Y4 - GOSH > Antenatal problems > Flashcards

Antenatal problems Flashcards

(56 cards)

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1
Q

what causes backache and sciatica in pregnancy

A

hormonal changes causing softening of ligaments

exacerbated by altered posture due to the weight of the uterus

the softening and weight on the uterus can lead to soft tissue pressuring on the sciatic nerve - sciatica

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2
Q

management of backache and sciatica in pregnancy

A

life-style - eg sleeping position

alternative therapies incl relaxation and massage

physiotherapy input - back care classes

simple analgesia - paracetamol and ibruprofen

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3
Q

what is symphysis pubis dysfunction

A

It describes pregnancy-associated pain, instability and dysfunction of the symphysis pubis joint and/or sacroiliac joint.

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4
Q

management of symphysis pubis dysfunction

A

physiotherapy advise and support

simple analgesia

limit abduction of the leg at delivery

C/S usually not indicated

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5
Q

when does haemorrhoids occur in pregnancy

A

tend to be in 3rd trimester

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6
Q

management of haemorrhoids in pregnancy

A

avoid constipation from early pregnancy which can inc pressure on the anus to cause haemorrhoids in later pregnancy

ice packs and digital reduction of prolapsed haemorrhoids

ibuprofen suppositories and topical agents for symptomatic relief

if thrombosed, may require surgical referral

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7
Q

how come pregnant ladies have a higher risk of constipation

A

progesterone - reduces smooth muscle tone, affecting bowel activity

often made worse by iron supplement

severity decreases with gestation

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8
Q

what are the management of the constipation in pregnancy

A

life-style modification - inc fruit, fibre and water intake

can take fibre supplements

osmotic laxatives (lactulose)

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9
Q

when is varicose vein worse in pregnancy

A

worse when inc with gestation

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10
Q

causes of varicose veins in pregnancy

A

due to progesterone relaxes vasculature + uterus mass reduce venous return

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11
Q

management of varicose veins in pregnancy

A

regular exercise

compression stockings

consider thromboprophylaxis if other risk factors are present

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12
Q

causes of GORD in pregnancy

A

progesterone relaxes the oesophagal sphincter allowing gastric reflux - worsen with inc intra-abdominal pressure from the growing foetus

worse as the gestation continue

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13
Q

causes of carpal tunnel syndrome

A

oedema compressing the median nerve in the wrist

usually, resolve after delivery

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14
Q

management of carpal tunnel syndrome

A

sleeping with hands over the side of the bed may help

wrist splints may be beneficial

surgical referral if neuro deficit

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15
Q

management of GORD in pregnancy

A

lifestyle modification - sleeping propped up, avoid spicy food

alginate preparations and simple antacids

if severe, H2 receptors antagonist (ranitidine)

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16
Q

what is morning sickness

A

N+V induced by hCG hormone but tends to better in 2nd trimester

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17
Q

when is morning sickness worst

A

first trimester due to the placental hCG still being produced

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18
Q

what can worsen morning sickness

A

multiple and molar pregnancies

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19
Q

management of morning sickness

A

lifestyle - ginger tea, eating small meals, inc fluid

acupuncture

anti-emetics - prochlorperazine, promethazine, metoclopramide (PPM)

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20
Q

what is hyperemesis gravidarum

A

excessive vomiting in pregnancy, so much so that the individuals is unable to maintain adequate hydration and endangers fluid, electrolyte and nutritional status

