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MD3: Women's > Pregnancy symptoms > Flashcards

Flashcards in Pregnancy symptoms Deck (16)
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1
Q

What is the definition of hyperemesis gravidarum?

A

Severe N+V (intractable) > than normal for pregnancy that leads to dehydration, electrolyte disturbance, weight loss >=5% pre-pregnancy weight or requires hospital admission

2
Q

What are risk factors for hyperemesis?

A

Anything that causes high B-hCG

  • Multiple pregnancy
  • Molar pregnancy

Past history

Ethnicity - higher in asian population

3
Q

What is the natural hx of hyperemesis?

A

Symptoms generally started by 5W, peak ~11-12W and 80% will resolve by end of 1T - some continue through until 2nd or 3rd T

4
Q

What are the features of hyperemesis?

A
  • Occurs frequently throughout the day, any time
  • Typically worse in the afternoon/evening (often b/c of fatigue)
  • Worse with stress
  • Weight loss, dehydration (headache, dizziness, postural hypotension), thiamine deficiency (rarely) - ataxia, confusion, opthalmoplegia
5
Q

What are important features on history for patient with hyperemesis?

A

Antenatal history and past obstetric hx

  • Multiple pregnancy
  • Hx molar pregnancy
  • Previous hyperemesis

Vomiting

  • Frequency, volume, blood, bile
  • Exacerbating - time of day, fatigue, stress, smells, certain foods
  • Tried anything - pharm or non-pharm

Input hx - Fluid intake

Associated features (exclude non-obs cause)

  • Abdo pain, distention, constipation
  • Pruritis, jaundice, pale stools, dark urine
  • fever, diarrhoea, travel hx, sick contacts
  • urinary symptoms

Psychosocial impact, functional impact

PMHx, medications, allergies, social hx

6
Q

What are important examinations for patient with hyperemesis?

A

Fluid status - postural BP, cap refil, vitals (tachycardia)
Neurological exam - if concerned about thiamine deficiency
Abdominal examination - exclude surgical cause
Urine dipstick - infection

7
Q

What Ix for patient with hyperemesis?

A

Must Ix for possible cause of hyperemesis and complications

U&Es, LFTs, FBE, CRP
Urine MCS
Ultrasound

8
Q

What is the Rx of hyperemsis?

A
  • Admit if require resus/TPN
  • IV fluids, monitor U&E and replace K+ if required
  • IV antiemetics - metoclopramide, ondanestron
  • Thiamine if required
  • Dietitian referal if require TPN
  • Non-pharm Rx - rest to avoid excess fatigue, avoid triggers, stress management techniques, small frequent meals
9
Q

What are the medication options for Rx of N+V in pregnancy?

A
1st = B6
2nd = Metoclopramide
3rd = Ondanesteron (class B)
10
Q

What are DDx for abdominal pain in pregnancy?

A
Round ligament pain
Pain associated with stretching of rectus abdominus muscle 
Placental abruption
Labour 
Miscarriage 

Non-obstetric

  • Biliary colic - increased risk of gall stones in pregnancy
  • Obstruction
  • Hepatic cause
  • UTI, GIT infection
  • Ovarian pathology
11
Q

What are the features of round ligament pain?

A

Start from the 2nd trimester
Lower abdominal pain usually into groin
Usually unilateral, left side particularly common
Occurs from prolonged standing, sudden change in movement i.e. standing from seated position, coughing, sneezing
Often worse at end of the day

Due to stretching of round ligament as uterus is enlarging

12
Q

What are key features on history for women presenting with abdominal pain in pregnancy?

A
  • Antenatal hx and past obstetric hx (issues with placenta, growth of baby)
  • PV bleeding, foetal movements
  • Acute or recurrent/chronic issue
  • Location of pain, radiation, quality, severity, triggers/exacerbating factors (end of day, prolonged standing, coughing/sneezing, standing up, movement, worse with breathing), relationship to meals
  • Associated symptoms - N+V, fever, distention, diarrhoea, constipation, urinary symptoms, pale stools, dark urine, pruritis
  • Travel history, sick contacts
  • PMHx - gallstones, pelvic surgeries, liver problems, CVD, HTN, diabetes, clots
  • FHx - gallstones, clots
  • Medications, allergies
  • Social hx
13
Q

What pharmacological Rx can be used for constipation in pregnancy?

A
Bulking agents (metamucil)
Osmotic laxative (Magnesium hydroxide)
Stimulant laxatives (senna)
14
Q

What medications can be used for reflux in pregnancy?

A

Antacids - can use ‘liberally’
Elevation of head at night, minimise fluids 2-3hr before bed
H2-antagonist safe in pregnancy
PPI can be used but less known about effects in pregnancy so only if refractory case

15
Q

Why do you get constipation in pregnancy?

A

Progesterone - relaxant effect on smooth muscle of GI
Immobility
Dehydration - vomiting
Iron supplements

16
Q

Why do you get reflux in pregnancy?

A

Progesterone causes relaxation of the oesophageal sphincter

Later in pregnancy the gravid uterus puts pressure on the stomach