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Theo's Obs And Gynae > Antenatal Problems > Flashcards

Antenatal Problems Flashcards

0
Q

When does nausea and vomiting usually occur in pregnancy, and when does it resolve?

A

Occurs particularly in first trimester

Tends to resolve spontaneously by 16-20 weeks

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1
Q

How many pregnant women are affected by nausea and vomiting?

A

Nausea - 80-85%
Vomiting - 52%

Most common complaint in pregnancy

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2
Q

How can nausea and vomiting in pregnancy be managed?

A

Lifestyle - eating small meals, increasing fluid intake

Ginger

Acupressure

Antiemetics - prochlorpromazine, promethazine, metoclopramide

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3
Q

What causes constipation in pregnancy?

A

Progesterone reduces smooth muscle tone, which affects bowel activity

Can be made worse by iron supplementation

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4
Q

When does constipation occur in pregnancy?

A

Appears to decrease with gestation:

1st trimester - 39%
2nd trimester - 30%
3rd trimester - 20%

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5
Q

How can constipation be managed in pregnancy?

A

Increasing fruit, fibre, and water intake

Fibre supplements

Osmotic laxatives - lactulose

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6
Q

When does heartburn (gastro-oesophageal reflux) occur in pregnancy?

A

Common in all stages in pregnancy:

1st trimester - 22%
2nd trimester - 39%
3rd trimester - 72%

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7
Q

What is the mechanism behind heartburn in pregnancy?

A

Progesterone relaxes the oesophageal sphincter allowing gastric reflux

This gradually worsens with increasing abdominal pressure from the growing foetus

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8
Q

How can heartburn in pregnancy be managed?

A

Sleep propped up, avoid spicy foods

Alginate preparations and simple antacids

If severe, H2 antagonists (ranitidine)

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9
Q

Why does carpal tunnel syndrome occur in pregnancy?

A

Due to oedema compressing the median nerve in the wrist

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10
Q

How can carpal tunnel syndrome in pregnancy be managed?

A

Usually resolves spontaneously after delivery

Wrist splints may be helpful

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11
Q

What causes back pain and sciatica in pregnancy?

A

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

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12
Q

How can back pain and sciatica in pregnancy be managed?

A

Change sleeping position

Relaxation and massage

Physiotherapy - back care classes

Simple analgesia

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13
Q

When do haemorrhoids tend to occur in pregnancy?

A

3rd trimester

8-30% of women

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14
Q

How are haemorrhoids in pregnancy managed?

A

Avoid and treat constipation

Ice packs and digital reduction of prolapsed haemorrhoids

Suppositories and topical agents for symptomatic relief

If thrombosed, require surgical referral

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15
Q

How are varicose veins managed in pregnancy?

A

Common complaint which increases worth gestation

Regular exercise
Compression hosiery
Consider thromboprophylaxis if other risk factors are present

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16
Q

Are skin changes and itching common in pregnancy?

A

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

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17
Q

What urinary symptoms are common in pregnancy?

A

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

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18
Q

What is symphysis pubis dysfunction?

A

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

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19
Q

How is symphysis pubis discomfort managed?

A

Physiotherapy

Simple analgesia

A stability belt may be worn

Condition tends to only improve on delivery

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20
Q

How common is hyperemesis gravidarum?

A

1/1000 pregnancies

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21
Q

What is hyperemesis gravidarum?

A

Excessive vomiting in pregnancy

Patients with multiple or molar pregnancies are at increased risk, due to high levels is hCG

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22
Q

What are the symptoms and signs of hyperemesis gravidarum?

A 
Occurs in 1st trimester
Vomiting
Weight loss
Muscle wasting
Dehydration
Inability to swallow saliva
Electrolyte imbalance
Malory-Weiss tears
23
Q

What investigations should be done for suspected hyperemesis gravidarum?

A

Urinalysis for ketones
MSU to exclude UTI
UandEs
LFTs - hyperemesis may cause liver failure

USS to exclude multiple and molar pregnancies

24
Q

What are the complications of hyperemesis gravidarum?

A

Maternal:
Liver and renal failure
Hyponatraemia
Thiamine deficiency - wernickes

Foetal:
IUGR

25
Q

How is hyperemesis managed?

