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Year 4 GOSH > Minor Antenatal Problems > Flashcards

Minor Antenatal Problems Flashcards

1
Q

How common is constipation in pregnancy? Does it increase or decrease as it progresses?

A

Common but decreases as pregnancy advances, 1st trimester = 39% vs 20% in 3rd

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2
Q

What are some causes of constipation in pregnancy? (3)

A

1) Pressure of uterus on rectum
2) Iron tablets given to treat anaemia in pregnancy
3) Progesterone slows transmit of food through GI tract

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3
Q

How common is reflux in pregnancy? Does it increase or decrease as pregnancy advances?

A

70% of pregnancies

Increases as pregnancy advances

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4
Q

What causes reflux in pregnancy?

A

Progesterone causes relaxation of oesophageal sphincter and there is increased pressure on distal oesophagus from gravid uterus = increased incidence of reflux oesophagitis

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5
Q

List two risk factors for reflux in pregnancy

A
  • Polyhydramnios = excuss amniotic fluid in the uterus

- Multiple pregnancy

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6
Q

What must be excluded when investigating reflux in pregnancy?

A

Pre-eclampsia (can present with epigastric pain)

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7
Q

What is the treatment of reflux in pregnancy?

A
  • Lifestyle eg small meals, sit up after meals, avoid spicy meals etc
  • Alginate preparations eg gaviscon
  • Ranitidine (H2 blocker) in severe cases
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8
Q

What is obstetric cholestasis?

A

= Intrahepatic cholestasis of pregnancy

  • Abnormal LFTs (mainly elevated ALT and AST)
  • Intense pruritus in absence of skin rash
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9
Q

How does obstetric cholestasis present?

A
  • Usually 3rd trimester
  • Intense pruritus esp palms of hands and soles of feet
  • Worse at night
  • Signs of severe cholestasis eg pale stool, dark urine, jaundice
  • Itching can precede abnormal LFTs by days / weeks

NB itching is common in pregnancy (only a minority will have obstetric cholestasis)

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10
Q

What are some risks associated with obstetric cholestasis?

A
  • Inc risk of fetal distress (partly due to inc likelihood of meconium passage) and intrauterine death
  • Preterm birth
  • Maternal morbidity due to increased itching and lack of sleep
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11
Q

What are some risk factors of obstetric cholestasis?

A
  • PMH / FH of obstetric cholestasis
  • Multiple pregnancy
  • Gallstones
  • Hep C
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12
Q

What investigations are done for obstetric cholestasis?

A
  • LFTs
  • Bile acids
  • 1/2 times a week

Rule out other causes of liver disfunction eg EBV, CMV, medications

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13
Q

What is the treatment of obstetric cholestasis?

A

No cure

  • Topical creams to reduce itching
  • Urso (ursodeoxycholic acid) to reduce bile acids in blood and improve LFTs
  • Should resolve after delivery
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14
Q

What is symphysis pubis dysfunction?

A

A collection of signs and symptoms causing pain in public and sacroiliac joints

  • Usually mild but can cause debilitating pain
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15
Q

What is the management of symphysis pubis dysfunction?

A
  • Physiotherapy
  • Corsets
  • Analgesics
  • Crutches if severe
  • Usually cured after delivery
  • CS not indicated

NB care with leg abduction

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16
Q

List dome ddx of abdo pain in pregnancy

A
  • Universal to some degree
  • Ligament stretch
  • Appendicitis
  • Pancreatitis
  • UTIs
  • Fibroids

NB medical and surgical problems have a worse prognosis during pregnancy

17
Q

What can cause backache in pregnancy?

A
  • Almost universal (35-61%)
  • Attributed to hormonal softening of ligaments, exacerbated by altered posture due to weight of uterus
  • Pressure on sciatic nerves may cause sciatica
18
Q

What is the management of backache in pregnancy?

A
  • Physiotherapy
  • Simple analgesia
  • Advice on posture and lifting
  • Firm mattress
  • Corset
  • Should resolve after delivery
19
Q

How common is ankle oedema in pregnancy?

A
  • Very common and worsens towards the end of pregnancy
  • Benign oedema helped by raising foot of bed at night
  • Unreliable sign of pre-eclampsia: sudden increase in swelling should prompt BP and urinalysis, sacral, finger and facial swelling may also ensue

NB don’t give diuretics during pregnancy

20
Q

How common are leg cramps in pregnancy? How should they be treated?

A
  • Affect 30%

- NaCl tablets, calcium salts of quinine may provide benefits

21
Q

Why is carpal tunnel syndrome more common in pregnancy?

A
  • Retained fluid compressing medial nerve = paraesthesia of thumb, index finder and lateral aspect of middle finger
  • Usually mild and temporary
22
Q

How should carpal tunnel sybndrome be managed in pregnancy?

A
  • Splints on wrist
  • Sleeping with hands over the side of the bed
  • If ?neurological deficit = surgical referral
23
Q

What is vaginitis in pregnancy usually due to?

A
  • Candidiasis = common in pregnancy and more difficult to treat
24
Q

How does vaginitis in pregnancy present?

A
  • Vulval pruritis
  • Non-offensive white-grey discharge associate with excoriation

NB normal vaginal discharge may be heavier during pregnancy but pathological causes should be excluded (swabs)

25
Q

How is candidiasis treated during pregnancy?

A
  • Imidazole vaginal pessaries eg clotrimazole
26
Q

What is thought to be the cause of morning sickness? Which trimester is it most common?

A
  • Elevated hCG
  • Most common in 1st trimester (starts around 6wks and resolve 16-20wks)
Nausea = 85%
Vomitting = 50%

NB not limited to morning

27
Q

What can worsen morning sickness?

A
  • Multiple pregnancies

- Molar pregnancies

28
Q

What is the concern of severe vomiting develops?

A

Hyperemesis gravidarum = needs admission

29
Q

What is the management of morning sickness?

A
  • Eating little and often
  • Inc fluid intake
  • Ginger
  • Anti-emetics: prochlorperazine, promethazine, metoclopramide
30
Q

Why do haemorrhoids often occur in pregnancy? When do they tend to occur?

A

(Occur in 8-30%)

Weight of gravid uterus reduces venous return and bearing down during labour

Tend to occur during 3rd trimester

31
Q

What is the management of haemorrhoids during pregnancy?

A
  • Avoid constipation from early pregnancy
  • Ice packs
  • Digital reduction of prolapsed haemorrhoids
  • Suppositories and topical agents for symptomatic relief
  • If thrombosed = may require surgical referral
32
Q

What is thought to be the cause of varicose veins during pregnancy? Is it common?

A

Progesterone relaxing vasculature and fetal mass effect decreasing venous return

Very common and increases with gestation

33
Q

What is the management of varicose veins in pregnancy?

A
  • Regular exercise
  • Compression hoisery
  • Consider thromboprophylaxis if other RF present

Year 4 GOSH (16 decks)

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