Antenatal Problems Flashcards
When does nausea and vomiting usually occur in pregnancy, and when does it resolve?
Occurs particularly in first trimester
Tends to resolve spontaneously by 16-20 weeks
How many pregnant women are affected by nausea and vomiting?
Nausea - 80-85%
Vomiting - 52%
Most common complaint in pregnancy
How can nausea and vomiting in pregnancy be managed?
Lifestyle - eating small meals, increasing fluid intake
Ginger
Acupressure
Antiemetics - prochlorpromazine, promethazine, metoclopramide
What causes constipation in pregnancy?
Progesterone reduces smooth muscle tone, which affects bowel activity
Can be made worse by iron supplementation
When does constipation occur in pregnancy?
Appears to decrease with gestation:
1st trimester - 39%
2nd trimester - 30%
3rd trimester - 20%
How can constipation be managed in pregnancy?
Increasing fruit, fibre, and water intake
Fibre supplements
Osmotic laxatives - lactulose
When does heartburn (gastro-oesophageal reflux) occur in pregnancy?
Common in all stages in pregnancy:
1st trimester - 22%
2nd trimester - 39%
3rd trimester - 72%
What is the mechanism behind heartburn in pregnancy?
Progesterone relaxes the oesophageal sphincter allowing gastric reflux
This gradually worsens with increasing abdominal pressure from the growing foetus
How can heartburn in pregnancy be managed?
Sleep propped up, avoid spicy foods
Alginate preparations and simple antacids
If severe, H2 antagonists (ranitidine)
Why does carpal tunnel syndrome occur in pregnancy?
Due to oedema compressing the median nerve in the wrist
How can carpal tunnel syndrome in pregnancy be managed?
Usually resolves spontaneously after delivery
Wrist splints may be helpful
What causes back pain and sciatica in pregnancy?
Common problem
Due to hormonal softening of ligaments, exacerbated by altered posture due to weight of the uterus
Pressure on the sciatic nerve may cause neurological symptoms
How can back pain and sciatica in pregnancy be managed?
Change sleeping position
Relaxation and massage
Physiotherapy - back care classes
Simple analgesia
When do haemorrhoids tend to occur in pregnancy?
3rd trimester
8-30% of women
How are haemorrhoids in pregnancy managed?
Avoid and treat constipation
Ice packs and digital reduction of prolapsed haemorrhoids
Suppositories and topical agents for symptomatic relief
If thrombosed, require surgical referral
How are varicose veins managed in pregnancy?
Common complaint which increases worth gestation
Regular exercise
Compression hosiery
Consider thromboprophylaxis if other risk factors are present
Are skin changes and itching common in pregnancy?
Yes
Rashes are usually self-limiting and not serious
Emollients at OTC itching creams may help
Most will resolve after delivery, but can refer to dermatologist if severe
What urinary symptoms are common in pregnancy?
Frequency in first trimester due to increased GFR
Stress incontinence in third trimester due to pressure on pelvic floor
UTIs are common in pregnancy - exclude with dipstick
What is symphysis pubis dysfunction?
Usual mild, can be severely painful
Occurs jn up to 10%
Usually occurs in third trimester
Symphysis pubis joint becomes loose, and the two halves of the pelvis rub on each other when walking it moving
How is symphysis pubis discomfort managed?
Physiotherapy
Simple analgesia
A stability belt may be worn
Condition tends to only improve on delivery
How common is hyperemesis gravidarum?
1/1000 pregnancies
What is hyperemesis gravidarum?
Excessive vomiting in pregnancy
Patients with multiple or molar pregnancies are at increased risk, due to high levels is hCG
What are the symptoms and signs of hyperemesis gravidarum?
Occurs in 1st trimester Vomiting Weight loss Muscle wasting Dehydration Inability to swallow saliva Electrolyte imbalance Malory-Weiss tears
What investigations should be done for suspected hyperemesis gravidarum?
Urinalysis for ketones
MSU to exclude UTI
UandEs
LFTs - hyperemesis may cause liver failure
USS to exclude multiple and molar pregnancies
What are the complications of hyperemesis gravidarum?
Maternal:
Liver and renal failure
Hyponatraemia
Thiamine deficiency - wernickes
Foetal:
IUGR
How is hyperemesis managed?
Admit if not tolerating oral fluid!
IV fluids
Daily UandEs
Consider promethazine
Thiamine infusions may be necessary
What is prolonged pregnancy?
Any pregnancy that exceeds 42 weeks (294 days)
Dated from the first day of the last menstrual period in a woman with regular 28 day cycles
What are the foetal risks of prolonged pregnancy
Placenta ages and fails to function properly and amniotic fluid may decrease
Meconium aspiration Oligohydramnios Macrosomia, shoulder dystocia Cephalhaematoma Foetal distress in labour Neonatal hypothermia, hypoglycaemia (too little glucose producing stores), polycythaemia, growth restriction
What is foetal postmaturity syndrome?
