An Evidence-Based Clinical Textbook in Obstetrics & Gynaecology for MRCOG-2
An Evidence-Based Clinical Textbook in Obstetrics & Gynaecology for MRCOG-2
SECOND EDITION
Richa Saxena MBBS MD (Obstetrics and Gynaecology) PG Diploma in Clinical Research
Obstetrician and Gynaecologist Course Mentor: Cracking MRCOG
New Delhi, India
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An Evidence-Based Clinical Textbook in Obstetrics & Gynaecology for MRCOG-2
First Edition: 2017
Second Edition: 2021
9789390020645
Printed at
My mother Mrs Bharati Saxena for always being there…. .
“My mother is the most beautiful woman I have ever seen. All I am I owe to my mother. I attribute all my success in life to the moral, intellectual and physical education I received from her.”
—George Washington
“Twenty years from now you will be more disappointed by the things that you didn't do than by the ones you did do.”
—Mark Twain
Surely, none of the obstetrician gynaecologist would desire that not making an effort to acquire MRCOG degree becomes one of those things they did not do at a time when it would have been possible. Attaining the MRCOG degree has always been the dream of many doctors. Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG) can be considered as a gold standard, international qualification in the field of obstetrics and gynaecology and is often thought to represent the zenith of one's career. The book “An Evidence-Based Clinical Textbook in Obstetrics and Gynaecology for MRCOG-2” is an attempt to bring together the fundamental topics related to clinical sciences, which are of prime importance for the doctors who are planning to appear in MRCOG Part 2 Examination and wish to pursue their specialisation in obstetrics and gynaecology in the UK.
Getting the MRCOG degree entails passing through a series of a three-part examination in which Part 1 is a written examination, testing the candidate's knowledge related to basic sciences. Part 2 examination is a written examination testing candidate's clinical knowledge pertaining to the speciality of obstetrics and gynaecology. Part 3 is a clinical skills examination based on Objective Structured Clinical Examination (OSCE). For more details related to the MRCOG examination, kindly refer to the Royal College of Obstetricians and Gynaecologists (RCOG) website, https://www.rcog.org.uk/.
“When you want to succeed as bad as you want to breathe, then you shall be successful.”
—Eric Thomas
There is no denying of the fact that the MRCOG, especially part 2 examination, is a difficult examination and requires a lot of hard work and dedication on the part of the candidate. A fact remains that no book can replace the hard work the candidate would be required to put in. However, this book would definitely help the candidate to study smartly by providing them with the right amount of knowledge and guide them through the various nuances and finer aspects of the examination, enabling them to emerge out successfully through the examination.
The second edition of the book “An Evidence-Based Clinical Textbook in Obstetrics and Gynaecology for MRCOG-2” has been primarily inspired by the success of the first edition. Similar to the previous edition, the second edition has also adopted an evidence-based approach, especially focussing on the current standards in health care. It helps in the amalgamation of clinical expertise, patient values, and the best research evidence so that it can be used in the decision-making process for patient care.
The second edition has been thoroughly updated as per the latest evidence-based guidelines as recommended by the National Institute for Health and Clinical Excellence (NICE), Royal College of Obstetricians and Gynaecologists (RCOG), Green-Top Guidelines, etc. in the field of obstetrics and gynaecology. The book also covers the updated figures for maternal and perinatal mortality as described by MBRRACE UK (2019).
The previous categorisation of the book into three parts: general, obstetrics, and gynaecology as well the pattern of previous sections have been retained in this comprehensive new edition. This new edition comprises of 98 chapters, distributed into 17 sections and is based as per the current MRCOG-2 curriculum available from the RCOG website. Nevertheless, there has been an addition of several new chapters such as thromboembolism in pregnancy, genetic disorders, postpartum collapse, Zika virus infection, etc. COVID-19 and its management during pregnancy has also been discussed at length in this new edition.
