Common Antenatal Problems Flashcards
What are two common sources of chronic pain in pregnancy? Why does this pain occur?
Back and pelvis (PGP)
- During pregnancy the ligaments around the back and pelvis soften causing hyperflexibility and associated pain
What can you suggest to women with chronic backache in pregnancy?
What would warrant further investigation?
Support brace, firm mattress and flat shoes may help
You should do a full peripheral nerve examination - if there are any nerve symptoms then this should warrant further investigation
What manoeuvres exacerbate pelvic girdle pain?
How common is it?
How should it be managed?
Pushing on the pubic symphysis and pushing down on each pelvic brim (rocking pelvis from side to side)
- this can aid diagnosis
VERY COMMON (14-22%)
Usually manage with PCM - can suggest obstetric physiotherapist if severe and discuss C-section over vaginal birth
Other than backache and PGP what other MSK problems are more common during pregnancy?
Carpal tunnel syndrome
What is carpal tunnel syndrome?
Why is it more common in pregnancy?
The compression as it passes under the flexor retinaculum in the anterior part of the wrist
Oedema around the wrist / hands makes carpal tunnel more common during pregnancy
What management can be suggested for carpal tunnel syndrome during pregnancy?
Rest with elevation of the wrist can ease the oedema and thus compression
Hydrocortisone injections into the area or surgical decompression can be offered in extreme cases
What GI problems are common during pregnancy?
Constipation, Haemorrhoids and Reflux / Heartburn are really common
What often makes constipation worse during pregnancy?
Pregnant women are commonly anaemic and iron therapy makes constipation worse
What can be done to manage constipation during pregnancy?
DIETARY ADVICE important (increased fruit, veg and fibre)
Laxatives can be given but bowel stimulants such as senna should be avoided as they can stimulant uterine smooth muscle
Why do haemorrhoids occur during pregnancy?
The weight of the uterus bearing down reduced venous return from the superficial veins around the anus
How are haemorrhoids managed during pregnancy?
Consider local acting creams and always try and treat constipation - straining can increase the chance of haemorrhoids occurring
Why is reflux more likely during pregnancy?
What advice can you give for women with reflux?
Due to increased IAP and relaxation of smooth muscles due to progesterone during pregnancy
Advise avoiding large meals, spicy food, smoking and alcohol
Can advise to sleep in more upright position (lying down makes worse)
What medicines can be offered for reflux in pregnancy?
Magnesium and Aluminium based preparations tend to be the safest
There is also no known teratogenicity to ranitidine or H2 antagonists
PPIs are also quite widely used
What might be the cause of itching in pregnancy?
Depends if the itching is LOCALISED (usually to perineum) - cause is commonly candida infection, or pediculosis pubis)
OR GENERALISED
- Consider obstetric cholestasis, eczema, scabies or urticaria
Causes of itching + rash in pregnancy
Polymorphic eruption of pregnancy (most common)
Prurigo of pregnancy
Pruritic Folliculitis
Pemphigoid gestations
How does obstetric cholestasis present?
Intense itching - particularly bad on soles, palms and abdomen
Upon doing LFTs there is a raised bilirubin with an INTRAHEPATIC PATTERN in 90% but only 20% will have a clinically detectable jaundice
- remember ALP is produced by the placenta anyway so this will always be raised but other LFTS will be raised in OC
What are the risks associated with obstetric cholestasis?
Increased risk of premature birth
How should women with obstetric cholestasis be managed?
usually inducing delivery at 37w
URSODEOXYCHOLIC ACID
VITAMIN K SUPPLEMENTATION
How should leg cramps in pregnant women be managed?
Elevate the foot of bed 20cm
Salt supplements should NOT be used and neither should quinine but calcium appears to help some women
How common is nausea and vomiting in pregnancy?
What is the cause?
VERY COMMON - commonly starts around 6 weeks and should settle by week 12-14
DOES NOT just occur in the morning - can occur throughout the day
Appears to be related to rise and fall of B-hCG