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Pregnancy is associated with profound anatomical, physiological, biochemical and endocrine changes that affect multiple organs and systems. Red blood cell (RBC) volume falls during the first 8 weeks of pregnancy, increasing back to non-pregnant levels by 16 weeks and then rising to 30 percentage above non-pregnant levels by term. Marked physiological changes of cardiovascular system, respiratory system, renal system, and gastrointestinal system are significantly observed. During pregnancy the skin undergoes a number of changes, mainly thought to be due to hormonal changes. The additional demand for folate during pregnancy leads to a rapid fall in red cell folate and to a high incidence of megaloblastic anaemia in those women taking anticonvulsant drugs for control of epilepsy. For appendicectomy the type of incision depends on the gestation and the location of the appendix. The routine use of urinalysis for monitoring of glycaemic control during pregnancy is unreliable.
Cord prolapse is an obstetric emergency with a high risk of perinatal mortality. Selective transvaginal scanning in women with high-risk factors such as a transverse lie, malpresentation (e.g. footling or lexed breech) or high presenting part of fetus, may be useful. Amniotomy is contraindicated if the cord is palpable below or by the side of the presenting part during vaginal examination. Women with prelabour (prolonged) rupture of membranes (PROM) should be offered a speculum examination irrespective of the period of gestation. A digital vaginal examination indicates the presence of PROM or preterm PROM (PPROM) with cardiotocograph (CTG) abnormalities such as variable decelerations, prolonged decelerations and bradycardia and a suspicion of cord prolapse. Emergency caesarean section (CS) is frequently needed but assisted or operative vaginal delivery may be possible if the cervix is fully dilated. Post-delivery debriefing and counselling of parents and risk-management discussions are needed.
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