Addition of online content is another new value-adding feature of this book. The book buyers would get access to more than 250 questions (in form of EMQs and SBAs), which have been added in an interactive format on an online portal. This additional content can be redeemed by using the scratch code going inside the front cover of the book. Besides a detailed explanation, which is provided with each question, an 8–9-hour-long video discussing these questions and other tips and tricks for clearing the Part 2 examination has also been added. The references of each chapter can also be accessed online by scanning a QR code. In case the reader wants to obtain more information related to a specific online reference, it can be clicked to access the actual journal article. This would also enable the reader to access the Green-Top Guidelines available online and read them in its entirety.
The text in each chapter has been organised in the form of a predefined template, including headings such as introduction, aetiology/indications, diagnosis, differential diagnosis, management, complications, and evidence-based medicine. A new heading, titled ‘key features’, has been added to all the chapters in the new edition. This heading would help the reader in summarising the chapter. Important topics in each chapter have been delineated with help of a specific symbol so that the reader lays special emphasis on these topics. This style facilitates innovative learning and would enable the readers to quickly revise just before the examination by taking a glance at the key features and portions of the text indicated with an icon of a ‘pin’.
Writing a book is a colossal task. It can never be completed without divine intervention and approval. Therefore, I have decided to end this preface with a small prayer of thanks to the Almighty, which I was taught in my childhood.
“Father, lead me day by day, ever in thy own sweet way. Teach me to be pure and good and tell me what I ought to do.”
—Amen
Simultaneously, I would like to extend my thanks and appreciation to all the related authors and publishers whose references have been used in this book. Book creation is teamwork and I acknowledge the way the entire staff of M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India, worked hard on this manuscript to give it a final shape. I would especially like to thank Mr Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Ms Chetna Malhotra (Associate Director—Content Strategy), Ms Pooja Bhandari (Production Head), Kritika Dua (Senior Development Editor), Ashwani Singh (Assistant Manager), Yogeshwar Pal (Medical Editor and Coordinator), Raj Kumar (Typesetter), Nitin Bharadwaj (Graphic Designer), Sarvesh Singh (Proofreader), and Ms Seema Dogra (Cover Designer) for publishing the book.
I believe that writing a book involves a continuous learning process. Though extreme care has been taken to maintain the accuracy while writing this book, constructive criticism would be greatly appreciated.
Please e-mail me your comments at the e-mail address: richa@drrichasaxena.com. Also, please feel free to visit my website www.drrichasaxena.com for obtaining information related to various other books written by me and to make use of the free online resources available for the doctors attempting the MRCOG examination.
Richa Saxena
Preface to the First Edition (Extract)
Recently, there has been a growing consensus regarding the use of evidence-based approach for healthcare management. Evidence-based practice has been defined as follows:
“The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”
—Sackett D, 1996
This book, An Evidence-Based Clinical Textbook in Obstetrics and Gynaecology for MRCOG-2, an evidence-based approach, typically focusses on the current standards in health care. It helps in the amalgamation of clinical expertise, patient values, and the best research evidence so that it can be used in the decision-making process for patient care. It is intended for the doctors who are planning to appear in MRCOG examination and wish to pursue their specialisation in obstetrics and gynaecology in the UK. This comprehensive textbook comprises of 93 chapters, distributed into 17 sections and is based as per the current MRCOG-2 curriculum (available from: https://www.rcog.org.uk/en/careers-training/mrcog-exams/part-2-mrcog/syllabus). Designed into three parts, the textbook covers all the relevant topics related to general principles of medical practice, obstetrics, and gynaecology which are further segregated into sections like general principles, antenatal period, medical disorders during pregnancy, complications specific to pregnancy and those during early pregnancy, foetal complications (diagnosis and management), intrapartum period, delivery and its complications, postpartum period, the newborn infant, general gynaecology, abnormalities of menstruation, reproductive medicine, urogynaecological and pelvic floor abnormalities, gynaecological oncology, gynaecological infections as well as pregnancy prevention. To facilitate easy learning, the text is organised in accordance with a predefined template, including introduction, aetiology/indications, diagnosis, differential diagnosis, management, complications, clinical pearls, and evidence-based medicine. An effort has been made to incorporate all the recent most evidence-based guidelines (Green-top Guidelines, NICE Guidelines, etc.) in the text. Numerous flowcharts and diagrams have been incorporated in the text to make it more understandable for the students. The book also includes the latest statistics related to the causes of maternal and neonatal mortality in the UK as published by the MBRRACE UK in December 2016. It also includes details pertaining to the Green-top Guidelines (No. 52) for prevention and management of postpartum haemorrhage (published in December 2016).
