Minor Antenatal Problems Flashcards
How common is constipation in pregnancy? Does it increase or decrease as it progresses?
Common but decreases as pregnancy advances, 1st trimester = 39% vs 20% in 3rd
What are some causes of constipation in pregnancy? (3)
1) Pressure of uterus on rectum
2) Iron tablets given to treat anaemia in pregnancy
3) Progesterone slows transmit of food through GI tract
How common is reflux in pregnancy? Does it increase or decrease as pregnancy advances?
70% of pregnancies
Increases as pregnancy advances
What causes reflux in pregnancy?
Progesterone causes relaxation of oesophageal sphincter and there is increased pressure on distal oesophagus from gravid uterus = increased incidence of reflux oesophagitis
List two risk factors for reflux in pregnancy
- Polyhydramnios = excuss amniotic fluid in the uterus
- Multiple pregnancy
What must be excluded when investigating reflux in pregnancy?
Pre-eclampsia (can present with epigastric pain)
What is the treatment of reflux in pregnancy?
- Lifestyle eg small meals, sit up after meals, avoid spicy meals etc
- Alginate preparations eg gaviscon
- Ranitidine (H2 blocker) in severe cases
What is obstetric cholestasis?
= Intrahepatic cholestasis of pregnancy
- Abnormal LFTs (mainly elevated ALT and AST)
- Intense pruritus in absence of skin rash
How does obstetric cholestasis present?
- 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)
What are some risks associated with obstetric cholestasis?
- 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
What are some risk factors of obstetric cholestasis?
- PMH / FH of obstetric cholestasis
- Multiple pregnancy
- Gallstones
- Hep C
What investigations are done for obstetric cholestasis?
- LFTs
- Bile acids
- 1/2 times a week
Rule out other causes of liver disfunction eg EBV, CMV, medications
What is the treatment of obstetric cholestasis?
No cure
- Topical creams to reduce itching
- Urso (ursodeoxycholic acid) to reduce bile acids in blood and improve LFTs
- Should resolve after delivery
What is symphysis pubis dysfunction?
A collection of signs and symptoms causing pain in public and sacroiliac joints
- Usually mild but can cause debilitating pain
What is the management of symphysis pubis dysfunction?
- Physiotherapy
- Corsets
- Analgesics
- Crutches if severe
- Usually cured after delivery
- CS not indicated
NB care with leg abduction
List dome ddx of abdo pain in pregnancy
- Universal to some degree
- Ligament stretch
- Appendicitis
- Pancreatitis
- UTIs
- Fibroids
NB medical and surgical problems have a worse prognosis during pregnancy
What can cause backache in pregnancy?
- 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
What is the management of backache in pregnancy?
- Physiotherapy
- Simple analgesia
- Advice on posture and lifting
- Firm mattress
- Corset
- Should resolve after delivery
How common is ankle oedema in pregnancy?
- 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
How common are leg cramps in pregnancy? How should they be treated?
- Affect 30%
- NaCl tablets, calcium salts of quinine may provide benefits
Why is carpal tunnel syndrome more common in pregnancy?
- Retained fluid compressing medial nerve = paraesthesia of thumb, index finder and lateral aspect of middle finger
- Usually mild and temporary
How should carpal tunnel sybndrome be managed in pregnancy?
- Splints on wrist
- Sleeping with hands over the side of the bed
- If ?neurological deficit = surgical referral
What is vaginitis in pregnancy usually due to?
- Candidiasis = common in pregnancy and more difficult to treat
How does vaginitis in pregnancy present?
- 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)
How is candidiasis treated during pregnancy?
- Imidazole vaginal pessaries eg clotrimazole
What is thought to be the cause of morning sickness? Which trimester is it most common?
- Elevated hCG
- Most common in 1st trimester (starts around 6wks and resolve 16-20wks)
Nausea = 85% Vomitting = 50%
NB not limited to morning
What can worsen morning sickness?
- Multiple pregnancies
- Molar pregnancies
What is the concern of severe vomiting develops?
Hyperemesis gravidarum = needs admission
What is the management of morning sickness?
- Eating little and often
- Inc fluid intake
- Ginger
- Anti-emetics: prochlorperazine, promethazine, metoclopramide
Why do haemorrhoids often occur in pregnancy? When do they tend to occur?
(Occur in 8-30%)
Weight of gravid uterus reduces venous return and bearing down during labour
Tend to occur during 3rd trimester
What is the management of haemorrhoids during pregnancy?
- 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
What is thought to be the cause of varicose veins during pregnancy? Is it common?
Progesterone relaxing vasculature and fetal mass effect decreasing venous return
Very common and increases with gestation
What is the management of varicose veins in pregnancy?
- Regular exercise
- Compression hoisery
- Consider thromboprophylaxis if other RF present
