Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Reproductive Health (Y4) > 4- Early pregnancy complications (hyperemesis gravidarum and abortion) > Flashcards

4- Early pregnancy complications (hyperemesis gravidarum and abortion) Flashcards

1
Q

when does N and V start in pregnancy

A

starts 4-7 weeks

peaking around 10-12 weeks gestation

resolves 16-20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

cause of N and V in pregnnacy

A

rapidly increasing levels of hCG produced by the placenta- triggers chemoreceptor trigger zone
- higher levels make symptoms worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

which sort of pregnancies can make n and v worse

A
  • first pregnancy
  • overweight women
  • molar pregnancies
  • multiple pregnancies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The severe form of nausea and vomiting in pregnancy is called

A

hyperemesis gravidarum
- Hyper- refers to lots, -emesis refers to vomiting
- Gravida- relates to pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

when can Hyperemesis gravidarum be diagnosed

A

prolonged/ protracted NVP (N+V of pregnancy) +

  • More than 5 % weight loss compared with before pregnancy
  • Dehydration
  • Electrolyte imbalance

other signs of true HG
- marked ketosis
- nutritional def

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

which scale can be used to measure severity of NVP

A

Pregnancy-Unique Quantification of Emesis (PUQE) score. This gives a score out of 15:

< 7: Mild
7 – 12: Moderate
> 12: Severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

management of mild HG

A

In the community
1) Antiemetics are used to suppress nausea. Vaguely in order of preference and known safety, the choices are:

  • Prochlorperazine (stemetil)
  • Cyclizine
  • Ondansetron
  • Metoclopramide

2) Antacids can be used if acid reflux a problem
- ranitidine or omeprazole

3) Complementary therapies
- Ginger
- acupressure on the wrist at the PC6 point (inner wrist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

when should admission for HG be considered

A
  • Unable to tolerate oral antiemetics or keep down any fluids
  • More than 5 % weight loss compared with pre-pregnancy
  • Ketones are present in the urine on a urine dipstick (2 + ketones on the urine dipstick is significant)
  • Other medical conditions need treating that required admission
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

In patient care for mod-severe HG

A
  • IV or IM antiemetics
  • IV fluids (normal saline with added potassium chloride)
  • Daily monitoring of U&Es while having IV therapy
  • Thiamine supplementation to prevent deficiency (prevents Wernicke-Korsakoff syndrome)
  • Thromboprophylaxis (TED stocking and low molecular weight heparin) during admission
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

In patient care for mod-severe HG

A
  • IV or IM antiemetics
  • IV fluids (normal saline with added potassium chloride)
  • Daily monitoring of U&Es while having IV therapy
  • Thiamine supplementation to prevent deficiency (prevents Wernicke-Korsakoff syndrome)
  • Thromboprophylaxis (TED stocking and low molecular weight heparin) during admission
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

define termination

A

elective procedure to end a pregnancy

Abortion is the removal of an embryo or fetus from the uterus before viabilitoty
- spontanaeous abortion- miscarriage
- induced abortion- termination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

up to how many weeks is an abortion legal

The earlier in pregnancy an abortion is undertaken, the safer it is likely to be

A

24 weeks

has been reduced from 28

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

simple criteria for abortion

A

An abortion can be performed before 24 weeks if continuing the pregnancy involves greater risk to the physical or mental health of:

  • The woman
  • Existing children of the family

The threshold for when the risk of continuing the pregnancy outweighs the risk of terminating the pregnancy is a matter of clinical judgement and opinion of the medical practitioners.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

An abortion can be performed at any time during the pregnancy if:

A
  • Continuing the pregnancy is likely to risk the life of the woman
  • Terminating the pregnancy will prevent “grave permanent injury” to the physical or mental health of the woman
  • There is “substantial risk” that the child would suffer physical or mental abnormalities making it seriously handicapped
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The legal requirements for an abortion are (abortion act 1967):

A
  1. Two registered medical practitioners must sign to agree abortion is indicated
  2. It must be carried out by a registered medical practitioner in an NHS hospital or approved premise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how are abortion services accessed

A
  • by self-referral
  • by GP
  • GUM
  • family planning clinic referral.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

conscientious objection: if you as a doctor object to abortions what should you do

Medical professionals have the right to conscientious objection, however even those who wish to abstain from involvement in the procedure must be trained in and recognise the need for evidence based counselling and safe abortion care, including referral pathways.

A

pass on to another doctor able to make the referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

before having an abortion women should be offered

A

counselling and information to help decision making from a trained practitioner. Informed consent is essential.

18
Q

termination can be managed either

A

medically or surgically

19
Q

when is a medical abortion most appropriate

A

counselling and information to help decision making from a trained practitioner. Informed consent is essential.

20
Q

medical mangement of abortion

A

It involves two treatments:
1. Mifepristone (anti-progestogen)
2. Misoprostol (prostaglandin analogue) 1 – 2 day later

21
Q

Mifepristone MOA

A

is an anti-progestogen medication that blocks the action of progesterone, halting the pregnancy and relaxing the cervix.

