Antepartum bleeding and fetal surveillance">
        <outline text="Praevia: painless bleeding, no digital exam"/>
        <outline text="Abruption: painful bleeding, may be concealed"/>
        <outline text="Vasa praevia: fetal bleeding at membrane rupture"/>
        <outline text="Growth restriction versus constitutionally small">
          <outline text="Redistribution to brain and heart"/>
          <outline text="Serial rather than single measurements"/>
        </outline>
      </outline>
      <outline text="Labour and intrapartum emergencies">
        <outline text="Fetal heart monitoring is indirect">
          <outline text="Autonomic response, not an oxygen meter"/>
        </outline>
        <outline text="Shoulder dystocia: head traction injures plexus">
          <outline text="Suprapubic pressure, internal rotation, posterior arm"/>
        </outline>
        <outline text="Cord prolapse: elevate presenting part"/>
        <outline text="Uterine rupture: bradycardia, loss of station"/>
      </outline>
      <outline text="Postpartum haemorrhage">
        <outline text="Tone, tissue, trauma, thrombin"/>
        <outline text="Atony: massage, empty bladder, uterotonics"/>
        <outline text="Visual estimates underestimate loss"/>
        <outline text="Activate protocol on physiology, not numbers"/>
        <outline text="Fibrinogen falls early">
          <outline text="Higher pregnancy range: mild fall can be severe"/>
        </outline>
      </outline>
      <outline text="Postpartum transition">
        <outline text="Autotransfusion can expose heart failure"/>
        <outline text="Endometritis: fever, tenderness, offensive lochia"/>
        <outline text="Sepsis: fever may be absent">
          <outline text="Trend and organ function carry more weight"/>
        </outline>
        <outline text="Lactation: assess transfer, not motivation"/>
        <outline text="Medicines: no blanket stop to feeding"/>
        <outline text="Mental illness from blues to psychosis">
          <outline text="Explicit risk assessment for intrusive thoughts"/>
        </outline>
        <outline text="Discharge: separate safety plans"/>
        <outline text="Transfer records for lifelong prevention"/>
      </outline>
    </outline>
  </body>
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