Mastering the DRCOG by Groves, Jamila; Bacon, Lesley; Cochrane, Ruth

By Groves, Jamila; Bacon, Lesley; Cochrane, Ruth

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Smoking cessation pre-conception If either partner smokes, then smoking cessation is encouraged. A new tablet, Varenicline (marketed as Champix), is also proving successful in supporting people trying to abandon their nicotine addiction. However, many smokers do break their habit simply by individual concentration and determination. Cervical screening and sexual health pre-conception Cervical screening is encouraged if such is due. Opportunistic testing for sexually transmitted infections is also encouraged.

Many women, however, never meet their obstetrician as pregnancy, and delivery, takes place naturally without the need for any medical intervention. However, should there be any deviation from normal, or should problems develop during labour, the obstetrician is the source of expertise and, as such, will often play a large role in the care of the woman and her fetus. The obstetrician is often involved in seeing women following miscarriage or still-birth, in addition to the GP who will continue to be the first port of call for the patient in the community once she has delivered.

Women are offered oral vitamin K at a dose of 10 mg daily to minimise the chance of post-partum and neonatal bleeding. Uterine fibroids are common, particularly among older women of African or Caribbean origin; during pregnancy, fibroids can be the cause of considerable pain. The resulting fibroid mass becomes a source of severe pain. Pain from red degeneration of fibroids can be managed with paracetamol or a mild opiate as necessary. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and diclofenac, should be avoided in pregnancy as they can cause closure of the fetal ductus arteriosus, and possibly persistent pulmonary hypertension of the newborn.

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