The text aptly offers all the required information a specialist registrar or senior house officer requires during his/her training and while preparing for the MRCOG examination. In fact, this book would also assist all the applicants, especially overseas, preparing for MRCOG examination (part 1 as well as parts 2 and 3). It would equip them with the knowledge to answer the SBAs and EMQs asked during MRCOG-2 examination. It would also enhance their clinical knowledge to be able to attempt the OSCES in MRCOG-3 examination. Also, any healthcare professional in the UK interested in learning more about the health care of women is likely to benefit from this book. In a nutshell, this book would serve as an invaluable companion not only for the doctors aiming towards higher training in obstetrics and gynaecology, but would also serve as a useful source of ready reference for those in established practice.
Simultaneously, I would like to extend my thanks and appreciation to all the related authors and publishers whose references have been used in this book. I believe that writing a book involves a continuous learning process. Though extreme care has been taken to maintain the accuracy while writing this book, constructive criticism would be greatly appreciated. Please e-mail me your comments at the e-mail address: richa@drrichasaxena.com.
Richa Saxena
MRCOG Standards
The New Core Curriculum and the MRCOG
As per the new course curriculum (2019) by the RCOG, the Capabilities in Practice (CiPs) are assessed by the different parts of the MRCOG examination. The Part 2 MRCOG, which covers the knowledge required during clinical practice, is used for the summative assessment of CiP 9, CiP 10, CiP 11, and CiP 12, along with elements of CiP 2 to demonstrate developing clinical expertise. Various CiPs as assessed by the MRCOG-2 examination are as follows:
Skill Assessed: Developing the Doctor (Generic)
CiP 2: The doctor is able to successfully work within health organisations
Skill Assessed: Developing the Obstetrician and Gynaecologist (Specialty-specific)
CiP 9: The doctor is competent in recognising, assessing, and managing emergencies in gynaecology and early pregnancy
CiP 10: The doctor is competent in recognising, assessing, and managing emergencies in obstetrics
CiP 11: The doctor is competent in recognising, assessing, and managing non-emergency gynaecology and early pregnancy care
CiP 12: The doctor is competent in recognising, assessing, and managing non-emergency obstetrics care.
This comprehensive textbook is based as per the current MRCOG-2 curriculum (available from: https://www.rcog.org.uk/globalassets/documents/careers-and-training/mrcog-exam/mrcog-syllabus-curriculum-2019.pdf). Described below are various CiPs and the various knowledge areas covered by them. Different knowledge areas on which different chapters of this textbook are based are also tabulated below:
CiP 2
Knowledge Areas | Book chapters covering the syllabus |
---|---|
Clinical skills Teaching and research | Chapter 1: Principles of Clinical Practice in the NHS |
Topics Covered
Knowledge Area 1: Clinical Skills
|
Knowledge Area 2: Teaching and Research
|
CiP 9
Knowledge Areas | Book chapters covering the syllabus |
---|---|
Core surgical skills Post-operative care | Chapter 2: General Principles of Surgery |
