D&M Preg

Question 1

Pregnancy referral criteria – 9

Answer 1

1. Hyperemesis gravidarum (dehydrated, electrolyte imbalance)
2. Severe unstoppable vomiting
3. Inability to keep fluids/food down for 24hrs
4. Very dark urination, or no urination
5. Abdominal pain or fever
6. Weakness or feeling faint
7. Blood in vomit
8. Persistent nausea & vomiting
9. UTI

Question 2

Morning sickness OTC advice - 7

Answer 2

1. Avoid foods/smells which trigger symptoms
2. Eat ginger or plain biscuits/cracker before getting up
3. Eat small frequent meals, high in carbohydrates & low in fats
4. Have plenty of rest since tiredness can make symptoms worse
5. P6 pressure point
6. Multivitamins or ginger may work
7. Drinking little & often may help prevent vomiting

Question 3

Pain management – 5

Answer 3

1. Analgesics might be needed for headache, musculoskeletal pain or dental pain – Only give paracetamol
2. Do not stand or sit for too long
3. Rest when painful & ‘put feet up’
4. Wear flat shoes
5. Stretch tight muscles & soak in warm baths

Question 4

Heartburn – 2

Answer 4

1. 1st line: Avoid stooping, trigger foods, stop smoking
2. 2nd line: Simple antacids/alginates, no PPIs

Question 5

Heartburn referral – 4

Answer 5

1. Symptoms unresponsive to treatments
2. Patient is unable to eat due to symptoms
3. Cause unrelated to pregnancy (peptic ulcer, IBS)
4. Alarm symptoms present - GI bleeding, progressive unintentional weight loss, persistent vomiting, difficulty swallowing

Question 6

Constipation – 3

Answer 6

1. 1st LINE: increased dietary fibre, increase fluid intake, light exercise. If possible, stop medications which causes constipation.
2. 2nd line: Bulk forming laxatives, refer if not working
3. Avoid stimulants (e.g. senna) due to risk of uterine contractions

Question 7

Haemorrhoids – 2

Answer 7

1. Use of a cold compress are useful if the haemorrhoids are swollen and painful.
2. Treatment – no one treatment has overwhelming evidence for effectiveness their product could be down to patient choice/past experience.

Question 8

Vaginal thrush – 3

Answer 8

1. Usually clears after delivery
2. Avoid oral fluconazole
3. If clotrimazole products are used – applicators should generally not be used

Question 9

Coughs & colds – 5

Answer 9

1. Avoid use of decongestants – use Menthol inhalation instead
2. Care with combination preparations
3. Paracetamol for symptomatic relief
4. Some cough & throat lozenges can be recommended
5. Speak to GP about Vicks vapo rub

Question 10

Threadworms – 3

Answer 10

1. Nothing OTC
2. Change bed linen daily
3. If symptoms appear refer

Question 11

Problems during breastfeeding - 6

Answer 11

1. Feeding related problems
2. Sore/cracked nipples
3. Blocked duct
4. Too little/much milk
5. Engorgement
6. Thrush & breastfeeding
   Nipple – miconazole cream after feeds
   Mouth – miconazole oral gel >4 months only