O&G

Metastatic (usually bilateral) ovarian tumours with signet-ring cells — most commonly from gastric cancer, then colorectal, breast and appendix. Finding bilateral ovarian masses should prompt a search for a GI primary, not just a gynae work-up.

• Risks to the fetus: severe anaemia and hydrops fetalis (also myocarditis and fetal loss), highest with infection before 20 weeks.
• Surveillance: weekly ultrasound for ~12 weeks after infection.
• Measure the middle cerebral artery peak systolic velocity — an elevated MCA-PSV is the non-invasive marker of fetal anaemia and triggers referral for intrauterine transfusion.

It is a multi-system disease, not just a blood pressure number — hypertension plus evidence of end-organ dysfunction. A spot urine protein:creatinine ratio >30 mg/mmol is significant proteinuria; but proteinuria is not required if there is renal, hepatic, haematological, or neurological involvement, or fetal growth restriction.

• Left lateral tilt (or manual uterine displacement) relieves aortocaval compression by the gravid uterus, improving venous return and uteroplacental blood flow.
• In maternal cardiac arrest, add amniotic fluid embolism and eclampsia to your reversible-cause list — and plan resuscitative hysterotomy early if there is no ROSC.
• Maternal deaths are classified as direct (from pregnancy itself) or indirect (pre-existing disease aggravated by pregnancy).

Amniotic fluid entering the maternal circulation triggers an anaphylactoid reaction — massive cytokine release and vasodilation, acute right ventricular failure from pulmonary hypertension with pulmonary oedema, and DIC with catastrophic haemorrhage.

• A clinical diagnosis of exclusion, usually confirmed retrospectively: sudden hypoxia/respiratory distress, hypotension/cardiovascular collapse, and DIC.
• Almost always occurs intrapartum or immediately postpartum. Mortality is very high, and neonatal hypoxic-ischaemic encephalopathy is common in survivors.
• Risk factors: advanced maternal age, multiparity, induction of labour, operative delivery, placental abnormalities. (Artificial rupture of membranes is often cited but the association is weak.)
• Exclude the far commoner postpartum haemorrhage first — but remember the two coexist, since AFE causes DIC.

• An Apgar <5 at 5 and 10 minutes is a poor prognostic marker and correlates with hypoxic-ischaemic encephalopathy — but it is a description of the newborn's condition, not a measure of asphyxia on its own.
• The General Movements Assessment at around 3 months corrected age (fidgety movements period) is one of the best early predictors of cerebral palsy — better than neuroimaging or neurological examination alone, and it allows early intervention.