By Simon Cartwright
This name is directed essentially in the direction of well-being care pros open air of the U.S.. it's a concise, easy-to-refer-to guide of universal stipulations visible in most cases perform and the way to regard them. each one situation is mentioned in a typical manner that would be universal to such a lot GPs – review, together with heritage and exam, and administration. through the ebook there are ‘alert’ packing containers (marked with an exclamation point!) in addition to worthwhile tricks and ‘useful tips’, trigger in bins. This variation is totally brand new with the very most modern details and comprises nationwide guidance on treating significant ailments noticeable in fundamental care.
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Extra resources for Churchill’s Pocketbook of General Practice
Chlamydia, gonorrhoea and herpes simplex are rarely associated with vaginal discharge (see also STIs, p. 46). • • • • It is reasonable to treat ﬁrst or occasional episodes of candida according to clinical ﬁndings, without doing swabs. An HVS in transport medium is needed for culture of Candida, BV, Trichomonas and most bacterial causes of pyogenic infection. An endocervical swab in transport medium is needed for gonococcal culture. An endocervical chlamydia swab is needed for chlamydia diagnosis.
All pregnant women and partners of carriers should be offered screening. Refer couples who are both heterozygous. Management Advice Smoking and alcohol. Women should be advised to stop smoking and to reduce their alcohol intake to a minimum. Diet and nutrition • • • • Advise a well-balanced diet. Advise a diet rich in folic acid (green vegetables, bread, potatoes, fruit and fortiﬁed cereals). Advise all women to take supplements of folic acid, 400 mg per day, from before conception to 12 weeks of gestation.
CONTRACEPTION POSTPARTUM CONTRACEPTION POSTPARTUM CONTRACEPTION No contraception is necessary for the ﬁrst 25 days postpartum. If breastfeeding, avoid the COC, as oestrogen may inhibit lactation. When to start • • • COC and POP: can be started at 21 days postpartum. IUCD/IUS: can be inserted at 6 weeks (postnatal check) or at 12 weeks after a caesarean section. Diaphragm: can be ﬁtted at 6 weeks (postnatal check). 19 This page intentionally left blank CHAPTER 221 OBSTETRICS RUNNING HEAD B OBSTETRICS Preconceptual counselling 22 Booking visit 23 Subsequent antenatal visits 25 Prenatal screening and diagnosis 25 Bleeding in early pregnancy (Ͻ14 weeks) 27 Bleeding in later pregnancy 28 Nausea and vomiting 28 Heartburn 28 Swollen ankles 29 Varicose veins 29 Glycosuria 29 Proteinuria 30 Anaemia 30 Rhesus-negative mothers 31 Pre-eclampsia 31 Abnormal lie 32 High head 32 Back pain 32 Postpartum bleeding 32 Postpartum pyrexia 33 Postnatal depression 33 Postnatal check 34 Breast-feeding 35 22 OBSTETRICS PRECONCEPTUAL COUNSELLING PRECONCEPTUAL COUNSELLING Preconceptual counselling ensures that the woman is fully informed about measures which may be taken to protect herself and the developing foetus during any future pregnancy.