Pain and Vomiting in Early Pregnancy

Question 1

The pain felt during a miscarriage varies in intensity and frequency depending on what?

Answer 1

How far through the miscarriage is

Question 2

What is a more predominant symptom than pain in a miscarriage?

Answer 2

Bleeding

Question 3

What is the predominant symptom of an ectopic pregnancy?

Answer 3

Pain

Question 4

Describe the pain felt in an ectopic pregnancy?

Answer 4

Starts as a dull ache and develops into a sharp stabbing pain

Question 5

Ectopic pregnancy can lead to peritonism, what are some signs of this?

Answer 5

Rigidity and rebound tenderness

Question 6

What are some pregnancy unrelated causes of pain in early pregnancy?

Answer 6

UTI, appendicitis, vaginal infections, PID

Question 7

What are the treatment options for rhesus negative women who have a miscarriage or ectopic pregnancy?

Answer 7

Conservative/medical/surgical

Question 8

What is the management option for rhesus negative women who have a molar pregnancy?

Answer 8

Surgery

Question 9

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?

Answer 9

500IU of anti-D / to prevent antibodies being formed which may affect a future pregnancy

Question 10

How is hyperemesis gravidarum clinically diagnosed?

Answer 10

Persistent vomiting and weight loss > 5% of pre-pregnancy body weight

Question 11

When do symptoms of normal, pregnancy induced N+V usually a) start b) peak c) resolve?

Answer 11

a) 6-8 weeks b) 9-11 weeks c) 16 weeks

Question 12

What is responsible for causing nausea and vomiting in pregnancy?

Answer 12

beta hCG

Question 13

What can hyperemesis gravidarum result in?

Answer 13

Dehydration, malnutrition, electrolyte disturbances, ketosis, weight loss and altered liver function

Question 14

What are some deficiencies that hyperemesis gravidarum result in?

Answer 14

Hyponatraemia and thiamine deficiency

Question 15

What can thiamine deficiency result in?

Answer 15

Wernicke’s encephalopathy

Question 16

Hyperemesis gravidarum is a diagnosis of exclusion. What are some things you must exclude?

Answer 16

UTI, gastritis, peptic ulcers, viral hepatitis, pancreatitis

Question 17

What are 3 investigations used for hyperemesis gravidarum?

Answer 17

Urinalysis, blood tests, US

Question 18

What is a urinalysis used for in hyperemesis gravidarum?

Answer 18

If there are ketones, the patient must be admitted and also to exclude a UTI

Question 19

What is an US used for in hyperemesis gravidarum?

Answer 19

To exclude multiple and molar pregnancies which can cause increased vomiting

Question 20

Hyperemesis gravidarum is most common when?

Answer 20

In a first pregnancy, and in women who experience N+V in relation to the COCP, motion and migraines

Question 21

What are some principles of management of hyperemesis gravidarum?

Answer 21

IV fluids, nutritional support, parenteral anti-emetics, vitamine supplementation

Question 22

What can be used in recurrent, severe cases of hyperemesis gravidarum?

Answer 22

Steroids

Question 23

What is given to patients with hyperemesis gravidarum who have decreased mobility and extreme dehydration?

Answer 23

Thomboprophylaxis

Question 24

What are some first line anti-emetics for hyperemesis gravidarum?

Answer 24

Cyclizine and prochlorperazine

Question 25

What are some second line anti-emetics for hyperemesis gravidarum?

Answer 25

Ondansetron and metoclopramide

Question 26

Why is early resolution of hyperemesis gravidarum especially important in those with chronic conditions?

Answer 26

To keep their medications working

Question 27

How long does hyperemesis gravidarum usually last for?

Answer 27

Mainly just the 1st trimester

Question 28

What is the ultimate treatment in extremely severe cases of hyperemesis gravidarum?

Answer 28

Termination of pregnancy