A

Admit if not tolerating oral fluid!
IV fluids
Daily UandEs

Consider promethazine

Thiamine infusions may be necessary

26
Q

What is prolonged pregnancy?

A

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

27
Q

What are the foetal risks of prolonged pregnancy

A

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
28
Q

What is foetal postmaturity syndrome?

A

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
29
Q

What are the maternal risks of prolonged pregnancy?

A

Maternal anxiety
Induction if labour
Increased risk of trauma due to large baby
Increased risk of caesarean delivery

30
Q

How is prolonged pregnancy managed?

A

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

31
Q

How does the pattern of foetal movements change as pregnancy progresses?

A

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

32
Q

When are foetal movements detectable by USS?

A

7-8 weeks

33
Q

When are foetal movements detectable by maternal perception?

A

16-20 weeks

34
Q

How can foetal movements be assessed?

A

Subjective maternal perception - kick chart

Doppler

Real time ultrasound scan

35
Q

What investigations should be undertaken in reduces foetal movements?

A

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

36
Q

What is the significance of reduces foetal movement?

A

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

37
Q

When can a baby be diagnosed as small for gestational age?

A

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

38
Q

How should SFGA babies be assessed?

A

Depending on presence of risk factors:

Umbilical artery Doppler scan
Serial ultrasound assessment of foetal size

39
Q

What are the ultrasound requirements for IUGR?

A

Elevated femoral length to abdominal circumference

Elevated ratio of head circumference to abdominal circumference

Unexplained oligohydramnios

40
Q

What investigations other than Doppler ultrasonography may be required for SGA babies?

A

Uterine artery Doppler, fetal anatomical survey

Karyotyping

Serological screening for cytomegalovirus and toxoplasmosis

41
Q

What interventions should be considers in preterm SFGA foetus?

A

Women with SFGA foetus between 24+0 and 35+6 where delivery is being considered should receive single course of antenatal corticosteroids

42
Q

When should delivery be considered if an SFGA baby has an abnormal umbilical Doppler?

A

Between 30-32 weeks of gestation

Delivery before 37 weeks is definitely recommended

Deliver by Caesarean section, but induction can be offered

43
Q

What are the characteristic abnormalities from maternal rubella infection?

A 
Sensorineural deafness
Cataracts
Congenital heart disease
Learning difficulties
Hepatosplenomegaly
Microcephalic
44
Q

How do pregnant women present with rubella infection?

A

Non specific, flu like illness
Macular rash covering trunk

Confirm with serological antibody testing

45
Q

What food can contain listeria?

A

Pate
Soft cheese
Blue cheese

46
Q

How does listeria infection present?

A 
Fever
Headache
Malaise
Backache
Abdo pain
Pharyngitis
Conjunctivitis

Diagnosed by blood culture

47
Q

What are the complications of listeria infection in pregnancy?

A

Miscarriage
Stillbirth
Preterm delivery
Neonatal listeriosis

48
Q

How is group b streptococci infection diagnosed and managed?

A

Asymptomatic to mother - picked up on vaginal swabs

Antibiotics must be given during labour to reduce neonatal infection

49
Q

How does chicken pox infection present in pregnancy women?

A

Prodromal malaise and fever
Itchy vesicular rash

Causes dermatomal skin scarring, limb hypoplasia, eye defects, neurological defects

50
Q

Where does toxoplasmosis infection come from?

A

Unwashed fruit and veg
Unpasteurised goats milk
Contamination from soil or cat faeces
Raw poorly cooked meat

51
Q

What are the foetal effects of toxoplasmosis?

A 
Miscarriage
Stillbirth
Hydrocephalus
Deafness
Blindness
52
Q

What are the foetal symptoms of cytomegalovirus infection?

A

20% show signs at birth: Hydrops, IUGR, microcephalic, hepatosplenomegaly, thrombocytopenia

80% show signs at later life: learning difficulties, hearing loss, visual impairment

53
Q

What are foetal complications or parvovirus infection?

A

Hydrops
Haemolytic anaemia
Myocarditis

Presents in mother with fever, malaise, arthralgia

54
Q

What should women who are at risk of hypertension during pregnancy take prophylactically?

A

Aspirin 75mg OD from 12 weeks to the birth of the baby

Theo's Obs And Gynae (22 decks)

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