Abdominal Pain in O&G; Breathlessness; VTE in Pregnancy;

Question 1

How would you differentiate the following with regards to their abdominal pain presentation and associate symptoms

• Labour
• Pre-eclampsia
• Uterine rupture
• Placental abruption

Answer 1

Labour:
- Contraction pain
- W SROM or mucous plug

Pre-eclampsia
- epigastric or RUQ pain
- W HTN, proteinuria, headaches, swelling, blurred vision

Uterine rupture:
- Constant pain; profound shock
- W fetal distress, PV bleeding

Placental abruption:
- Sudden onset severe pain; rock hard uterus
- W fetal distress

Question 2

How would you differentiate the following with regards to their abdominal pain presentation and associate symptoms

• PID
• Endometriosis
• Ectopic pregnancy
• Ovarian Cancer
• Fibroids

Answer 2

PID:
- Acute pelvic pain
- W heavy vaginal disease; bleeding

Endometriosis:
- Mild - severe - debilitating pain
- Pain ++ during menstruation
- W bloating, worsened during bladder / bowel movement & sex

Ectopic pregnancy
- One sided abdomen pain - impulsive and sharp stabbing
- W +ve pregnancy test; previous Hx of STIs

Ovarian Cancer:
- Abdominal pain / discomfort
- W WL; bloating; (sometimes SOB / haemoptysis)

Fibroids
- Constant, severe lower abdomen pain
- W menorrhagia and dysmennorrhea

Question 3

What are key differentials that need to consider for a pregnant, breathless patient?

Question 4

What is key to note about RR during pregnancy? [1]

Answer 4

RR doesn’t increase physiologicaly during pregnancy. If it’s raised then a sign of pathology
- Breathe deeper, but not faster

NB: HR normal is around 100 bpm

Question 5

What are blood gas results like in normal pregnancy? [3]

Answer 5

Breathe deeper, but not faster during pregnancy

Blood gas results:
* blow off more CO2 - should be lower
* breathe in more O2 - should be higher

Creates a respiratory alkalosis - which becomes a compensated metabolic acidosis

Question 6

What questions can you ask to determine if a patient is suffering from physiological breathlessness? [1]

Answer 6

Ask if it’s worse when walking or talking
- If worse when talking then might indicate physiological breathlessness

Question 7

Describe what causes physiologically caused dysopnea and how often it occurs [2]

Answer 7

60-70% of pregnant women

Unsure mechanism
- likely related to progesterone induced hyperventilation

Question 8

A pregnant patient presents with breathlessness. What questions would you ask to help determine the cause?

Answer 8

New onset?
- Help to distinguish if previous pathology that is exascerbated or a new pathology
- New problem - think PE; peripartum cardiomyopathy
- Older problem - think asthma
- If observations normal and associated with no other symptoms - think physiological dyspnea of pregnancy

Question 9

A pregnant patient presents with breathlessness and a swollen leg. What are key differentials?

What are key differentials?

Answer 9

If not above knee and presents with no other symptoms / signs
- think physiological dyspnea of pregnancy

If unilateral leg swelling
- Think VTE

If bilateral & hypertension (w/ proteinuira)
- Think pre-eclampsia - also ask about headache and visual changes
-

Question 10

What is key to note about the dx of PE in pregnancy? [1]

Answer 10

D-dimer accuracy is poor so can’t send
- If CXR normal - do a V/Q
- If CXR abnormal - do a CTPA

Question 11

Describe the risk of radiation from a V/Q or CTPA for baby and mother

Answer 11

For baby, risk of radiation is below level or harm

For mother - pregnant breast is at increased sensitivty to radiation, so more concerned about future risk of breast cancer

Question 12

Do.. https://zerotofinals.com/obgyn/antenatal/vte/