Antenatal Problems

Question 0

When does nausea and vomiting usually occur in pregnancy, and when does it resolve?

Answer 0

Occurs particularly in first trimester

Tends to resolve spontaneously by 16-20 weeks

Question 1

How many pregnant women are affected by nausea and vomiting?

Answer 1

Nausea - 80-85%
Vomiting - 52%

Most common complaint in pregnancy

Question 2

How can nausea and vomiting in pregnancy be managed?

Answer 2

Lifestyle - eating small meals, increasing fluid intake

Ginger

Acupressure

Antiemetics - prochlorpromazine, promethazine, metoclopramide

Question 3

What causes constipation in pregnancy?

Answer 3

Progesterone reduces smooth muscle tone, which affects bowel activity

Can be made worse by iron supplementation

Question 4

When does constipation occur in pregnancy?

Answer 4

Appears to decrease with gestation:

1st trimester - 39%
2nd trimester - 30%
3rd trimester - 20%

Question 5

How can constipation be managed in pregnancy?

Answer 5

Increasing fruit, fibre, and water intake

Fibre supplements

Osmotic laxatives - lactulose

Question 6

When does heartburn (gastro-oesophageal reflux) occur in pregnancy?

Answer 6

Common in all stages in pregnancy:

1st trimester - 22%
2nd trimester - 39%
3rd trimester - 72%

Question 7

What is the mechanism behind heartburn in pregnancy?

Answer 7

Progesterone relaxes the oesophageal sphincter allowing gastric reflux

This gradually worsens with increasing abdominal pressure from the growing foetus

Question 8

How can heartburn in pregnancy be managed?

Answer 8

Sleep propped up, avoid spicy foods

Alginate preparations and simple antacids

If severe, H2 antagonists (ranitidine)

Question 9

Why does carpal tunnel syndrome occur in pregnancy?

Answer 9

Due to oedema compressing the median nerve in the wrist

Question 10

How can carpal tunnel syndrome in pregnancy be managed?

Answer 10

Usually resolves spontaneously after delivery

Wrist splints may be helpful

Question 11

What causes back pain and sciatica in pregnancy?

Answer 11

Common problem

Due to hormonal softening of ligaments, exacerbated by altered posture due to weight of the uterus

Pressure on the sciatic nerve may cause neurological symptoms

Question 12

How can back pain and sciatica in pregnancy be managed?

Answer 12

Change sleeping position

Relaxation and massage

Physiotherapy - back care classes

Simple analgesia

Question 13

When do haemorrhoids tend to occur in pregnancy?

Answer 13

3rd trimester

8-30% of women

Question 14

How are haemorrhoids in pregnancy managed?

Answer 14

Avoid and treat constipation

Ice packs and digital reduction of prolapsed haemorrhoids

Suppositories and topical agents for symptomatic relief

If thrombosed, require surgical referral

Question 15

How are varicose veins managed in pregnancy?

Answer 15

Common complaint which increases worth gestation

Regular exercise
Compression hosiery
Consider thromboprophylaxis if other risk factors are present

Question 16

Are skin changes and itching common in pregnancy?

Answer 16

Yes

Rashes are usually self-limiting and not serious

Emollients at OTC itching creams may help

Most will resolve after delivery, but can refer to dermatologist if severe

Question 17

What urinary symptoms are common in pregnancy?

Answer 17

Frequency in first trimester due to increased GFR

Stress incontinence in third trimester due to pressure on pelvic floor

UTIs are common in pregnancy - exclude with dipstick

Question 18

What is symphysis pubis dysfunction?

Answer 18

Usual mild, can be severely painful

Occurs jn up to 10%

Usually occurs in third trimester

Symphysis pubis joint becomes loose, and the two halves of the pelvis rub on each other when walking it moving

Question 19

How is symphysis pubis discomfort managed?

Answer 19

Physiotherapy

Simple analgesia

A stability belt may be worn

Condition tends to only improve on delivery

Question 20

How common is hyperemesis gravidarum?

Answer 20

1/1000 pregnancies

Question 21

What is hyperemesis gravidarum?

Answer 21

Excessive vomiting in pregnancy

Patients with multiple or molar pregnancies are at increased risk, due to high levels is hCG

Question 22

What are the symptoms and signs of hyperemesis gravidarum?

Answer 22

Occurs in 1st trimester
Vomiting
Weight loss
Muscle wasting
Dehydration
Inability to swallow saliva
Electrolyte imbalance
Malory-Weiss tears

Question 23

What investigations should be done for suspected hyperemesis gravidarum?

Answer 23

Urinalysis for ketones
MSU to exclude UTI
UandEs
LFTs - hyperemesis may cause liver failure

USS to exclude multiple and molar pregnancies

Question 24

What are the complications of hyperemesis gravidarum?

Answer 24

Maternal: Liver and renal failure Hyponatraemia Thiamine deficiency - wernickes Foetal: IUGR

Question 25

How is hyperemesis managed?

Answer 25

Admit if not tolerating oral fluid! IV fluids Daily UandEs Consider promethazine Thiamine infusions may be necessary

Question 26

What is prolonged pregnancy?

Answer 26

Any pregnancy that exceeds 42 weeks (294 days) Dated from the first day of the last menstrual period in a woman with regular 28 day cycles

Question 27

What are the foetal risks of prolonged pregnancy

Answer 27

Placenta ages and fails to function properly and amniotic fluid may decrease ``` Meconium aspiration Oligohydramnios Macrosomia, shoulder dystocia Cephalhaematoma Foetal distress in labour Neonatal hypothermia, hypoglycaemia (too little glucose producing stores), polycythaemia, growth restriction ```

Question 28

What is foetal postmaturity syndrome?

