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The placenta is an organ that connects a developing fetus to the uterine wall for the exchange of nutrients, antibodies and hormones between mother and fetus. The development of the placenta is essential for the removal of waste products, for fetal growth, development and the maintenance of a healthy pregnancy and it is an important endocrine organ.

Pre-eclampsia is a multisystem disorder associated with end-organ damage that forms part of the spectrum of hypertensive disorders of pregnancy. It occurs after 20 weeks’ gestation and contributes to significant maternal and fetal morbidity. In the UK, it was responsible for nearly 2.5% of maternal deaths in the recent maternal confidential death report. Placental growth factor-based testing and estimation of soluble fms-like tyrosine kinase 1 to placental growth factor (sFlt-1/PIGF) ratio can improve diagnostic accuracy and predict the risk of maternal complications.

Labour pain is one of the most painful experiences encountered in healthcare. Labour analgesia can be provided by neuraxial or non-neuraxial techniques. Non-neuraxial analgesia can be offered in women in whom neuraxial techniques are contraindicated or are unsuccessful. They may also be chosen as a first-line analgesia by some women. The use of patient-controlled analgesia using remifentanil is a useful alternative to an epidural and is being offered by increasing number of delivery units.

Neuraxial analgesia is the gold standard for managing pain during labour. Techniques employed to facilitate labour neuraxial analgesia include the use of an epidural catheter, the combined spinal epidural, the dural puncture epidural, and an intrathecal catheter. The adoption of these techniques for labour analgesia varies across different maternity units. Over time, numerous regimens have been developed for enhancing labour neuraxial analgesia effectiveness while minimizing maternal side effects.

Intravenous fluids are a core therapy in critical care and perioperative practice. Although most fluids that we use today are very similar to those of the mid 20th Century, our understanding of the physiology of the cardiovascular system, the microcirculation and the extravascular space has evolved considerably. In modern practice, thought should be given to the distribution of stressed and unstressed blood volume, the glycocalyx and the gelatinous interstitial matrix. All of these components change dynamically in volume depleted states.

The uterus serves the essential function of supporting the fetus throughout the duration of pregnancy until childbirth. It is anatomically divided into three main sections: the fundus, the body, and the cervix. The functioning of the uterus is primarily regulated by hormones, which induce considerable transformations during pregnancy. At the time of delivery, alterations in hormonal levels trigger cervical remodelling and uterine contractions, resulting in the expulsion of the fetus. Various medications can influence uterine activity and may be utilized to either initiate or inhibit labour.

Spinal-induced hypotension (SIH) is a common but potentially serious side effect of spinal anaesthetics during caesarean section, with potential maternal and fetal consequences. A number of non-pharmacological methods can be employed to reduce the incidence of SIH, including maternal positioning and fluids. However, these should be used in conjunction with pharmacological methods, which have been shown to be superior in reducing SIH. For many years phenylephrine has been the standard vasopressor in obstetrics, but emerging evidence indicates that there may be more appropriate pharmacological options, with a promising/recent focus on investigating noradrenaline.

Causes of childhood pain include peri-procedural, injury and disease. Systematic reviews have shown that pain can lead to anxiety, sleep disturbance, and have deleterious effects on daily life.Experienced pain is influenced by biological, psychological and social factors. Pain assessment in children is particularly challenging due to the wide variation in physiological responses, communication abilities and developmental stages of this group of patients. For example, their limited verbal repertoire can lead to an under-recognition of pain as compared to adults who may be better able to articulate their pain.

Which of the following is true regarding the interaction between infused fluids, volume status and interstitium?

Annually in the UK, around half a million children and infants undergo general anaesthesia. The provision of anaesthesia for this patient group can be a daunting task; the size of the patient is very variable, disease states and pathology are present that are not seen in other areas of practice, and there are substantial challenges of communicating and allaying anxiety. Additionally, unique medicolegal concepts exist. As those charged with the patients care during unique situations, it is important for anaesthetists to have a holistic understanding of the treatment they will be providing.

Total intravenous anaesthesia (TIVA) is the delivery of general anaesthesia entirely via the intravenous route. This can be achieved through a variety of drugs. The most common combination used is propofol and a short-acting opiate, such as remifentanil. Different target- controlled infusion (TCI) models are used, depending on the age of the child.TIVA use in paediatric anaesthesia offers certain benefits over volatile anaesthesia. Advantages for the patient include reduced postoperative nausea and vomiting (PONV), delirium, time in recovery and less airway reactivity.

Patients undergoing major vascular surgery are at high risk for myocardial infarction, renal failure, respiratory complications and death. Invasive procedures confer greater risk of complication, with patients undergoing open aortic surgery being at highest risk. Endovascular procedures are less invasive, yet not devoid of potentially serious complications. Reduction of myocardial oxygen demand is key, as is stabilizing cardiovascular parameters, maintaining normothermia, adequate volume resuscitation and effective analgesia.