Common conditions of preg Flashcards
What are some common pains in pregnancy?
Primary headache = manage same to non-preg,
Secondary headache (e.g. sinus headache) = urgent referral
Migraine = improve in 2nd and 3rd tri as oestrogen stabilise
Lower back pain = hormonal and biochemical changes –> avoid standing for long, rest
Pelvic girdle pain = discomfort and pain in pelvis and lower back –> preg specific exercise, physio, acupuncture, support garments
Carpal tunnel syndrome (seen in 3rd tri) –> tingling, burning, numbness, swelling in hand = night splinting or steroid injections, its caused by hormonal changes and oedema
Discuss the use of painkillers in pregnancy
Paracetamol = safe
Opioids = respiratory and/or w/drawal in neonate –> exacerbate constipation
- diet and exercise
- bulk forming agents, osmotic laxatives, stool softeners
- avoid stimulant laxatives
NSAIDs = stay away
Why should NSAIDs be avoided in preg?
C/I late pregnancy
- premature closure ductus arteriosus, foetal renal impairment
- dec vol of amniotic fluid, inhibit platelet aggregation
- delay labour and birth
Inc risk of miscarriage
Ibuprofen in early preg = impact fertility of baby girls
What is pregnancy rhinitis?
Common in 1st trimester, at any time due to hormonal changes on nasal mucosa = inc serous-mucous glands, inc vasculature
Sx = sneezing, nasal congestion, runny nose, post nasal drip
How is rhinitis in pregnancy treated?
Saline irrigation = safest, preferred
Exercise may improve symptoms
Mechanical alar (nasal) dilators
Nasal decongestants only provide temporary relief
How is cold and flu treated in pregnancy?
Antihistamines = sedating agents better –> dexchlorpheniramine, less evidence of loratidine
Decongestants = nasal spray are okay short term, oral is not recommended
Cough mixtures = pholcodine and bromhexine –> appear safe
Non-pharm = saline nasal spray, steam inhalation, non-medicated lozenges
Why does constipation occur in preg?
Seen in 3rd tri
Inc circ of progestogen, displacement of uterus against colon, dec mobility, iron supplements
How is constipation treated in preg?
Use bulk-forming laxatives
osmotic laxatives are also suitable
AVOID stimulant laxatives
What is the non-pharm management of haemorrhoids in preg?
Reduce constipation
inc fibre and fluid
avoid straining
What is the treatment of haemorrhoids in preg? (pharm/non-pharm)
Topical only
Anaesthetics, astringents, corticosteroids
Why are heamorrhoids common in pregnancy?
Inc pressure on anal canal
Inc constipation, straining
Discuss the occurrence of reflux in pregnancy
Common, all trimesters, pre-existing reflux will worsen
Limited evidence supporting pharm treatment in preg
Exacerbating factors = inc gastric pressure
Outline the non-pharm treatment of reflux/GORD/heartburn in pregnancy
1st line
I.D. and avoid triggers = fatty/spicy food, smoking, strenuous exercise, caffeine, alcohol, stress
Smaller, more frequent meals, chew slowly
Avoid bending, raise bed head
Outline the pharm treatment of reflux/GORD/heartburn in pregnancy
H2 antagonits = safe
PPIs = B3 category, not associated with adverse outcomes, safest is omeprazole
When should vomiting in preg be referrd?
Vomiting that starts after 14 wks = pyelonephritis, infections, metabolic conditions
May be indication of pre-eclampsia or acute fatty liver