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21
Q

how common is hyperemesis gravidarum

A

rare - 1 in 1000

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22
Q

RF for hyperemesis gravidarum

A

multiple pregnancy eg twins
molar pregnancy
due to higher levels of hCG present

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23
Q

when is the peak onset of hyperemesis gravidarum

24
Q

symptoms of hyperemesis gravidarum

Study These Flashcards
A 
1st trimester of pregnancy 
N+V
weight loss 
reduce oral intake 
muscle wasting 
dehydration 
liver tenderness 
ptyalism (inability to swallow saliva)
hypovolaemia 
electrolyte imbalance - ketones
behaviours disorders due to electrolytes imbalance 
haematemesis due to Mallory-Weiss tears
25
IX for hyperemesis gravidarum
urinalysis - ketones MSU - exclude UTI U and Es - dec K+, dec Na+, metabolic hypochloremic alkalosis LFT - inc transaminases, dec albumin USS - to exclude multiple and molar pregnancies and confirm
26
treatment of hyperemesis gravidarum
exclude other causes - UTI or thyrotoxicosis a small, little sip of water at first and small amount of carbohydrate admit if not better initially NBM then reintroduce later IV fluid (hartman's and NaCl), replace K+ if necessary daily U and Es - to check renal functions antiemetics - Promethazine or cyclizine first line then metoclopramide nutritional support if required - Thiamine to prevent Wernicke's encephalopathy if anti-emetic not working - try corticosteroids eg hydrocortisone/prenisolone IV acupuncture
27
complications of hyperemesis gravidarum
maternal risks - liver and renal failure, Wernicke's encephalopathy foetal risks - IUGR due to malnutrition, Wernicke's encephalopathy (may lead to death)
28
what is the acronym SWAN in the contest of small for dates mean?
S - starved small --> IUGR W- wrongly small --> wrong date A - abnormal small --> chromosomal, structural, infection etc N - normal small --> constitutional small
29
what is the definition of small for dates
foetus that has failed to achieve a specific biometiric or EFW by a specific gestational age
30
what measurement is the most accurate for foetal growth
Crown-Rump Length
31
what is the procedure for measuring foetal growth
CRL - between 8 and 13 weeks | subsequent foetal growth USS & plot on customised chart
32
what are some of the causes for large for dates
``` wrong date polyhydramnios - diabetes related, twins, foeal abnormality (unable to swallow) macrosomia - diabetes related multiple pregnancy presence of fibroids ```
33
definition of polyhydramnios
liquor volume increased > 10cm generally considered abnormal
34
aetiology of polyhydramnios
idiopathic maternal disorders (maternal DM, renal failure) twins foetal anomaly (ipper GI obstructions or inability to swallow) chest abnor
35
clinical features of polyhydramnios
maternal discomfort large for dates foetal part difficult to palpate
36
management of polyhydramnios
USS to diagnose Maternal glucose tolerant test if < 34 weeks and severe --> amnireduction or use NSAIDs to reduce foetal urine output consider steroids if < 34 weeks if pre-term delivery is considered
37
how should a baby with polyhydramnios be delivered
vaginal unless persistent unstable lie or other obstetric indication
38
complications of polyhydramnios
6 Ps of polyhydramnios 1) placental abruption 2) pretty unstable lie 3) premature labour 4) prolapse of cord 5) PPH 6) perinatal mortality
39
when will a woman be able to notice foetal movement
18-20 weeks
40
When is the baby most active?
usually afternoon and evening
41
how long does a baby normally sleep for?
20-40 minutes, rarely longer than 90 minutes
42
what is the normal movement of a baby?
no such normal pattern for a baby, it is all individualized the reduction/deviation from the normal pattern of a baby is what is the most worrying feature
43
what is the initial assessment of a pregnant woman for reduced foetal movement
lie down on the LHS for the next 2 hours and focus on the movement of the baby. if less than 10 separate episodes of movement --> should take action you can also try to drink some cold water to wake the baby up
44
aetiology of reduced foetal movement
baby sleeping anterior placenta and so less able to feel the baby movement baby's back is lying at the front of the uterus, you may feel fewer movements that if his back is lying alongside your own back medications eg strong pain relief or sedatives alcohol/smoking foetal illness and distress
45
advice for women who think their babies might have reduced movement?
1) if by 24th week, you have never felt the movement of the baby, you should contact midwife for a check on the baby's heartbeat. 2) if over 28 weeks, you must contact midwife/local maternity unit immediately. seek help immediately.
46
what is considered to be a prolonged pregnancy/postdate/post-term/post-maturity
exceeds 42 weeks from the first day of LMP
47
what is the chance of prolonged pregnancy if you had 1 x prev. prolonged pregnancy
30% (normally 3-10% chance if you never had one before)
48
what are the complications of prolonged pregnancy?
maternal - anxiety and psychological, inc interventions eg induction of labour/operative delivery (inc risk to genital tract trauma foetal - inc perinatal mortality if after 42 weeks, intrapartum death 4x, early neonatal death 3x other risks - meconium aspiration pneumonia and assisted ventilation, oligohydramnios, macrosomia/shoulder dystocia and foetal injury, cephalhaematoma. foetal distress in labour neonatal period - hypothermia, hypoglycemia, polycythemia and growth restriction
49
management of prolonged pregnancy
1) confirm EDD 2) assess any other risks eg pre-eclampsia, DM, APH, IUGR 3) offer stretch and swap in 41 week 4) offer induction of labour at 41-42 weeks (reduce perinatal mortality)
50
what does PPROM stands for
preterm premature rupture of membrane
51
what is the most common cause of PPROM
overt infection (more common in earlier gestations)
52
clinical features of PPROM
vaginal loss? gush of fluid? trickle or dampness? signs of chorioamnionitis - fever/malaise, abdo pain incl contractions, purulent/offensive vaginal discharge maternal pyrexia maternal tachycardia uterine tenderness foetal tachycardia
53
investigation of PPROM
put pad on before hospital arrival Speculum examination not bimanual - confirmatory if pooled fluid in the posterior fornix/fluids running down the cervical canal. FBC, CRP, swabs (HVS, LVS) MSU CTG USS for foetal presentation, EFW and liquor volume
54
management of P-PROM
if evidence of chorioamnionitis - prepare for delivery - betamethasone 12 mg IM, deliver, board spectrum antibiotics cover (erythromycin 250mg QDS 10 days) if no evidence of chorioamnionitis - conservatively - prophylactic ABx (erythroymcin 250mg QDS) - inform SCBU and liaise with neonatologist - discharge after 48 hours and review in day unit twice a week for bloods and vital obs - induction from 34 weeks
55
which antibiotics should you not use in pregnancy
co-amoxiclav - inc NEC incidence
56
definition of PROM
membrane rupture after 37 weeks before the onset of labor

Y4 - GOSH (12 decks)

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