Early pregnancy care | Chapter 37: Ectopic Pregnancy Chapter 38: Spontaneous Miscarriage Chapter 39: Gestational Trophoblastic Neoplasia Chapter 98: Medical Termination of Pregnancy |
Topics Covered
Knowledge Area 3: Core Surgical Skills
|
Knowledge Area 4: Post-operative Care
|
Knowledge Area 13: Early Pregnancy Care
|
CiP 12
Knowledge Areas | Book chapters covering the syllabus |
---|---|
Antenatal care | Chapter 3: Routine Antenatal Care Chapter 4: Biochemical and Ultrasound Screening for Foetal Anomalies Chapter 5: Invasive and Non-Invasive Prenatal Diagnosis Chapter 6: Tests for Foetal Well-Being Chapter 7: Genetic Disorders |
Maternal medicine | Chapter 8: Hypertensive Disorders during Pregnancy Chapter 9: Cardiac Disease in Pregnancy Chapter 10: Thyroid Disorders during Pregnancy Chapter 11: Connective Tissue Disorders (Autoimmune Disorders) Chapter 12: Respiratory Diseases in Pregnancy Chapter 13: Epilepsy and Other Neurological Disorders Chapter 14: Hepatic and Gastrointestinal Diseases Chapter 15: Anaemia and Other Haematological Abnormalities Chapter 16: Thromboembolic Disorders in Pregnancy and Puerperium Chapter 17: Diabetes Mellitus and Gestational Diabetes Chapter 18: Abdominal Pain during Pregnancy Chapter 19: Varied Malignancies during Pregnancy Chapter 20: Dermatological Disorders during Pregnancy Chapter 21: Renal Disease during Pregnancy Chapter 22: Maternal Infection during Pregnancy Chapter 23: Smoking during Pregnancy Chapter 24: Alcohol and Drug Usage during Pregnancy Chapter 40: Foetal Growth Restriction Chapter 41: Foetal Infection Chapter 42: Non-immune Foetal Hydrops Chapter 43: Foetal Anomalies and their Management |
Topics Covered
Knowledge Area 5: Antenatal Care
|
Knowledge Area 6: Maternal Medicine
|
CiP 10
Knowledge Areas | Book chapters covering the syllabus |
---|---|
Management of labour | Chapter 25: Multifoetal Gestation Chapter 26: Preterm Labour and Premature Rupture of Membranes Chapter 27: Antepartum Haemorrhage Chapter 28: Rhesus Isoimmunisation Chapter 29: Abnormal Presentation Chapter 30: Intrauterine Death Chapter 31: Recurrent Miscarriage Chapter 32: Pregnancy after Previous Caesarean Delivery Chapter 33: Post-term Pregnancy (Prolonged Pregnancy) Chapter 34: Liquor Abnormalities Chapter 35: Maternal Mortality Chapter 36: Medications during Pregnancy Chapter 44: Normal and Abnormal Progress of Labour Chapter 45: Induction of Labour Chapter 46: Anaesthesia and Analgesia in Labour Chapter 47: Perineal Injuries |
Management of delivery | Chapter 48: Caesarean Delivery Chapter 49: Instrumental Vaginal Delivery Chapter 50: Shoulder Dystocia Chapter 51: Antepartum and Intrapartum Foetal Asphyxia |
Postpartum complications | Chapter 52: Postpartum Haemorrhage Chapter 53: Maternal Collapse during Pregnancy and Postpartum Period Chapter 54: Puerperal Pyrexia Chapter 55: Psychiatric Disorders in the Puerperium (Mood Disturbances) Chapter 56: Problems with Breastfeeding Chapter 57: Asphyxia Neonatorum Chapter 58: Care of a Newborn Child Chapter 59: Perinatal Mortality |
Topics Covered
Knowledge Area 7: Management of Labour
|
Knowledge Area 8: Management of Delivery
|
Knowledge Area 9: Postpartum Problems (The Puerperium)
|
CiP 11
Knowledge Areas | Book chapters covering the syllabus |
---|---|
