Problems Specific to Pregnancy

Question 1

Outline the management of hyperemesis gravidarum

Answer 1

• Diet - small, frequent, slowly eaten meals
  
  • BRAT diet if severe (banana, rice, applesauce, toast) until tolerated
• Avoidance of environmental or diet triggers
• Medications
  
  • First-line - antihistamines e.g. diphenhydramine
  • Second-line - DA antagonists e.g. prochlorperazine, metoclopramide; 5-HT antagonists e.g. ondansetron
• Severe hyperemesis
  
  • Fluid resuscitation, vitamin replacement
  • Anti-nausea medication
  • TPN

Question 2

What are the triggers for investigation of recurrent abortion?

Answer 2

• > 3 consecutive miscarriages, any second trimester loss, any complicated pregnancy outcome history

Question 3

What tests might you order in the initial investigation of recurrent miscarriage?

Answer 3

• POC karyotype, anatomical studies (saline/MRI hysterogram), anticardiolipin antibodies, lupus anticoagulant, TFT (if history)

Question 4

List some risk factors for ectopic pregnancy

Answer 4

• Previous ectopic, tubal pathology/surgery, smoking, IUD (if failure), IVF

Question 5

What are some contraindications to methotrexate therapy for ectopc pregnancy?

Answer 5

• LFT/UEC/FBE derangement, immunodeficiency, heterotopic pregnancy, breastfeeding

Question 6

Where are DVTs most common during pregnancy? What management is appropriate?

Answer 6

• Most commonly in the left lower extremity (compression of the left iliac vein by the right iliac artery)
• Subcutaneous LMWH e.g. enoxaparin preferred (warfarin teratogenic in T1)