Symptoms of Pregnancy Flashcards

1
Q

What are symptoms of early pregnancy?

A
First 12 weeks
Amenorrhoea
Nausea
Vomiting
Bladder irritability
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2
Q

What are signs of early pregnancy?

A

Breasts engorge
Nipple enlarge (Darken at 12 weeks)
Montgomery’s tubercles (sebaceous glands on nipples) become prominent
Vulval vascularity increases
Cervix softens and looks bluish (4 weeks)
Temperature rises <37.8

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3
Q

What are other features of pregnancy?

A
Headaches, palpitation and fainting
Urinary frequency
Abdominal pain
Breathlessness
Constipation
GORD
Musculoskeletal problems - syphysis pubis dysfunction
Carpal tunnel syndrome
Itch/itchy rashes
Ankle oedema
Leg cramps
Chloasma
Nausea
Vomiting
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4
Q

What causes urinary frequency? What should you check for?

A

Pressure of fetal head on bladder in later pregnancy
GFR increases, increasing urine output
Exclude UTI

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5
Q

What should you check for in breathlessness?

A

VTE risk factors

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6
Q

Why does constipation occur? What should you suggest?

A

Gut motility decreases
Adequate oral fluids and high-fibre diet
Avoid stimulant laxatives - increase uterine activity in some

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7
Q

Why does GORD occur? Advice?

A

Progesterone medicated pyloric sphincter relaxation allows irritant bile to reflux into the stomach

This is then worsened from an enlarging fetus pressing on the upper GI tract

Avoid cigarette and spice
cold, small meals
Antaxids and H2RA may be used
Use more pillows

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8
Q

Why does symphysis pubis dsfunction occur? Management?

A

Pelvic ligament and muscle relaxation

Simple analgesia
Physiotherapy

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9
Q

Why does carpal tunnel syndrome occur?

A

In pregnancy due to fluid retention

Wrist splints until delivery

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10
Q

What is pruritic eruption of pregnancy?

A

Intensely itchy papilar/plaque rash on the abdomen and limbs
Most common in first pregnancies beyond 35 weeks gestation
Emollients and weak topical steroids ease it
Delivery cures it

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11
Q

What should you consider if there is a vesicular rash in pregnancy women?

A

Pemphigoid gestationis
Rare condition which may cause fatal hear loss and cardiac failure
Refer early as prednisolone may be needed

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12
Q

What should you check for in ankle oedema?

A

BP
Check urine for protein - pre-eclampsia
Check legs for DCT
Reassure

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13
Q

What should you suggest in leg cramps?

A

Raise foot of bed by 20cm

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14
Q

What is chloasma

A

Patch of darker pigmentation, usually on face

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15
Q

What is hyperemesis gravidarum?

A

Persisting vomiting in pregnancy which causes
5% pre-pregnacny weight loss
Dehydration
Electrolyte imbalance

Can lead to ketosis

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16
Q

What are risk factors for hyperemesis gravidarum?

A
Multiple pregnancies
Molar pregnancy
Previous HG
Trophoblastic disease
Nulliparity
Obesity
17
Q

What is the presentation of hyperemesis gravidarum?

A
Inability to keep food or fluids down
Weight loss
Nutritional deifciency
Dehydration
Hypovolaemia
Tachycardia
Postural hypotension
Electrolyte disturbance
Hypokalaemia
Hyponatraemia
Shcok
Polyneuritis due to vitamin B deficiency
Haematemesis from Mallory-Weiss tears
Liver/renal failure
Ptyalism (inability to swallow saliva)

Use PUQE score to classify severity

18
Q

What investigation in hyperemesis gravidarum?

A

Urine dip: Ketones and UTI (send MSU)

Bloods:
FBC: raised haematocrit
U&E: exclude hypokalaemia or hyponatraemia
LFT - transaminase may be abnormal, albumin low
TFT often abnormal and should only performed if other symptoms of hyperthyroidism

US:
multiple pregnancy, mole

19
Q

What is treatment for hyperemesis gravidarum?

A

Admit if unable to keep anything down despite oral anti-emetics for rehydration and correction of metabolites.
Aggressive fluid replacement with Saline or Hartmann’s IV

Daily U&E to guide sodium/potassium replacement

ANTIHISTAMINES first line - promethazine

Regular anti-emetics - promethazine, cyclizine, metoclopramide PO/IV/IM

Ondansetron PO/IV if these measured fail but is not licensed in pregnancy

IF intractable consider prednisolone or hydrocortisone course

20
Q

What should you prescribe to a woman presenting with hyperemesis gravidarum?

A

High dose folic acid
Thiamine (vitamin B1) to prevent Wernicke’s encephalopathy
Anti-emetic regularly

Daily thromboprophylaxis if in hospital

21
Q

What are complications of hyperemesis gravidarum?

A
Wernicke's encephalopathy
Mallory-Weiss tear
Central pontine myelinolysis
Acute tubular necrosis
Fetal: SGA, Pre-term birth