Pregnancy Complications (Pt 2)

Question 1

define hyperemesis gravidarum

Answer 1

severe nausea and vomiting occurring before 20th week of gestation

Question 2

clinical features of hyperemesis gravidarum

Answer 2

severe nausea + vomiting
dehydration
weight loss (5% compared to pre-pregnancy weight)

Question 3

investigations of hyperemesis gravidarum

Answer 3

bloods (FBC, U+Es, LFTs + RFTs)
US abdomen
urine dipstick

Question 4

criteria for diagnosis of hyperemesis gravidarum

Answer 4

electrolyte imbalance
5% weight loss compared to pre-pregnancy weight
dehydration

Question 5

what is a key finding for diagnosis of hyperemesis gravidarum

Answer 5

ketonuria

Question 6

management of severe hyperemesis gravidarum

Answer 6

IV fluids (with potassium chloride)
folic acid and thiamine supplementation
anti-emetics (e.g. cyclizine and promethazine)

Question 7

define ectopic pregnancy

Answer 7

a pregnancy which implants outside of the uterine cavity - often occurs within the fallopian tube

Question 8

risk factors of ectopic pregnancy

Answer 8

pelvic inflammatory disease
pelvic surgery 
IUS/IUD 
assisted reproduction
previous ectopic pregnancy 
advanced maternal age

Question 9

clinical features of ectopic pregnancy

Answer 9

unilateral pelvic pain + tenderness
radiating shoulder tip pain
vaginal bleeding or missed period

Question 10

common examination findings in ectopic pregnancy

Answer 10

unilateral abdominal tenderness
cervical tenderness
abdominal distension
haemodynamic instability

Question 11

investigations of ectopic pregnancy

Answer 11

urine pregnancy test
bloods (FBC, cross-match and serum progesterone)
transvaginal US

Question 12

investigation findings indicating an ectopic pregnancy

Answer 12

suboptimal β-hCG rise on pregnancy test after 48hrs

progesterone levels < 20nmol/L

Question 13

medical management of ectopic pregnancy

Answer 13

one off dose of methotrextae

follow-up appointment and counselling

Question 14

indications for surgical intervention in ectopic pregnancy

Answer 14

significant pain
adnexal mass >35mm
β-hCG >5000IU/L
US shows foetal heartbeat

Question 15

surgical management of ectopic pregnancy

Answer 15

salpingectomy

Question 16

indications for a salpingotomy over salpingectomy

Answer 16

one functioning fallopian tube

wishes to remain fertile

Question 17

define post-partum depression

Answer 17

a development of depressive illness following childbirth that is characterised by low mood in the postnatal period

Question 18

risk factors of post-partum depression

Answer 18

prior depression
FH of depression
baby blues
lack of social support

Question 19

clinical features of post-partum depression

Answer 19

low mood + energy 
anhedonia 
poor appetite 
poor/disturbed sleep 
feelings of guilt 
bonding issues

Question 20

assessments for post-partum depression

Answer 20

Edinburgh Postnatal Depression Scale (EPDS)

Patient Health Questionnaire (PHQ-9)

Question 21

management of mild post-partum depression

Answer 21

guidance to self-help materials

cognitive behavioural therapy or IPT

Question 22

management of moderate post-partum depression

Answer 22

psychological therapy

antidepressant medication

Question 23

management of severe postpartum depression

Answer 23

referral to mother and baby unit

Question 24

define postpartum psychosis

Answer 24

a severe mental illness that has an onset of between 2-3wks post delivery

Question 25

risk factors of postpartum psychosis

Answer 25

PMH of depression or bipolar disorder
PMH of postpartum psychosis
FH of postpartum psychosis

Question 26

clinical features of postpartum psychosis

Answer 26

delusions 
hallucinations 
depression 
mania 
confusion 
thought disorder

Question 27

investigations of postpartum psychosis

Answer 27

bloods

CT head

Question 28

management of postpartum psychosis

Answer 28

referral to mother and baby unit
antipsychotics
mood stabilisers