Women can begin using hormonal contraception right away after taking levonorgestrel (Levonelle) for emergency contraception. However, if ulipristal acetate was used instead, it may affect the effectiveness of hormonal contraception and women should use barrier methods or refrain from sex for 5 days before resuming hormonal contraception.

Emergency contraception is available in the UK through two methods: emergency hormonal contraception and intrauterine device (IUD). Emergency hormonal contraception includes two types of pills: levonorgestrel and ulipristal. Levonorgestrel works by stopping ovulation and inhibiting implantation, and should be taken as soon as possible after unprotected sexual intercourse (UPSI) for maximum efficacy. The single dose of levonorgestrel is 1.5mg, but should be doubled for those with a BMI over 26 or weight over 70kg. It is safe and well-tolerated, but may cause vomiting in around 1% of women. Ulipristal, on the other hand, is a selective progesterone receptor modulator that inhibits ovulation. It should be taken within 120 hours after intercourse, and may reduce the effectiveness of hormonal contraception. The most effective method of emergency contraception is the copper IUD, which may inhibit fertilization or implantation. It must be inserted within 5 days of UPSI, or up to 5 days after the likely ovulation date. Prophylactic antibiotics may be given if the patient is at high-risk of sexually transmitted infection. The IUD is 99% effective regardless of where it is used in the cycle, and may be left in-situ for long-term contraception.

Breastfeeding women can safely take SSRIs such as sertraline or paroxetine as the amount of antidepressant passed on to the infant through breast milk is very low and not considered harmful. Therefore, it is recommended that women with postnatal depression continue to breastfeed while receiving antidepressant treatment.

Understanding Postpartum Mental Health Problems

Postpartum mental health problems can range from mild ‘baby-blues’ to severe puerperal psychosis. To screen for depression, healthcare professionals may use the Edinburgh Postnatal Depression Scale, which is a 10-item questionnaire that indicates how the mother has felt over the previous week. A score of over 13 indicates a ‘depressive illness of varying severity’, and the questionnaire includes a question about self-harm. The sensitivity and specificity of this screening tool are over 90%.

‘Baby-blues’ are seen in around 60-70% of women and typically occur 3-7 days following birth. This condition is more common in primips, and mothers are characteristically anxious, tearful, and irritable. Postnatal depression affects around 10% of women, with most cases starting within a month and typically peaking at 3 months. The features of postnatal depression are similar to depression seen in other circumstances.

Puerperal psychosis affects approximately 0.2% of women and usually occurs within the first 2-3 weeks following birth. The features of this condition include severe swings in mood (similar to bipolar disorder) and disordered perception (e.g. auditory hallucinations). Reassurance and support are important for all these conditions, but admission to hospital is usually required for puerperal psychosis, ideally in a Mother & Baby Unit. Cognitive behavioural therapy may be beneficial, and certain SSRIs such as sertraline and paroxetine may be used if symptoms are severe. While these medications are secreted in breast milk, they are not thought to be harmful to the infant. However, fluoxetine is best avoided due to its long half-life. There is around a 25-50% risk of recurrence following future pregnancies.

According to NICE guidelines, screening for gestational diabetes should be done for women who have a first degree relative with non-insulin dependent diabetes. Additionally, if a second urine dipstick test is positive for glucose, it may also indicate the need for further investigation. However, a birth weight of 4.3kg falls within the normal range of 2.5-4.5kg and would not be a sufficient reason to conduct a glucose tolerance test.

Gestational diabetes is a common medical disorder that affects around 4% of pregnancies. It can develop during pregnancy or be a pre-existing condition. According to NICE, 87.5% of cases are gestational diabetes, 7.5% are type 1 diabetes, and 5% are type 2 diabetes. Risk factors for gestational diabetes include a BMI of > 30 kg/m², previous gestational diabetes, a family history of diabetes, and family origin with a high prevalence of diabetes. Screening for gestational diabetes involves an oral glucose tolerance test (OGTT), which should be performed as soon as possible after booking and at 24-28 weeks if the first test is normal.

