Pain and Vomiting in Early Pregnancy Flashcards
The pain felt during a miscarriage varies in intensity and frequency depending on what?
How far through the miscarriage is
What is a more predominant symptom than pain in a miscarriage?
Bleeding
What is the predominant symptom of an ectopic pregnancy?
Pain
Describe the pain felt in an ectopic pregnancy?
Starts as a dull ache and develops into a sharp stabbing pain
Ectopic pregnancy can lead to peritonism, what are some signs of this?
Rigidity and rebound tenderness
What are some pregnancy unrelated causes of pain in early pregnancy?
UTI, appendicitis, vaginal infections, PID
What are the treatment options for rhesus negative women who have a miscarriage or ectopic pregnancy?
Conservative/medical/surgical
What is the management option for rhesus negative women who have a molar pregnancy?
Surgery
Any rhesus negative women who is managed for a miscarriage/ectopic/molar pregnancy with surgery should be given what? What is the purpose of this?
500IU of anti-D / to prevent antibodies being formed which may affect a future pregnancy
How is hyperemesis gravidarum clinically diagnosed?
Persistent vomiting and weight loss > 5% of pre-pregnancy body weight
When do symptoms of normal, pregnancy induced N+V usually a) start b) peak c) resolve?
a) 6-8 weeks b) 9-11 weeks c) 16 weeks
What is responsible for causing nausea and vomiting in pregnancy?
beta hCG
What can hyperemesis gravidarum result in?
Dehydration, malnutrition, electrolyte disturbances, ketosis, weight loss and altered liver function
What are some deficiencies that hyperemesis gravidarum result in?
Hyponatraemia and thiamine deficiency
What can thiamine deficiency result in?
Wernicke’s encephalopathy
Hyperemesis gravidarum is a diagnosis of exclusion. What are some things you must exclude?
UTI, gastritis, peptic ulcers, viral hepatitis, pancreatitis
What are 3 investigations used for hyperemesis gravidarum?
Urinalysis, blood tests, US
What is a urinalysis used for in hyperemesis gravidarum?
If there are ketones, the patient must be admitted and also to exclude a UTI
What is an US used for in hyperemesis gravidarum?
To exclude multiple and molar pregnancies which can cause increased vomiting
Hyperemesis gravidarum is most common when?
In a first pregnancy, and in women who experience N+V in relation to the COCP, motion and migraines
What are some principles of management of hyperemesis gravidarum?
IV fluids, nutritional support, parenteral anti-emetics, vitamine supplementation
What can be used in recurrent, severe cases of hyperemesis gravidarum?
Steroids
What is given to patients with hyperemesis gravidarum who have decreased mobility and extreme dehydration?
Thomboprophylaxis
What are some first line anti-emetics for hyperemesis gravidarum?
Cyclizine and prochlorperazine
What are some second line anti-emetics for hyperemesis gravidarum?
Ondansetron and metoclopramide
Why is early resolution of hyperemesis gravidarum especially important in those with chronic conditions?
To keep their medications working
How long does hyperemesis gravidarum usually last for?
Mainly just the 1st trimester
What is the ultimate treatment in extremely severe cases of hyperemesis gravidarum?
Termination of pregnancy
