Pregnancy

Question 1

Approach to Decreased Foetal Movements in women > 28/40

Answer 1

All women concerned about DFM should present for immediate healthcare assessment

Risk factors of stillbirth
- Maternal age > 35, BMI > 25
- Antepartum haemorrhage
- G0 or G>3
- Diabetes, HTN, IVF
- Smoker, illicit drug use, low SES, Indigenous

Examination
- Vitals including BP, HR and Temp
- Abdominal palpation for fundal height, uterine tone and presentation
- Handheld doppler for FHR

Investigations
- CTG within 2 hours of presentation for at least 20 minutes or until satisfactory
- US - Consider within 24 hours
- Concern regarding possible Foetal to maternal haemorrhage? Perform kleihauer test or flow cytometry.

Question 2

Average expected weight gain by months

Answer 2

0-3 months - 150-200g/week
3-6 months - 100-150g/week
6-12 months - 70-90g/week

Question 3

Miscarriage Definitions

Answer 3

Threatened - Vaginal bleeding @ < 20/40
Inevitable - Passage of POC of non-viable IUP
Incomplete - Some retention of POC of non-viable IUP
Missed - Sonographic diagnosis of non-viable IUP with absence of vaginal bleeding

Question 4

Recurrent pregnancy loss

Answer 4

2+ Pregnancy losses

Differential
- Structural - Submucosal or intramural fibroid, septate uterus, Ashermann Syndrome
- Genetic - Parental chromosomal abnormality
- Endocrine - Hypothyroidism, Poorly controlled Diabetes Mellitus
- Genetic Thrombophilia - Factor 5 leiden, von Willebrands disease
- Acquired thrombophilia - Anti-phospholipid syndrome
- Infective - Chlamydia, Gonorrhoea

Question 5

6-week post-partum Check Points of Discussion

Answer 5

• Edinburgh Postnatal Depression Scale
• Breastfeeding experience
• Contraceptive Options
• Level of social / family support
• Screen for Intimate Partner Violence
• Sleep Quantity and Quality
• Any ongoing lochia
• Concerns regarding post-delivery healing
• Any concerns about child
• Continence Issues
• Concerns about intercourse

Question 6

Gastro-oesophageal reflux in pregnancy

Answer 6

Non-pharmacological measures
- Eat smaller meals
- Avoid lying down after eating
- Avoid eating or drinking 2-3 hours before bedtime or vigorous exercise
- Use wedge pillow or elevate head of bed for sleep.
- Avoidance of triggering food and drinks
- HIgh-fat meals, alcohol, coffee, chocolate, citrus, tomato products, spicy food, carbonated beverages.
- Only avoid established triggers for the patient.

Pharmacological
- H2-Receptor antagonists first line - Ranitidine, Famotidine
- PPI - Rabeprazole is Cat B1 whilst other PPIs are Cat B3. Best clinical response to omeprazole which is Cat B3
- Some studies find small association of PPI use and development of childhood asthma in child. Issues with this study’s design and majority of the children followed up did not have asthma.

Question 7

Antepartum Haemorrhage

Answer 7

Bleeding of the genital tract > 20/40
- Complicates 2-5% of pregnancies

Causes
- Marginal placental bleeds
- Local vaginal causes (cervical ectropion, polyp, dysplasia, carcinoma, trauma)
- Blood-stained show
- Placenta praevia
- Placental abruption
- Uterine rupture
- Vasa Praevia.