To diagnose gestational diabetes, NICE recommends using the following thresholds: fasting glucose is >= 5.6 mmol/L or 2-hour glucose is >= 7.8 mmol/L. Newly diagnosed women should be seen in a joint diabetes and antenatal clinic within a week and taught about self-monitoring of blood glucose. Advice about diet and exercise should be given, and if glucose targets are not met within 1-2 weeks of altering diet/exercise, metformin should be started. If glucose targets are still not met, insulin should be added to the treatment plan.

For women with pre-existing diabetes, weight loss is recommended for those with a BMI of > 27 kg/m^2. Oral hypoglycaemic agents, apart from metformin, should be stopped, and insulin should be commenced. Folic acid 5 mg/day should be taken from preconception to 12 weeks gestation, and a detailed anomaly scan at 20 weeks, including four-chamber view of the heart and outflow tracts, should be performed. Tight glycaemic control reduces complication rates, and retinopathy should be treated as it can worsen during pregnancy.

Targets for self-monitoring of pregnant women with diabetes include a fasting glucose level of 5.3 mmol/l and a 1-hour or 2-hour glucose level after meals of 7.8 mmol/l or 6.4 mmol/l, respectively. It is important to manage gestational diabetes and pre-existing diabetes during pregnancy to reduce the risk of complications for both the mother and baby.

Folic Acid Supplements for Women

Taking folic acid supplements before conception can be beneficial for women. It is important to note that the correct dose for women without risk factors is 400mcg, not 5mg. While 400mcg tablets are available over the counter, 5mg tablets require a prescription. Women should continue taking the supplements until 12 weeks of pregnancy. It is important to start taking folic acid before becoming pregnant to reap the benefits.

Cervical Screening During Pregnancy

According to the latest guidelines from the NHS Cervical Screening Programme, it is not recommended for women to have cervical screening while pregnant. However, if a smear test is due during pregnancy, it is advised to wait approximately three months after delivery before having the test. This recommendation is particularly relevant for women with no history of abnormal smears. It is important to follow these guidelines to ensure accurate results and to avoid any potential harm to the developing fetus. Therefore, if you are pregnant and due for a smear test, it is best to wait until after delivery to schedule your appointment.

In case of suspected rubella during pregnancy, it is important to consult with the local Health Protection Unit for guidance on appropriate investigations. If the mother is found to be non-immune to rubella, the MMR vaccine should be administered after delivery. However, the risk of transmission to the fetus in this scenario is uncertain. If transmission does occur, particularly later in the pregnancy, it can cause significant harm to the developing fetus. Hospitalization is not necessary at this point.

Rubella and Pregnancy: Risks, Features, Diagnosis, and Management

Rubella, also known as German measles, is a viral infection caused by the togavirus. Thanks to the introduction of the MMR vaccine, rubella is now rare. However, if contracted during pregnancy, there is a risk of congenital rubella syndrome. It is important to note that the incubation period is 14-21 days, and individuals are infectious from 7 days before symptoms appear to 4 days after the onset of the rash.

The risk of damage to the fetus is as high as 90% in the first 8-10 weeks of pregnancy, but damage is rare after 16 weeks. Congenital rubella syndrome can cause a range of features, including sensorineural deafness, congenital cataracts, congenital heart disease, growth retardation, hepatosplenomegaly, purpuric skin lesions, ‘salt and pepper’ chorioretinitis, microphthalmia, and cerebral palsy.

If a suspected case of rubella in pregnancy arises, it should be discussed immediately with the local Health Protection Unit (HPU) as type/timing of investigations may vary. IgM antibodies are raised in women recently exposed to the virus. It is important to note that it is very difficult to distinguish rubella from parvovirus B19 clinically. Therefore, it is crucial to check parvovirus B19 serology as there is a 30% risk of transplacental infection, with a 5-10% risk of fetal loss.

If a woman is tested at any point and no immunity is demonstrated, they should be advised to keep away from people who might have rubella. Non-immune mothers should be offered the MMR vaccination in the postnatal period. However, MMR vaccines should not be administered to women known to be pregnant or attempting to become pregnant.

