Pregnancy Complications (Pt 2) Flashcards
define hyperemesis gravidarum
severe nausea and vomiting occurring before 20th week of gestation
clinical features of hyperemesis gravidarum
severe nausea + vomiting
dehydration
weight loss (5% compared to pre-pregnancy weight)
investigations of hyperemesis gravidarum
bloods (FBC, U+Es, LFTs + RFTs)
US abdomen
urine dipstick
criteria for diagnosis of hyperemesis gravidarum
electrolyte imbalance
5% weight loss compared to pre-pregnancy weight
dehydration
what is a key finding for diagnosis of hyperemesis gravidarum
ketonuria
management of severe hyperemesis gravidarum
IV fluids (with potassium chloride)
folic acid and thiamine supplementation
anti-emetics (e.g. cyclizine and promethazine)
define ectopic pregnancy
a pregnancy which implants outside of the uterine cavity - often occurs within the fallopian tube
risk factors of ectopic pregnancy
pelvic inflammatory disease pelvic surgery IUS/IUD assisted reproduction previous ectopic pregnancy advanced maternal age
clinical features of ectopic pregnancy
unilateral pelvic pain + tenderness
radiating shoulder tip pain
vaginal bleeding or missed period
common examination findings in ectopic pregnancy
unilateral abdominal tenderness
cervical tenderness
abdominal distension
haemodynamic instability
investigations of ectopic pregnancy
urine pregnancy test
bloods (FBC, cross-match and serum progesterone)
transvaginal US
investigation findings indicating an ectopic pregnancy
suboptimal β-hCG rise on pregnancy test after 48hrs
progesterone levels < 20nmol/L
medical management of ectopic pregnancy
one off dose of methotrextae
follow-up appointment and counselling
indications for surgical intervention in ectopic pregnancy
significant pain
adnexal mass >35mm
β-hCG >5000IU/L
US shows foetal heartbeat
surgical management of ectopic pregnancy
salpingectomy
indications for a salpingotomy over salpingectomy
one functioning fallopian tube
wishes to remain fertile
define post-partum depression
a development of depressive illness following childbirth that is characterised by low mood in the postnatal period
risk factors of post-partum depression
prior depression
FH of depression
baby blues
lack of social support
clinical features of post-partum depression
low mood + energy anhedonia poor appetite poor/disturbed sleep feelings of guilt bonding issues
assessments for post-partum depression
Edinburgh Postnatal Depression Scale (EPDS)
Patient Health Questionnaire (PHQ-9)
management of mild post-partum depression
guidance to self-help materials
cognitive behavioural therapy or IPT
management of moderate post-partum depression
psychological therapy
antidepressant medication
management of severe postpartum depression
referral to mother and baby unit
define postpartum psychosis
a severe mental illness that has an onset of between 2-3wks post delivery
risk factors of postpartum psychosis
PMH of depression or bipolar disorder
PMH of postpartum psychosis
FH of postpartum psychosis
clinical features of postpartum psychosis
delusions hallucinations depression mania confusion thought disorder
investigations of postpartum psychosis
bloods
CT head
management of postpartum psychosis
referral to mother and baby unit
antipsychotics
mood stabilisers
