Gastrointestinal Conditions

Question 1

What is gastro-oesophageal reflux?

Answer 1

• Stomach acid leaks into oesophagus
• Caused by weakening of the ring muscle at the bottom of the oesophagus
• Also known as heartburn/ acid reflux

Question 2

What is a hiatus hernia?

Answer 2

• Part of the stomach moves up into the chest

- Causes narrowing of the stomach opening

Question 3

What are the symptoms of gastro-oesophageal reflux and/or hiatus hernia?

Answer 3

• Painful burning sensation in chest
• Acid reflux
• Bad breath
• N+V
• Pain when swallowing
• Oesophageal ulcers

Question 4

What are the associated pregnancy risks with gastro-oesophageal reflux and/or hiatus hernia?

Answer 4

• Muscle tone of lower oesophageal sphincter reduces further due to progesterone
• Symptoms worsen due to inter-abdominal pressure and progesterone
• Higher risk of hiatus hernia due to expanding uterus

Question 5

What is the antenatal management for gastro-oesophageal reflux and/or hiatus hernia?

Answer 5

• Refer to consultant if taking H2RA (e.g. omeprazole)
• Record weight at each AN appointment
• Avoid antacids containing sodium bicarbonate

Question 6

What is the intrapartum management for gastro-oesophageal reflux and/or hiatus hernia?

Answer 6

• Encourage drinking plenty of water
• Ranitidine
• Avoid prolonged 2nd stage

Question 7

What is the postnatal management for gastro-oesophageal reflux and/or hiatus hernia?

Answer 7

• Encourage BF

- Return to normal management (see GP)

Question 8

What are haemorrhoids?

Answer 8

• Swollen and inflamed veins in the rectum/anus

- Can be caused by straining on the toilet/ prolonged constipation

Question 9

What are the associated pregnancy risks with haemorrhoids?

Answer 9

• Uterus puts pressure on veins
• Vasodilation
• Constipation
• Pushing in 2nd stage can cause haemorrhoids

Question 10

What is the midwifery management for haemorrhoids?

Answer 10

• Avoid prolonged 2nd stage
• Advise warm baths
• Laxatives
• Reinforce pelvic floor exercises

Question 11

What is pelvic floor dysfunction?

Answer 11

• Group of disorders that cause abnormal bowel movements and storage
• Can be caused by damaged anal sphincter muscles

Question 12

What is the medical management for pelvic floor dysfunction/ anal sphincter disorders?

Answer 12

• Anti-diarrheal drugs
• Bulk laxatives
• Injectable bulking agents
• Dietary changes

Question 13

What is the additional management for pelvic floor dysfunction/ anal sphincter disorders?

Answer 13

• Bowel training
• Sacral nerve stimulation
• Surgery
• Physiotherapy

Question 14

What is irritable bowel syndrome?

Answer 14

Bowel disturbances categorised by certain triggers

Question 15

What are the risks associated with IBS in pregnancy?

Answer 15

• Abdominal pain
• Altered bowel habits
• Mucus in stools
• Constipation
• Differentiating between labour pain and IBS pain

Question 16

What is the management for women with IBS in pregnancy?

Answer 16

• Encourage physical activity
• Regular meals and drinking
• Reduce caffeine
• Psychological support
• Liaise with dietician and GI team

Question 17

What is ulcerative colitis?

Answer 17

• Inflammation of the colon and rectum, meaning the immune system attacks healthy tissue
• Small ulcers develop
• High risk of haemorrhage

Question 18

What are the symptoms of ulcerative colitis?

Answer 18

• Recurring diarrhoea
• Abdominal pain
• Needing to empty bowels more frequently

Question 19

What are the associated risks of ulcerative colitis in pregnancy?

Answer 19

• Symptoms worsen
• Risk of FGR
• Offer ELCS if woman has undergone GI surgery

Question 20

When should vaginal delivery be avoided for pregnant women with ulcerative colitis?

Answer 20

If the disease is active