By Simon Cartwright
This name is directed essentially in the direction of healthiness care pros outdoors of the USA. it's a concise, easy-to-refer-to guide of universal stipulations noticeable quite often perform and the way to regard them. every one situation is mentioned in a customary method that may be regularly occurring to so much GPs – review, together with background and exam, and administration. in the course of the publication there are ‘alert’ bins (marked with an exclamation point!) in addition to beneficial tricks and ‘useful tips’, trigger in containers. This variation is totally brand new with the very most up-to-date details and contains nationwide directions on treating significant illnesses noticeable in basic care.
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Bleeding with severe pain is likely to be due to placental abruption. If the woman’s blood group is rhesus negative, she requires an injection of anti-D 500 IU im within 72 hours of the start of bleeding. Do not perform a vaginal examination after 14 weeks in case of placenta praevia. NAUSEA AND VOMITING Vomiting in pregnancy can be extremely debilitating and the patient often requires considerable support and reassurance. Management • • • • Explain that the symptoms are likely to resolve by 14–16 weeks.
53 54 GYNAECOLOGY HORMONE REPLACEMENT THERAPY (HRT) Only hysterectomised women may be treated with unopposed oestrogens. • • • • • Oestrogen/progestogen preparations should be prescribed for women with an intact uterus (unopposed oestrogens may cause hyperplasia of the endometrium and possible endometrial cancer). g. Nuvelle or Prempak-C. g. Premique or Kliofem. Irregular bleeding is a common side-effect of these regimens during the early treatment stages. If it continues, endometrial abnormality should be excluded, and consideration given to cyclical HRT instead.
TRICHOMONAS Trichomonas is generally considered to be sexually transmitted and is often associated with other STIs. The discharge is usually frothy and yellow. Symptoms may include vaginal itching and soreness. Management Metronidazole 400 mg bd for 5 days. CHLAMYDIA See also p. 15 for opportunistic screening. Chlamydia is a major cause of PID, tubal infertility and ectopic pregnancy. It is the commonest curable STI in the industrialised world. Most women with chlamydia are asymptomatic. An endocervical chlamydia swab should be taken.