medical problems in pregnancy Flashcards
common symptoms of pregnancy
nausea and vomiting in early pregnancy
heartburn
constipation
haemorrhoids
vaginal discharge
backaches
when should nausea and vomiting resolve and what advise should be given to women
resolve spontaneously within 16-20 weeks
should not be associated with a poor pregnancy outcome
what treatment can be offered to women who wants to reduce their nausea and vomiting symptoms
non‑pharmacological: ---- ginger ---- P6 (wrist) acupressure ---- eating small but frequent meals ---- avoiding triggers ---- having lots to drink rest
pharmacological:
—- antihistamines - prometazine, cyclizine or prochlorperazine
what advise to give pregnant women complaining about constipation
increase water content
diet modification - bran or wheat fibre supplementation
exercise
advise about varicose veins
common symptom of pregnancy that will not cause harm and that compression stockings can improve the symptoms but will not prevent varicose veins from emerging.
whst Sx of vaginal discharge might prompt Ix
tch, soreness, offensive smell or pain on passing urine
advise for backache during pregnancy
exercising in water, massage therapy and group or individual back care classes
what is hyperemesis gravidarum
ass with
the sickness and vomiting are prolonged and very severe.
lacking in fluid in the body (dehydrated) and to lose weight.
vitamin deficiencies.
not able to eat, the pregnant woman can develop signs of starvation
multiple pregnancies trophoblastic disease hyperthyroidism nulliparity obesity
signs of hyperemesis gravidarum
ketones in urine
tachycardia
hypotension
RFs that make you more likely to experience N/V
If you are having a female baby.
If this is your first pregnancy.
If you have had - or your mother or sister has had - nausea and vomiting in previous pregnancies.
If you are having twins or another multiple pregnancy.
If you have a history of motion sickness.
If you have a history of migraines.
If you have experienced nausea when taking the combined oral contraceptive pill.
If you are stressed or anxious about something.
If you are obese.
If you are a younger woman
why does reflux occur in pregnant women
The increased level of certain hormones that occurs has a relaxing effect on the sphincter muscle. That is, the tightness (tone) of the sphincter is reduced during pregnancy.
The size of the baby in the tummy (abdomen) causes an increased pressure on the stomach.
Sx of reflux in pregnant women
Heartburn. This is a burning feeling which rises from the upper tummy (abdomen) or lower chest up towards the neck.
Waterbrash. This is a sudden flow of sour-tasting saliva in your mouth.
Upper abdominal pain or discomfort.
Pain in the centre of the chest behind the breastbone (sternum).
Feeling sick (nausea) and being sick (vomiting).
Bloating.
Quickly feeling ‘full’ after eating.
lifestyle modification advise for reflux in pregnant women
avoid triggers
good posture
bedtime
what foods to avoid that may prompt pregnancy
Peppermint. Tomatoes. Chocolate. Fatty and spicy foods. Fruit juices. Hot drinks. Coffee. Alcoholic drinks. (Current advice is t
medication for reflux to give pregnant women
antacids - contain Mg or Al ‘as required basis’
contain SODIUM CARBONATE OR MAGNESIUM TRISILLICATE SHOULD BE AVOIDED AS THEY CAN HARM BABY
take it 2 hours before or after iron supplements
alginates
omeprazole
ranitidine
Sx of constipation in pregnancy
Opening the bowels less than usual.
Passing hard, pellet-like stools.
Tummy cramps.
Wind.
if lifestyle modification for contsipation fails what meds can be given
‘Softening’ laxatives
These simply soften the stools. They tend to cause more wind and are not always helpful in pregnancy. This is because they don’t tend to speed the passage of the stool very well through the bowel.
‘Stimulant’ laxatives
These tend to make the bowel work faster. They are more effective than softening laxatives in pregnancy. However, they can cause cramping pains and wind as they start to work.
why can pregnant women feel breathless
diaphragm gets squashed by baby so less space for it to expand
lead to hyperventilation
- panicky, tingly, dizzy and faint.
other causes of breathlessness in pregnancy
asthma
anaemia
Sx of piles
swollen veins around the back passage
itchy, ache, throb
bleeding
what are the Sx of varicose veins in pregnancy
Aching and pain in the legs.