Gynaecological problems | Chapter 60: Normal and Abnormal Embryological Development Chapter 61: Karyotypic Abnormalities Chapter 62: Menstrual Cycle Chapter 63: Adolescent and Paediatric Gynaecology Chapter 64: Menopause and Hormone Therapy Chapter 65: Injuries of the Female Genital Tract and Female Genital Mutilation Chapter 66: Child Abuse, Sexual Assault, and Rape Chapter 67: Dyspareunia and Other Psychosexual Problems Chapter 68: Abnormal Uterine Bleeding Chapter 69: Uterine Leiomyoma Chapter 70: Dysmenorrhoea and Pelvic pain Chapter 71: Premenstrual Syndrome Chapter 72: Chronic Pelvic Pain and Endometriosis Chapter 73: Adenomyosis |
Subfertility | Chapter 74: Normal Conception Chapter 75: Primary and Secondary Amenorrhoea Chapter 76: Male Infertility Chapter 77: Female Infertility Chapter 78: Polycystic Ovarian Disease Chapter 79: Hirsutism Chapter 80: Assisted Reproductive Techniques Chapter 81: Primary Ovarian Insufficiency Chapter 82: Fertility Preservation Chapter 83: Unexplained Infertility |
Sexual and reproductive health | Chapter 93: Sexually Transmitted Infections Chapter 94: Vaginal Discharge Chapter 95: Pelvic Inflammatory Disease Chapter 96: Benign Vulvar Problems and Vulval Pain Syndromes Chapter 97: Contraception (Temporary and Permanent) |
Gynaecological oncology | Chapter 87: Endometrial Cancer Chapter 88: Ovarian Neoplasia (Benign and Malignant) Chapter 89: Cervical Intraepithelial Neoplasia Chapter 90: Invasive Cervical Cancer Chapter 91: Rare Cancers of the Female Genital Organs Chapter 92: Vulvar Cancer |
Urogynaecology and pelvic floor problems | Chapter 84: Urogenital Prolapse Chapter 85: Urinary Incontinence Chapter 86: Urinary Tract Infection and Bladder Pain Syndrome |
Topics Covered
Knowledge Area 10: Gynaecological Problems
|
Knowledge Area 11: Subfertility
|
Knowledge Area 12: Sexual and Reproductive Health
|
Knowledge Area 14: Gynaecological Oncology
|
Knowledge Area 15: Urogynaecology and Pelvic Floor Problems
|
Reference:
Royal College of Obstetricians and Gynaecologists. (2019). MRCOG Syllabus and Knowledge Requirements for Core Curriculum 2019. [Online] Available from: https://www.rcog.org.uk/globalassets/documents/careers-and-training/mrcog-exam/mrcog-syllabus-curriculum-2019.pdf [Accessed November 2020].
Introduction to the Symbols Used in the Textbook
Promoting evidence-based medicine is the basic purpose of this book. Assembled into three parts, General, Obstetrics, and Gynaecology, the comprehensive textbook is divided into 17 sections and 98 chapters that are written as per the current MRCOG-2 curriculum. All the chapters have been organised into various subparts with the help of the symbols as described below.
Abbreviations
+ssRNA
Positive Sense Single-stranded RNA Virus
2019-nCoV
Novel Coronavirus
ACE
Angiotensin-converting Enzyme
ACOG
American College of Obstetricians and Gynecologists
ADPKD
Autosomal Dominant Polycystic Kidney Disease
AED
Antiepileptic Drug
AFI
Amniotic Fluid Index
AFV
Amniotic Fluid Volume
AIDS
Acquired Immune Deficiency Syndrome
ALT
Alanine Aminotransferase
ANA
Antinuclear Antibodies
ANC
Antenatal Care
Anti-Sm
Anti-Smith Antibodies
AP
Anteroposterior
APGAR
Appearance, Pulse, Grimace, Activity and Respiration
APLS/APS
Antiphospholipid Antibody Syndrome/Antiphospholipid Syndrome
aPTT/APTT
Activated Partial Thromboplastin Time