22
Q

Misoprostol MOA

A

is a prostaglandin analogue, meaning it binds to prostaglandin receptors and activates them. Prostaglandins:
- soften the cervix
- stimulate uterine contractions.

From 10 weeks gestation, additional misoprostol doses (e.g. every 3 hours) are required until expulsion.

23
Q

Rhesus negative women with a gestational age of …….. weeks or above having a medical TOP should have ….. ……..

A

Rhesus negative women with a gestational age of 10 weeks or above having a medical TOP should have anti-D prophylaxis.

24
Q

anaesthesia for surgical abortion

A
  • Local anaesthetic
  • Local anaesthetic plus sedation
  • General anaesthetic
25
Q

process of surgical abortion

A

1) prior to surgery patients are given cervical priming medications: misoprostol, mifepristone or osmotic dilators
2) Two option:

  • Cervical dilatation and suction of the contents of the uterus (usually up to 14 weeks)
  • Cervical dilatation and evacuation using forceps (between 14 and 24 weeks)
26
Q

when is cervical dilatation and suction used

A

up to 14 weeks

27
Q

when is cervical dilatation and evacuation used

A

between 14 and 24 weeks

28
Q

Rhesus negative women having a surgical TOP should have

A

anti-D prophylaxis.

29
Q

post-abortion confirmations

A

urine pregnancy test is performed 3 weeks after the abortion

30
Q

post-abortion care

A
  • pregnancy test
  • Contraception is discussed and started where appropriate.
  • Support and counselling is offered.
31
Q

common presentations of abortion

A

vaginal bleeding and abdominal cramps intermittently for up to 2 weeks after the procedure.

32
Q

Complications

A
  • Bleeding (haemorrhage)
  • Uterine rupture
  • Pain
  • Infection
  • Failure of the abortion (pregnancy continues)
  • Damage to the cervix, uterus or other structures
32
Q

Complications

A
  • Bleeding
  • Pain
  • Infection
  • Failure of the abortion (pregnancy continues)
  • Damage to the cervix, uterus or other structures
33
Q

RF for HG

A
  • First pregnancy
  • Previous history of hyperemesis gravidarum
  • Raised BMI
  • Multiple pregnancy
  • Hydatidiform mole
34
Q

history for N and V

A
35
Q

examination for N and V

A
36
Q

investigations for HG

A

Bedside Tests
* Weight
* Urine dipstick: quantify ketonuria (1+ ketones)

Laboratory Tests
* Mid-stream urine
* Full blood count: anaemia, infection, haematocrit (can be raised)
* Urea and Electrolytes: hypokalaemia, hyponatraemia, dehydration, renal disease
* Blood glucose: exclude diabetic ketoacidosis if diabetic

Refractory or Severe Cases
* Liver function tests: exclude liver disease e.g. hepatitis or gallstones, monitor malnutrition
* Amylase: exclude pancreatitis
* Thyroid function tests: hypo-/hyper-thyroid
* Arterial blood gas: exclude metabolic disturbances, monitor severity

Imaging
* Ultrasound scan: confirm viability, confirm gestation, exclude multiple pregnancy and trophoblastic disease.

37
Q

Signs of Severe HG

A
  • Debilitating, chronic nausea
  • Frequent vomiting of bile or blood
  • Chronic ketosis and dehydration
  • Muscle weakness and extreme fatigue
  • Medication does not stop vomiting/nausea
  • Inability to care for self (shower, prepare food)
  • Loss of over 5-10% of your pre-pregnancy weight
  • Weight loss (or little gain) after the first trimester
  • Inability to eat/drink sufficiently by about 14 weeks
38
Q

complications of HG

A

Neuro
- central pontine myelinolysis
- wernicke encephalopathy (due to thaimin deficiency)

GI
- oesphageal damage
- gastroparesis (delayed gastric emptying)

Malnutrition and dehydration

Acute renal failure

39
Q

the right to reproductive health is defined in

A

the Universal Declaration of Human Rights, includes the right to have full autonomy over reproductive decisions, including how many children to have and when to have them

40
Q

safe abortion care pathway

A
41
Q

Information to provide after the abortion

Before leaving the facility, women should receive instructions about how to care for themselves after they go home, including:

A
  • how much bleeding to expect in the next few days and weeks
    • how to recognise potential complications, including signs of ongoing pregnancy
    • when they can resume normal activities (including sexual intercourse)
    • how and where to seek help if required

Women who want to try again to conceive should be advised to wait until after having at least one normal menstrual period, longer if chronic health problems (e.g. anaemia) require treatment.

42
Q

diagnosing HG

A

Diagnosis of exclusion
1)History of hyperemesis in previous pregnancies

2)Usually no abdominal pain

3) Infections
* UTI, gastroenteritis, appendicitis, pancreatitis etc

4) Metabolic
* Biochemical thyrotoxicosis
* Graves disease
* Addisons, DKA

5) Drugs
* Antibiotics, iron preparations

6) Tumours
* hydatidiform mole formation, Choriocarcinoma, teratoma with elements of choriocarcinoma
* germ cell tumors
* islet cell tumor

Reproductive Health (Y4) (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions