Minor disorders of pregnancy Flashcards
What are some common minor disorders of pregnancy?
-N+V
-Reflux
-Constipation
-Symphysis pubis dysfunction
-Backache and sciatica
-Carpal tunnel syndrome
-Haemorrhoids
-Varicose veins
-Urinary symptoms
-Vaginal discharge
-Itching and rashes
-Acute fatty liver of pregnancy
When does N+V usually occur in pregnancy and how is it managed?
-1st trimester - usually resolves at 16-20 weeks
-Increased in multiple pregnancy or molar pregnancies
-Management:
–Eat small meals
–Increase fluids
–Acupressure
–Antiemetics
When does REFLUX usually occur in pregnancy and how is it managed?
-Throughout pregnancy but especially in 3rd trimester
-Caused by progesterone relaxing the oesophageal sphincter and is worsened by increasing intra-abdominal pressure
-Management:
–Sleep propped up
–Avoid spicy food
–Antacids / h2 receptor antagonists (ranitidine)
When does CONSTIPATION usually occur in pregnancy and how is it managed?
-Decreases with gestation
-Progesterone reduces smooth muscle tone, made worse with iron supplements
-Management:
–Increase fibre and fluid intake
–Fibre supplements
–Lactulose (softener)
When does BACKACHE usually occur in pregnancy and how is it managed?
-Caused by hormonal softening of ligaments, altered posture and pressure on sciatic nerves
-Management:
–Optimise sleeping position
–Relaxation + massage
–Physio
–Analgesia
Why does CARPAL TUNNEL SYNDROME usually occur in pregnancy and how is it managed?
-Oedema compresses the median nerve (resolves after pregnancy)
-Management:
–Sleeping with hands over bed side
–Splints
–?Surgical referral
When do HAEMORRHOIDS usually occur in pregnancy and how are they managed?
-3rd trimester
-Management:
–Treat / avoid constipation
–Ice packs
–Digital reduction
–Suppositories
–Surgical referral if thrombosed
When do VARICOSE VEINS usually occur in pregnancy and how is it managed?
-Increase with gestation
-Caused by progesterone relaxing vasculature and foetal mass decreasing venous return
-Management:
–Regular exercise
–Compression
–Consider thromboprophylaxis
When do URINARY SYMPTOMS usually occur in pregnancy and how are they managed?
-In 1st trimester caused by increased GFR
-In 3rd trimester caused by stress incontinence
-Management:
–Avoid caffeine
–Avoid fluid late at night
-UTI is common - picked up by MC+S
–Avoid trimethoprim in 1st trimester + nitrofurantoin in 3rd
What usually causes VAGINAL DISCHARGE in pregnancy and how is it managed?
-Increased blood flow to the vagina and cervix causes white / clear mucinoid discharge
-If infection –> offensive, coloured, itchy
-If ROM –> watery, profuse
-Management:
–Exclude + treat ROM, STI, candidiasis
When does ACUTE FATTY LIVER usually occur in pregnancy and how is it managed?
-3rd trimester
-Associated with abdo pain, N+V, jaundice, hypoglycaemia, can lead to pre-eclampsia
-Management:
–Stabilise and plan for delivery
When dose ITCHING AND RASHES usually occur in pregnancy and how is it managed?
-Common + usually self-limiting
-Management:
–Emollients
–Reassurance
–Exclude infectious causes ie OBSTETRIC CHOLESTASIS:
–1% of women in 3rd trimester
–Pruritis on palms + soles
–Increased bilirubin
–Manage with ursodeoxycholic acid for symptoms, induce at 37 weeks, increased stillbirth rate
–Weekly LFTs
What are the common issues in the first trimester?
-Nausea
-Fatigue
-Breast tenderness
-Frequent urination
-NB most miscarriages and birth defects occur here
What are the common issues in 2nd trimester?
-Back pain
-Abdo pain
-Leg cramps
-Constipation
-Heartburn
-However, decreased nausea, better sleep and energy levels
What are the common issues in the third trimester?
-SOB
-Haemorrhoids
-Urinary incontinence
-Varicose veins
-Sleeping problems