ARB
Angiotensin II Receptor Blockers
ARDS
Acute Respiratory Distress Syndrome
ARM
Artificial Rupture of Membranes
ASD
Atrial Septal Defect
AST
Aspartate Aminotransferase
BCSH
British Committee for Standards in Haematology
BMI
Body Mass Index
BP
Blood Pressure
BPM
Beats Per Minute
BPP
Biophysical Profile
BPS
Bladder Pain Syndrome
CA-MRSA
Community-acquired Methicillin-resistant Staphylococcus aureus
cART
Combined Antiretroviral Therapy
CBC
Complete Blood Count
CDC
Center of Disease Control and Prevention
CEMACH
Confidential Enquiries into Maternal and Child Health
CEMD
Confidential Enquiries into Maternal Deaths
CESDI
Confidential Enquiries into Stillbirths and Deaths in Infancy
cffDNA
Cell-free Foetal DNA
CI
Confidence Interval
CMACE
Centre for Maternal and Child Enquiries
CNS
Central Nervous System
CO
Carbon Monoxide
COMA
Committee on Medical Aspects for Food and Nutrition Policy
CoV
Coronavirus
COVID-19
Coronavirus Disease 2019
CPR
Cardiopulmonary Resuscitation
CRP
C-reactive protein
CS
Caesarean Section
CST
Contraction Stress Test
CT
Computed Tomography
CTG
Cardiotocography
CTPA
Computerised Tomography Pulmonary Angiography
CVS
Chorionic Villus Sampling
CZS
Congenital Zika syndrome
D&C
Dilatation and Curettage
DAD
Diffuse Alveolar Damage
DFMC
Daily Foetal Movement Count
DIC
Disseminated Intravascular Coagulation
DLC
Differential Leucocyte Count
Ds
Double-stranded
DVT
Deep Vein Thrombosis
ECG
Electrocardiogram
ELISA
Enzyme-linked Immunosorbent Assay
ERCS
Elective Repeat Caesarean Section
ESHRE
European Society of Human Reproduction and Embryology
ESR
Erythrocyte Sedimentation Rate
ESSIC
European Society for the Study of Interstitial Cystitis
FDA
Food and Drug Administration
FDP
Fibrin Degradation Products
FEV1
Forced Expiratory Volume in 1 Second
ffDNA
Free-foetal Deoxyribonucleic Acid
fFN
Foetal Fibronectin
FFP
Fresh Frozen Plasma
FH
Familial Hypercholesterolaemia
FHR
Foetal Heart Rate
FHS
Foetal Heart Sound
FIGO
International Federation of Gynecology and Obstetrics
FISH
Fluorescent In-Situ Hybridisation
FMH
Foetomaternal Haemorrhage
FNAC
Fine-needle Aspiration Cytology
FSH
Follicle-stimulating Hormone
FVL
Factor V Leiden
FVS
Foetal Varicella Syndrome
G6PD
Glucose-6-Phosphate Dehydrogenase
GBS
Group B Streptococcus
GDG
Guideline Development Group
GFR
Glomerular Filtration Rate
GI
Gastrointestinal
GnRH
Gonadotrophin-releasing Hormone
GP
General Practitioner
GTG
Green-top Guideline
GUM
Genitourinary Medicine
HAART
Highly Active Antiretroviral Therapy
HAV
Hepatitis A Virus
HBIG
Hepatitis B Immunoglobulin
HBsAg
Hepatitis B Surface Antigen
HBV
Hepatitis B Virus
hCG
Human Chorionic Gonadotrophin
HCV
Hepatitis C Virus
HDV
Hepatitis D Virus
HELLP
Haemolysis, Elevated Liver Enzymes and Low Platelet count
HEV
Hepatitis E Virus
HG
Hyperemesis Gravidarum
HGV
Hepatitis G Virus
HIV
Human Immunodeficiency Virus
HLA
Human Leucocyte Antigen
HPV
Human Papillomavirus
HR
Heart Rate
HRT
Hormone Replacement Therapy
HSV
Herpes Simplex Virus
ICU
Intensive Care Unit
Ig
Immunoglobulin
IM
Intramuscular
INR
International Normalised Ratio
ISSHP
International Society for the Study of Hypertension in Pregnancy
IUCD
Intrauterine Contraceptive Device
IUGR
Intrauterine Growth Restriction/Retardation
IV
Intravenous
IVF
In Vitro Fertilisation
L:S ratio
Lecithin:Sphingomyelin ratio
LDA
