Labor pain experience is highly individualized and will depend on a woman's emotional, motivational, cognitive, cultural and social circumstances.
There is no other circumstance where it is considered acceptable for a patient to experience severe pain that is amenable to safe intervention while under a physician's care.
The pain felt during the 1st stage of labor originates from the rhythmic contractions of the lower uterine segment and progressive cervical dilation mediated via T10-L1 spinal nerves.
The pain in the 2nd stage of labor is more intense due to stretching of the vagina, vulva and perineum as the fetus descends in the birth canal superimposed by the pain of uterine contractions, and is transmitted through the S2-S4 spinal segments.
Most women presenting with complications in early pregnancy are assessed, diagnosed and managed at early pregnancy assessment units (EPAUs). These units aim to provide thorough assessments, access to specialist investigations (scan, human chorionic gonadotrophin [hCG]), a rapid turnaround of results, and co-ordination of further management.
Estrogen receptor α (ESR1) mutations Y537S and D538G are associated with reduced overall survival (OS) in patients with human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer, according to findings of a secondary analysis of the BOLERO-2* clinical trial.
Sheba Jarvis, Catherine Nelson-Piercy,
01 Dec 2014
During pregnancy, a woman may notice the development of a number of new symptoms. Many of these are widely accepted as a normal part of uncomplicated pregnancy but others may be of more concern. The anatomical and physiological changes that accompany normal pregnancy are profound, and it is therefore not surprising that as the various systems adapt, which can result in changes that overlap with those seen in disease. Additionally, sub-clinical disease can be unmasked during pregnancy, when the physiological adaptation to pregnancy provides an additional stress test.
This review article outlines the prevalence of nausea and vomiting of pregnancy (NVP) and hyperemesis gravidarum (HG), definition of NVP and HG, aetiology, risk factors, complications of HG, recommended investigations, primary care management, hospital and ambulatory daycare, therapeutic management of HG supported by good clinical evidence, discharge planning, and importance of the multidisciplinary team to provide high quality care in patients with NVP and HG.