Swelling of the feet and ankles.
Vulval varicose veins, which cause aching and throbbing in the vulval area. This is worse on standing.
what is pelvic girdle pain
symphysis pubis is the joint between the two halves of the pelvis at the front - down low, over the front of your bladder. It can become very painful in pregnancy
why does pelvic girdle pain occur in pregnant women
joint in the bone can become loosened and the bones separate a little and then rub against one another.
Mx pelvic girdle pain
pillow between the knees
exercise
phsiotherapy
when should screening for anaemia should take place
booking
28 weeks of gestation
level of Hb to diagnsoe anaemia at booking and at 2/3rd tirmester
less than 110
less that 150
most common symptoms of anaemia in pregnant women
Fatigue
Dyspnoea
Dizziness
Ix for anaemia in pregnant women
Hb
MCV less than 76
normal MCV - (76-96)
Mx of anaemia in pregnant women
established iron deficiency anaemia
100-200mg of iron daily
should continue for at least three months and at least six weeks postpartum
Ix for thalasseamias
MCV ≤80 fl requires investigation, with an HbA2 ≥3.5% being positive for B2-thalassaemia.
Chorionic villus sampling in the first quarter of pregnancy and fetal cord blood sampling under ultrasound guidance in the second quarter can be used to detect B2-thalassaemia major, and termination of pregnancy offered.
If sickle cell anaemia is suspected what do u do
Where suspected, women should receive folate supplementation of 5 mg per day. FBC should be routinely checked at 20, 28 and 32 weeks.
complications of anaemia
Maternal death. Fetal death. Premature delivery. Low birth-weight babies. Cardiac failure. Their babies having subsequent developmental problems. Poor work capacity/performance. Susceptibility to infection.
when can u say a preg woman has had significant exposure to VZV
Significant exposure to chickenpox includes having face-to-face contact, being in the same room for 15 minutes of more, or in a large open ward. It is also important to enquire about contact before the chickenpox rash develops (as infectivity begins 2 days before the onset of the rash until lesions crust).
how do you check if women is immune to VZV or not
blood test to VZV
If exposure is deemed to be significant and the pregnant woman is non-immune AND <20 WEEKS what do u fo
give VZIG within 10 days of the exposure as it help prevent or attenuate chickenpox IF GESTATION <20 WEEKS
If exposure is deemed to be significant and the pregnant woman is non-immune AND >20 WEEKS what do u fo
VZIG or aciclovir within days 7 to 14 after exposure
VZV risk to mother
varicella pneumonitis, hepatitis or encephalitis
features of fetal varicella syndrome
- Fetal growth restriction
- Microcephaly, hydrocephalus and learning disability
- Scars and significant skin changes located in specific dermatomes
- Limb hypoplasia (underdeveloped limbs)
- Cataracts and inflammation in the eye (chorioretinitis)
skin scarring
eye defects (microphthalmia)
limb hypoplasia
microcephaly
learning disabilities
if women gets chickenpox while pregnant
> 20 weeks guve aciclovir within 24 hours of onset of the rash
RFs of HELLP syndrome
Age >35. Nulliparity. Previous gestational hypertension. Multiple pregnancy. Previous HELLP syndrome. Caucasian racial origin. Antiphospholipid syndrome (APS) - 10.5% of patients with HELLP syndrome have APS
presentation of HELLP syndrome
onspecific symptoms including malaise, fatigue, right upper quadrant or epigastric pain, nausea, vomiting, or flu-like symptoms.
worst at night but gets better during the day
OE of HELLP
oedema
HTN
proteinuria
Ix of HELLP
Haemolysis with fragmented red cells on the blood film, due to microangiopathic haemolytic anaemia.
raised LDH and bilirubin due to destruction of RBCs
AST/ALT is also elevated