Disorders of Sex Development: Common Conditions and Characteristics

Disorders of sex development refer to a group of conditions that affect the development of an individual’s reproductive system. The most common disorders are androgen insensitivity syndrome, 5-α reductase deficiency, male and female pseudohermaphroditism, and true hermaphroditism. Androgen insensitivity syndrome is an X-linked recessive condition that results in end-organ resistance to testosterone, causing genotypically male children to have a female phenotype. 5-α reductase deficiency, on the other hand, is an autosomal recessive condition that results in the inability of males to convert testosterone to dihydrotestosterone, leading to ambiguous genitalia in the newborn period. Male and female pseudohermaphroditism are conditions where individuals have testes or ovaries but external genitalia are female or male, respectively. Finally, true hermaphroditism is a very rare condition where both ovarian and testicular tissue are present. Understanding the characteristics of these conditions is crucial in providing appropriate medical care and support for affected individuals.

Understanding Contraception: A Basic Overview

Contraception has come a long way in the past 50 years, with the development of effective methods being one of the most significant advancements in medicine. There are various types of contraception available, including barrier methods, daily methods, and long-acting methods of reversible contraception (LARCs).

Barrier methods, such as condoms, act as a physical barrier and can help protect against sexually transmitted infections (STIs). However, their success rate is relatively low, particularly when used by young people. Daily methods include the combined oral contraceptive pill, which inhibits ovulation but increases the risk of venous thromboembolism and certain types of cancer. The progesterone-only pill thickens cervical mucous, but irregular bleeding is a common side effect.

LARCs include implantable contraceptives, injectable contraceptives, and intrauterine devices (IUDs). The implantable contraceptive and injectable contraceptive both inhibit ovulation and thicken cervical mucous, with the implant lasting up to three years and the injection lasting 12 weeks. The IUD decreases sperm motility and survival, while the intrauterine system (IUS) prevents endometrial proliferation and thickens cervical mucous, with irregular bleeding being a common side effect.

In summary, understanding the different types of contraception available and their methods of action can help individuals make informed decisions about their reproductive health.

Cardiac arrest cannot be listed as the sole cause of death on a death certificate as it is a method of dying and requires further clarification.

While the use of old age is discouraged, it may be listed on a death certificate for patients over the age of 80 if specific criteria are met (refer to the provided link).

The only acceptable abbreviations for HIV and AIDS should be used on a death certificate.

Death Certification in the UK

There are no legal definitions of death in the UK, but guidelines exist to verify it. According to the current guidance, a doctor or other qualified personnel should verify death, and nurse practitioners may verify but not certify it. After a patient has died, a doctor needs to complete a medical certificate of cause of death (MCCD). However, there is a list of circumstances in which a doctor should notify the Coroner before completing the MCCD.

When completing the MCCD, it is important to note that old age as 1a is only acceptable if the patient was at least 80 years old. Natural causes is not acceptable, and organ failure can only be used if the disease or condition that led to the organ failure is specified. Abbreviations should be avoided, except for HIV and AIDS.

Once the MCCD is completed, the family takes it to the local Registrar of Births, Deaths, and Marriages office to register the death. If the Registrar decides that the death doesn’t need reporting to the Coroner, he/she will issue a certificate for Burial or Cremation and a certificate of Registration of Death for Social Security purposes. Copies of the Death Register are also available upon request, which banks and insurance companies expect to see. If the family wants the burial to be outside of England, an Out of England Order is needed from the coroner.

Anorexia Nervosa and its Associated Hormonal Changes

Anorexia nervosa is a serious eating disorder that affects many individuals. It is characterized by a distorted body image and an intense fear of gaining weight. Patients with anorexia often experience hormonal changes that can have significant effects on their health.

One of the most common hormonal changes associated with anorexia is functional hypogonadotrophic hypogonadism. This condition is characterized by low levels of follicle-stimulating hormone (FSH) and luteinising hormone (LH). Despite this, plasma testosterone levels are typically normal in females with anorexia.

Cortisol levels may also be affected in patients with anorexia. While they may be within the normal range, they may fail to suppress with dexamethasone. Additionally, basal levels of T3 may be depressed, while thyroxine (T4) and TSH levels may be normal. Finally, ferritin levels are often low in a state of malnutrition.

Overall, anorexia nervosa can have significant effects on a patient’s hormonal balance. It is important for healthcare providers to be aware of these changes and to monitor patients accordingly.