SHP

Question 1

Indigestion/heartburn treatment + advice for pregnancy

Answer 1

Diet
Eat small frequent meals
Avoid chocolate, fatty, spicy foods, coffee, alcohol

Lifestyle
Do not eat 3 hrs before sleep
Raise head of bed
Stop smoking

Treatment
Antacids + Alginate (Gaviscon Advance)

Question 2

Constipation treatment + advice for pregnancy

Answer 2

Diet & Lifestyle
Fibre + Fluid
Physical activity

Laxatives
Fybogel Hi-Fibre
Lactulose

Question 3

Haemorroid treatment + advice for pregnancy

Answer 3

Diet & Lifestyle
Fibre + Fluid

Treatment
Topical cream/ointment (Anusol)
Get diagnosis from GP / midwife

Question 4

Thrush treatment and advice for pregnancy

Answer 4

Refer!
When prescribed antifungal, advise to use fingers instead of applicator, may cause damage to cervix

If you have thrush when your baby is born, the baby may catch it during the delivery. This is nothing to worry about and can easily be treated.

Question 5

Treatment + advice for nausea and vomiting in pregnancy

Answer 5

Diet & Lifestyle
Rest & Sleep
Drink plenty of water
Ginger
Acupressure to wrist
Eat plain biscuits 20 mins before getting up
Avoid cold / sweet beverages
Eat small frequent meals high in carbs/protein, low in fats
Avoid triggers
REFER: pain, blood, repeated & unstoppable vomiting

Question 6

Treatment + advice for headache in pregnancy

Answer 6

Treatment
Paracetamol only
Lowest dose, only if needed

Advice
Plenty of water
Get enough rest
Relaxation techniques: yoga
TENS

Question 7

Treatment + advice of hayfever in pregnancy

Answer 7

Non-pharmacological
Avoid allergen
Barrier ointment around nostrils / nasal saline irrigation
Pharmacological
Topical: intranasal sodium cromoglicate/ corticosteroids
Oral: cetrizine + loratidine/ levocetrizine
Decongestions not recommended (could decrease blood flow to baby)

Question 8

Pregnancy diet advice: what to eat/avoid?

Answer 8

WHAT TO EAT
Fibre (starch-based foods, fruit & veg)
Iron (red meat, green veg)
Calcium (milk, cheese)
Folic acid (green veg, brown rice, fortified cereals)
Vitamin D (oily fish, eggs, margarine)
Folic acid - 400mcg OD 4 weeks before conception, and throughout 12 weeks of pregnancy (if child risk of spinal cord defect - take 5mg OD)
Avoid herbal remedies
WHAT TO AVOID
Vitamin A - teratogenic (liver - liver pate, cod liver oil, supplements)
Listeria (soft cheese, shellfish, raw fish, unpasteurised milk)
Salmonella (raw eggs/meat)

Question 9

Can pregnant woman drink coffee and alcohol?

Answer 9

CAFFEINE - reduce blood supply to fetus
Max 200mg/day (2 cups of instant coffee)
ALCOHOL - NO
May cause foetal alcohol syndrome (developmental defects)

Question 10

How often pregnant woman need to exercise?

Answer 10

EXERCISE
Aerobic + muscle strength physical activity
Min 30 mins of physical activity every day

Question 11

Consequence of smoking on baby during pregnancy?

Answer 11

Stop smoking
Risk of stillbirth / pre-term baby

Question 12

When and why to breastfeed?

Answer 12

When?
First: within 1 hr of birth
Exclusive breastfeeding for first 6 mths
8-12 times in 24 hrs
Introduce solid foods at 6 mths tgt with continued breastfeeding up til 2 yrs or more
Why?
Baby: lower risk of infection & atopic disease, improve neurological development
Mother: lower risk of premenopausal breast cancer & ovarian cancer & hip fractures

Question 13

Breastfeeding - birth control? caffeine? alcohol?

Answer 13

Birth control? Yes
Caffeine? Not recommended, can reach baby, make baby restless
Alcohol? No

Question 14

Breastfeeding woman finds that her breasts are swollen, hot and painful

Answer 14

Mastitis
Swollen, hot, painful
REFER: flucoxacillin (levels that enter breast milk is low)
Paracetamol to reduce pain
Continue to breastfeed, start feed with sore breast
Place warm towel on breast for relief

Question 15

Young 23 yrs old girl
“Hi, I just had sex yesterday with my boyfriend. Can I ask what are the emergency contraceptives available for me to take?”

Answer 15

Age? Pregnant before?
How was last period?
UPSI before?
Contraceptive? Taken before?
Meds?
COPPER IUD (<0.1%)
Most effective
GP or Sexual Health Clinic
Up to 5 days after UPSI / Up to 5 days after expected date of ovulation
Free
ULIPRISTAL ACETATE (1-2%)
ellaOne
UPSI within 5 days
No age restrictions
Take as soon as possible
Side effects: N&V, headache, fatigue, muscle pain
If vomit within 3 hrs, take again
Affect menstrual timing
LEVONORGESTREL (0.6-2.6%)
Levonelle
UPSI within 72 hrs
16 yrs and over
Take as soon as possible
Side effects: N&V, headache, fatigue, low abdominal pain
If vomit within 2 hrs, take again
Affect menstrual timing

Question 16

Does contraception have any effect on pregnancy?

Answer 16

NO

Question 17

Explained combined oral contraceptives 21 vs 28 vs progestogen only pills

Answer 17

Combined (COCP) - oestrogen and progesterone
→ Monophasic 21 days
21 active pills, 7 day pill free

→ Monophasic 28 days
21 active pills, 7 dummy pills
Better compliance

Progestogen Only Pill (POP)
→ 1 pill daily
→ choose a convenient time in the day to take your first pill
→ continue to take a pill at the same time each day until the pack is finished
→ start your next pack of pills the following day – there’s no break between packs of pills

Side effect - acne, headache, breakthrough bleeding, mood change, nausea
Risk - migraine, DVT, breast & cervical cancer
Benefit: reduce PMS, reduce heavy bleeding, reduce menstrual pain, improve acne, improve polycystic ovarian syndrome

Question 18

How to treat?
Erectile dysfunction
Pulmonary artery hypertension
Trigger:
Physical (alcohol)
Mental (stress)
Medication

Answer 18

18 yrs and over ONLY
Once a day, max 1
On empty stomach (before meal, 2 hrs after meal)
1hr before sex
Work up to 4 hrs after dose
Need to be sexually aroused to have effect
Takes longer to work after meal
Avoid grapefruit juice - may increase conc. of sildenafil
Avoid antifungal, antibiotic, cimetidine - may increase conc of sildenafil
Avoid alcohol - reduce effect
Avoid nitrates (GTN)
SE: headache, hot flush, dizziness
Viagra Connect (OTC)

Question 19

Advice for erectile dysfunction

Answer 19

Reduce stress
Balanced diet
Avoid smoking

Question 20

2nd week of taking COCP, missed 2nd, 3rd, 4th day. Today is 5th day.
Has sex yesterday. What should I do?

Answer 20

Take one pill now. Discard missed pills. Continue as usual, and use barrier method.

Question 21

Usually take POP 5pm everyday. Taking the 3hr POP. Last took the pill yesterday at 3pm. It’s 3pm now. What should I do?

Answer 21

Take one pill now. No need EC, no need barrier.

Question 22

Taking 12 hr POP. Usually take 9am everyday. Last took the pill yesterday 9am. It’s 9pm now.

Answer 22

Take one pill now. Take EC. Condom until taken 2 pills in a row.