Describes post-term infants who show signs of intrauterine malnutrition
Neonatal features; Scaphoid abdomen Little subcutaneous fat on the body and limbs Peeling skin over Palm and feet Overgrown nails Skin stained with meconium
What are the maternal risks of prolonged pregnancy?
Maternal anxiety
Induction if labour
Increased risk of trauma due to large baby
Increased risk of caesarean delivery
How is prolonged pregnancy managed?
Attempt to determine EDD as accurately as possible
Offer stretch and sweep at 41 weeks
Offer induction of labour between 41 and 42 weeks
Foetal monitoring - initial USS and daily CTGs after 42 weeks, monitoring foetal movements
How does the pattern of foetal movements change as pregnancy progresses?
Foetal movements plateau at 32 weeks
Length of time between cycles of activity increases
The number of foetal ‘kicks’ decreases, but foetal trunk movement continues at the same rate
Foetal movements tend to increase throughout the day and peak at night
When are foetal movements detectable by USS?
7-8 weeks
When are foetal movements detectable by maternal perception?
16-20 weeks
How can foetal movements be assessed?
Subjective maternal perception - kick chart
Doppler
Real time ultrasound scan
What investigations should be undertaken in reduces foetal movements?
History of reduced foetal movements and obstetric risk factors
Doppler to confirm foetal heart beat
CTG to assess foetal compromise (absence of accelerations)
USS if after 28 weeks and normal CTG
What is the significance of reduces foetal movement?
Usually no problems if one episode
Risk of poor outcome increased if recurrent episodes of reduces foetal movements
Abrupt cessation is an ominous finding - increased risk of perinatal mortality
When can a baby be diagnosed as small for gestational age?
When foetal abdominal circumference or estimated foetal weight is less than the tenth centile
Includes foetuses with IUGR as well as babies that are constitutionally small
How should SFGA babies be assessed?
Depending on presence of risk factors:
Umbilical artery Doppler scan
Serial ultrasound assessment of foetal size
What are the ultrasound requirements for IUGR?
Elevated femoral length to abdominal circumference
Elevated ratio of head circumference to abdominal circumference
Unexplained oligohydramnios
What investigations other than Doppler ultrasonography may be required for SGA babies?
Uterine artery Doppler, fetal anatomical survey
Karyotyping
Serological screening for cytomegalovirus and toxoplasmosis
What interventions should be considers in preterm SFGA foetus?
Women with SFGA foetus between 24+0 and 35+6 where delivery is being considered should receive single course of antenatal corticosteroids
When should delivery be considered if an SFGA baby has an abnormal umbilical Doppler?
Between 30-32 weeks of gestation
Delivery before 37 weeks is definitely recommended
Deliver by Caesarean section, but induction can be offered
What are the characteristic abnormalities from maternal rubella infection?
Sensorineural deafness Cataracts Congenital heart disease Learning difficulties Hepatosplenomegaly Microcephalic
How do pregnant women present with rubella infection?
Non specific, flu like illness
Macular rash covering trunk
Confirm with serological antibody testing
What food can contain listeria?
Pate
Soft cheese
Blue cheese
How does listeria infection present?
Fever Headache Malaise Backache Abdo pain Pharyngitis Conjunctivitis
Diagnosed by blood culture
What are the complications of listeria infection in pregnancy?
Miscarriage
Stillbirth
Preterm delivery
Neonatal listeriosis
How is group b streptococci infection diagnosed and managed?
Asymptomatic to mother - picked up on vaginal swabs
Antibiotics must be given during labour to reduce neonatal infection
How does chicken pox infection present in pregnancy women?
Prodromal malaise and fever
Itchy vesicular rash
Causes dermatomal skin scarring, limb hypoplasia, eye defects, neurological defects
Where does toxoplasmosis infection come from?
Unwashed fruit and veg
Unpasteurised goats milk
Contamination from soil or cat faeces
Raw poorly cooked meat
What are the foetal effects of toxoplasmosis?
Miscarriage Stillbirth Hydrocephalus Deafness Blindness
What are the foetal symptoms of cytomegalovirus infection?
20% show signs at birth: Hydrops, IUGR, microcephalic, hepatosplenomegaly, thrombocytopenia
80% show signs at later life: learning difficulties, hearing loss, visual impairment
What are foetal complications or parvovirus infection?
Hydrops
Haemolytic anaemia
Myocarditis
Presents in mother with fever, malaise, arthralgia
What should women who are at risk of hypertension during pregnancy take prophylactically?
Aspirin 75mg OD from 12 weeks to the birth of the baby