Answer 28

Describes post-term infants who show signs of intrauterine malnutrition ``` Neonatal features; Scaphoid abdomen Little subcutaneous fat on the body and limbs Peeling skin over Palm and feet Overgrown nails Skin stained with meconium ```

Question 29

What are the maternal risks of prolonged pregnancy?

Answer 29

Maternal anxiety Induction if labour Increased risk of trauma due to large baby Increased risk of caesarean delivery

Question 30

How is prolonged pregnancy managed?

Answer 30

Attempt to determine EDD as accurately as possible Offer stretch and sweep at 41 weeks Offer induction of labour between 41 and 42 weeks Foetal monitoring - initial USS and daily CTGs after 42 weeks, monitoring foetal movements

Question 31

How does the pattern of foetal movements change as pregnancy progresses?

Answer 31

Foetal movements plateau at 32 weeks Length of time between cycles of activity increases The number of foetal 'kicks' decreases, but foetal trunk movement continues at the same rate Foetal movements tend to increase throughout the day and peak at night

Question 32

When are foetal movements detectable by USS?

Answer 32

7-8 weeks

Question 33

When are foetal movements detectable by maternal perception?

Answer 33

16-20 weeks

Question 34

How can foetal movements be assessed?

Answer 34

Subjective maternal perception - kick chart Doppler Real time ultrasound scan

Question 35

What investigations should be undertaken in reduces foetal movements?

Answer 35

History of reduced foetal movements and obstetric risk factors Doppler to confirm foetal heart beat CTG to assess foetal compromise (absence of accelerations) USS if after 28 weeks and normal CTG

Question 36

What is the significance of reduces foetal movement?

Answer 36

Usually no problems if one episode Risk of poor outcome increased if recurrent episodes of reduces foetal movements Abrupt cessation is an ominous finding - increased risk of perinatal mortality

Question 37

When can a baby be diagnosed as small for gestational age?

Answer 37

When foetal abdominal circumference or estimated foetal weight is less than the tenth centile Includes foetuses with IUGR as well as babies that are constitutionally small

Question 38

How should SFGA babies be assessed?

Answer 38

Depending on presence of risk factors: Umbilical artery Doppler scan Serial ultrasound assessment of foetal size

Question 39

What are the ultrasound requirements for IUGR?

Answer 39

Elevated femoral length to abdominal circumference Elevated ratio of head circumference to abdominal circumference Unexplained oligohydramnios

Question 40

What investigations other than Doppler ultrasonography may be required for SGA babies?

Answer 40

Uterine artery Doppler, fetal anatomical survey Karyotyping Serological screening for cytomegalovirus and toxoplasmosis

Question 41

What interventions should be considers in preterm SFGA foetus?

Answer 41

Women with SFGA foetus between 24+0 and 35+6 where delivery is being considered should receive single course of antenatal corticosteroids

Question 42

When should delivery be considered if an SFGA baby has an abnormal umbilical Doppler?

Answer 42

Between 30-32 weeks of gestation Delivery before 37 weeks is definitely recommended Deliver by Caesarean section, but induction can be offered

Question 43

What are the characteristic abnormalities from maternal rubella infection?

Answer 43

``` Sensorineural deafness Cataracts Congenital heart disease Learning difficulties Hepatosplenomegaly Microcephalic ```

Question 44

How do pregnant women present with rubella infection?

Answer 44

Non specific, flu like illness Macular rash covering trunk Confirm with serological antibody testing

Question 45

What food can contain listeria?

Answer 45

Pate Soft cheese Blue cheese

Question 46

How does listeria infection present?

Answer 46

``` Fever Headache Malaise Backache Abdo pain Pharyngitis Conjunctivitis ``` Diagnosed by blood culture

Question 47

What are the complications of listeria infection in pregnancy?

Answer 47

Miscarriage Stillbirth Preterm delivery Neonatal listeriosis

Question 48

How is group b streptococci infection diagnosed and managed?

Answer 48

Asymptomatic to mother - picked up on vaginal swabs Antibiotics must be given during labour to reduce neonatal infection

Question 49

How does chicken pox infection present in pregnancy women?

Answer 49

Prodromal malaise and fever Itchy vesicular rash Causes dermatomal skin scarring, limb hypoplasia, eye defects, neurological defects

Question 50

Where does toxoplasmosis infection come from?

Answer 50

Unwashed fruit and veg Unpasteurised goats milk Contamination from soil or cat faeces Raw poorly cooked meat

Question 51

What are the foetal effects of toxoplasmosis?

Answer 51

``` Miscarriage Stillbirth Hydrocephalus Deafness Blindness ```

Question 52

What are the foetal symptoms of cytomegalovirus infection?

Answer 52

20% show signs at birth: Hydrops, IUGR, microcephalic, hepatosplenomegaly, thrombocytopenia 80% show signs at later life: learning difficulties, hearing loss, visual impairment

Question 53

What are foetal complications or parvovirus infection?

Answer 53

Hydrops Haemolytic anaemia Myocarditis Presents in mother with fever, malaise, arthralgia

Question 54

What should women who are at risk of hypertension during pregnancy take prophylactically?

Answer 54

Aspirin 75mg OD from 12 weeks to the birth of the baby