Symptoms of Pregnancy Flashcards
What are symptoms of early pregnancy?
First 12 weeks Amenorrhoea Nausea Vomiting Bladder irritability
What are signs of early pregnancy?
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
What are other features of pregnancy?
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
What causes urinary frequency? What should you check for?
Pressure of fetal head on bladder in later pregnancy
GFR increases, increasing urine output
Exclude UTI
What should you check for in breathlessness?
VTE risk factors
Why does constipation occur? What should you suggest?
Gut motility decreases
Adequate oral fluids and high-fibre diet
Avoid stimulant laxatives - increase uterine activity in some
Why does GORD occur? Advice?
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
Why does symphysis pubis dsfunction occur? Management?
Pelvic ligament and muscle relaxation
Simple analgesia
Physiotherapy
Why does carpal tunnel syndrome occur?
In pregnancy due to fluid retention
Wrist splints until delivery
What is pruritic eruption of pregnancy?
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
What should you consider if there is a vesicular rash in pregnancy women?
Pemphigoid gestationis
Rare condition which may cause fatal hear loss and cardiac failure
Refer early as prednisolone may be needed
What should you check for in ankle oedema?
BP
Check urine for protein - pre-eclampsia
Check legs for DCT
Reassure
What should you suggest in leg cramps?
Raise foot of bed by 20cm
What is chloasma
Patch of darker pigmentation, usually on face
What is hyperemesis gravidarum?
Persisting vomiting in pregnancy which causes
5% pre-pregnacny weight loss
Dehydration
Electrolyte imbalance
Can lead to ketosis
What are risk factors for hyperemesis gravidarum?
Multiple pregnancies Molar pregnancy Previous HG Trophoblastic disease Nulliparity Obesity
What is the presentation of hyperemesis gravidarum?
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
What investigation in hyperemesis gravidarum?
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
What is treatment for hyperemesis gravidarum?
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
What should you prescribe to a woman presenting with hyperemesis gravidarum?
High dose folic acid
Thiamine (vitamin B1) to prevent Wernicke’s encephalopathy
Anti-emetic regularly
Daily thromboprophylaxis if in hospital
What are complications of hyperemesis gravidarum?
Wernicke's encephalopathy Mallory-Weiss tear Central pontine myelinolysis Acute tubular necrosis Fetal: SGA, Pre-term birth
