The Fellow Forge - O&G

Thirty-two weeks, a previous caesarean, and bright red painless bleeding. We follow her from "keep your fingers out" to an accreta over the scar, with a woman in the next room who has an abruption.In this episode:• Why there's no vaginal examination until the placenta has been located• Praevia versus abruption at the bedside, and why a normal scan doesn't rule out an abruption• Kleihauer and anti-D, steroids and magnesium thresholds• Placenta accreta spectrum: risk by number of caesareans, ultrasound signs and planned caesarean hysterectomy• Abruption, DIC and early fibrinogen• Vasa praevia under the 2025 RANZCOG guidanceA study discussion for FRANZCOG trainees, not clinical advice. Check your local guidelines.

A forceps birth at half past four in the morning, and a tear the midwife calls a second-degree. The rectal examination says otherwise. We follow her from grading and repair in theatre to planning her next birth.In this episode:• Classifying perineal tears, the buttonhole, and why a 3c tear gets its own grade• Risk factors, the perineal protection bundle and the 60-degree mediolateral episiotomy• The rectal examination every woman is offered after a vaginal birth• Second-degree repair, and OASIS repair layer by layer, including overlap versus end to end• Cervical tears, vulval haematomas, aftercare and the perineal clinic• Advice for the next birth after a sphincter injuryA study discussion for FRANZCOG trainees, not clinical advice. Check your local guidelines.

A registrar on the labour ward hears the words every trainee dreads: "I think she's bleeding." We follow one woman from that moment all the way to theatre, covering what FRANZCOG examiners expect you to know about primary PPH.

In this episode:

• Definitions, incidence and the four Ts, and why the uterus stops bleeding by squeezing, not clotting
• Active management of the third stage and prevention
• The simultaneous first response, and why a normal blood pressure is falsely reassuring
• Uterotonics in order: oxytocin, ergometrine, carboprost, misoprostol, plus tranexamic acid and the WOMAN trial
• A contracted uterus that keeps bleeding: trauma, retained tissue and uterine inversion
• Massive transfusion, fibrinogen and the escalation ladder from balloon to hysterectomy

A study discussion for FRANZCOG trainees, not clinical advice. Check your local guidelines.