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At what stage of labor would you first take pain medication?

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Ms Shelley progresses well in her pregnancy, has normal anomaly and serial growth scan. Her epilepsy remains stable, and she has not experienced any seizure activity in the pregnancy. Her nausea and vomiting have settled, and she has managed to stop smoking cannabis with the support of her local community-based substance misuse team. She is now 30 weeks. She has her first growth scan which shows thatbaby's growth is on the 17th centile with normal liquor and Doppler. It also shows that the placenta is no longer low lying. Despite this, she requests a caesarean section as she is anxious about having a seizure during labour.Q6. What considerations need to be made for management of labour anddelivery in women with epilepsy? How should you counsel Ms Shelley?

She has a maternal tachycardia of 120 bpm, respiratory rate of 22 breaths/min, oxygen saturation is 98% and she has a B.P of 95/58 mmHg. She has not passed urine since admission. On abdominal examination, her uterus is hard and "woody" with no resting tone, and she has ongoing fresh red bleeding. The emergency team are called to help stabilise her andprepare for a category 1 emergency caesarean section (baby to bedelivered within 30 minutes of the decision) for presumed fetal abruption. Verbal consent is obtained. A baby boy is born by caesarean section, with Apgars of 5/9/9. A retroplacental clot of 200 ml is noted at the time of the otherwise uneventful procedure.Q12. What are the potential problems and pitfalls of consent in an emergency situation in obstetrics? Is consent valid if it is not written consent?

Ms Shelley attends for a further growth scan at 34 weeks, in line with hospital policy. The scan shows that the fetal growth plots below the 3rd centile with normal liquor and Doppler.Q8. What are the potential causes / risk factors for a small for gestational age fetus?

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