Low-dose Aspirin
LFT
Liver Function Test
LH
Luteinising Hormone
LMWH
Low-Molecular-Weight Heparin
MAP
Morbidly Adherent Placenta
MAS
Meconium Aspiration Syndrome
MC
Monochorionic
MCH
Mean Corpuscular Haemoglobin
MCHC
Mean Corpuscular Haemoglobin Concentration
MCV
Mean Corpuscular Volume
MEN
Multiple Endocrine Neoplasia
MERS
Middle East Respiratory Syndrome
MEWS
Modified Early Warning Score
MOD
Multiple Organ Dysfunction
MOF
Multiple Organ Failure
MRI
Magnetic Resonance Imaging
MS
Multiple Sclerosis
MTC
Mother-to-Child
NCEPOD
National Confidential Enquiry into Patient Outcome and Death
NEC
Necrotising Enterocolitis
NHS
National Health Service
NICE
National Institute for Health and Clinical Excellence/National Institute for Clinical Excellence
NICU
Neonatal Intensive Care Unit
NIPD
Non-invasive Prenatal Diagnosis
NOACs
Non-vitamin K Antagonist Oral Anticoagulants
NPEU
National Perinatal Epidemiology Unit
NRTIs
Non-reverse Transcriptase Inhibitors
NSAIDs
Non-steroidal Anti-inflammatory Drugs
NST
Non-stress Test
OC
Obstetric Cholestasis
OCPs
Oral Contraceptive Pills
OPD
Outpatient Department
OR
Odds Ratio
PAPR
Powered Air-purifying Respirator
PC
Platelet Count
PCOS/PCOD
Polycystic Ovarian Syndrome/Polycystic Ovarian Disease
PCP
Pneumocystis carinii Pneumonia
PCR
Polymerase Chain Reaction
PE
Pulmonary Embolism
PEFR
Peak Expiratory Flow Rate
PET
Positron Emission Tomography
PFT
Pulmonary Function Test
PGI2
Prostacyclin/Prostaglandin I2
PID
Pelvic Inflammatory Disease
PIH
Pregnancy-induced Hypertension
PO
Per orally or per os
POF
Premature Ovarian Failure
POG
Period of Gestation
PPH
Postpartum Haemorrhage
PROM
Premature Rupture of Membranes
PT
Prothrombin Time
PV
Per Vaginally
QF-PCR
Quantitative Fluorescence Polymerase Chain Reaction
RBC
Red Blood Cell
RCOG
Royal College of Obstetricians and Gynaecologists
RCT
Randomised Controlled Trial
RDS
Respiratory Distress Syndrome
RIA
Radioimmunoassay
ROM
Rupture of Membranes
ROS
Reactive Oxygen Species
RPF
Renal Plasma Flow
RT-PCR
Reverse Transcription Polymerase Chain Reaction
SARS CoV-2
Severe Acute Respiratory Syndrome Coronavirus 2
SARS
Severe Acute Respiratory Syndrome
SC
Subcutaneous
SLE
Systemic Lupus Erythematosus
SNP
Single Nucleotide Polymorphism
SOGC
Society of Obstetricians and Gynaecologists of Canada
SPF
Sun Protection Factor
SSCP
Single Strand Conformation Polymorphism
STD
Sexually Transmitted Disease
T3
Tri-iodothyronine
T4
Thyroxine
TAS
Transabdominal Scan or Sonography
TENS
Transcutaneous Electrical Nerve Stimulation
TLC
Total Leucocyte Count
TORCH
Toxoplasmosis, Other Infections, Rubella, Cytomegalovirus, Herpes Simplex Virus
TSH
Thyroid-stimulating Hormone
TT
Thrombin Time
TTN
Transient Tachypnoea of the Newborn
TTTS
Twin-to-Twin Transfusion Syndrome
TVCL
Transvaginal Cervical Length
TVS
Transvaginal Scan or Sonography
TVT
Tension-free Vaginal Tape
TXA2
Thromboxane A2
UDCA
Ursodeoxycholic Acid
UFH
Unfractionated Heparin
UKOSS
UK Obstetric Surveillance System
UNICEF
United Nations Children's Fund
US
Ultrasonography
UTI
Urinary Tract Infection
UV
Ultraviolet
VBAC
Vaginal Birth after Caesarean
VDRL
Venereal Disease Research Laboratory
VTE
Venous Thromboembolism
VZIG
Varicella-Zoster Immunoglobulin
VZV
Varicella-Zoster Virus
WBC
White Blood Cell
WHO
World Health Organization
WY
Women Years
ZDV
Zidovudine
ZIKV
Zika Virus