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OBST GYN 712 > Understanding Nausea and Vomiting in Pregnancy > Flashcards

Understanding Nausea and Vomiting in Pregnancy Flashcards

Explore key concepts about nausea and vomiting in pregnancy with these informative flashcards. (62 cards)

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1
Q

What is nausea and vomiting in pregnancy (NVP)?

A

Nausea and vomiting in pregnancy (NVP) is defined as nausea and/or vomiting which starts before 16 weeks of gestation and for which there is no other cause.

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2
Q

What percentage of women are affected by nausea and vomiting in pregnancy?

A

90% of women.

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3
Q

Why should the term ‘morning sickness’ be avoided?

A

‘Morning sickness’ should be avoided because NVP can occur at any time during the day and it trivializes the condition.

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4
Q

What is hyperemesis gravidarum (HG)?

A

HG is a severe form of nausea and vomiting in pregnancy that can cause an inability to eat and drink normally and limits daily activities.

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5
Q

What is the PUQE score used for?

A

The PUQE score is used to assess the severity of nausea and vomiting in pregnancy.

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6
Q

What does a PUQE score of 6 indicate?

A

Mild nausea and vomiting in pregnancy.

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7
Q

What are the first-line antiemetics for nausea and vomiting in pregnancy?

A
  • Doxylamine and pyridoxine
  • Cyclizine
  • Prochlorperazine
  • Promethazine
  • Chlorpromazine
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8
Q

What is the recommendation for women with mild NVP?

A

Women with mild NVP should be managed in the community with anti-emetics.

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9
Q

True or False: Metoclopramide is safe for use in pregnancy.

A

True.

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10
Q

What lifestyle changes can help manage dyspepsia (intergestion) during pregnancy?

A
  • Sitting up after eating
  • Sleeping in a propped-up position
  • Eating small frequent meals
  • Reducing gastric irritants
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11
Q

What is the main treatment for constipation in pregnancy?

A

High fluid intake, high-fibre foods, and exercise.

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12
Q

What common symptom may many women experience as pregnancy progresses?

A

Breathlessness due to the growing uterus pushing the diaphragm.

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13
Q

What is a common cause of fatigue in early pregnancy?

A

Hormonal changes and the physical demands of pregnancy.

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14
Q

What is pruritus and how common is it in pregnancy?

A

Pruritus is generalized itching that affects as many as 23% of pregnant women.

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15
Q

What are some treatments for haemorrhoids in pregnancy?

A
  • Diet modification
  • Topical soothing preparations
  • Surgery (rarely considered)
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16
Q

What condition describes pregnancy-associated pain and dysfunction of the symphysis pubis joint?

A

Pelvic girdle pain (PGP).

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17
Q

What percentage of pregnant women may experience pelvic girdle pain?

A

14-22%.

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18
Q

What are common symptoms of carpal tunnel syndrome in pregnancy?

A

Hand symptoms such as numbness and tingling.

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19
Q

Fill in the blank: Leg cramps are usually worse at _______.

A

night.

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20
Q

What is the recommended treatment for leg cramps in pregnancy?

A

Massaging the affected leg and elevating the foot of the bed.

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21
Q

What should be monitored in pregnant women with unexplained itching without a rash?

A

Liver function tests (LFTs).

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22
Q

What is the mainstay of treatment for pruritus in pregnancy?

A

Emollients.

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23
Q

What should be considered in women with severe nausea and vomiting associated with weight loss?

A

Inpatient care.

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24
Q

What is the significance of checking for obstetric cholestasis in pregnant women with itching?

A

It may cause fetal complications.

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25
What common gastrointestinal issue affects up to 40% of pregnant women?
Constipation.
26
What should be excluded in women presenting with unexplained vaginal bleeding after 13 weeks?
Refer to secondary care for review.
27
28
What is the purpose of preconceptual care?
To help patients understand health issues affecting conception and pregnancy, encourage active preparation for pregnancy, optimize management of chronic health problems, and identify couples at increased risk of genetic malformations. ## Footnote Preconceptual care aims to provide couples with the knowledge and resources to make informed decisions regarding pregnancy.
29
What is the significance of folic acid supplementation before and during early pregnancy?
Folic acid supplementation prevents the majority of cases of neural tube defects (NTDs). Women should take at least 400 micrograms/day while trying to conceive and for at least the first three months of pregnancy. ## Footnote Women at high risk for NTDs should take a higher dose of 5 mg/day until 12 weeks of pregnancy.
30
When is the first antenatal visit critical in relation to organogenesis?
By the first antenatal visit, organogenesis is well underway, making interventions to avoid malformations potentially too late. ## Footnote This emphasizes the importance of preconceptual care.
31
What factors should be assessed for preconceptual care in women?
Factors include: * Timing of planned pregnancy * Folic acid use * Smear history * Smoking history * Alcohol intake * Weight * Medication history * Risks of hazardous exposure * Rubella immune status * History of chickenpox or shingles * Risk of hepatitis B * Risk of HIV infection * History of miscarriage * Risk of chromosomal abnormalities * Chronic health problems ## Footnote Each woman requires individual assessment to offer appropriate advice.
32
What is the optimal time between deliveries for pregnancy spacing?
The optimal time between delivery and the start of the next pregnancy is 12-18 months. ## Footnote Short interpregnancy intervals are risk factors for complications such as uterine rupture.
33
True or False: Smoking in pregnancy is associated with adverse effects.
True. ## Footnote Adverse effects include intrauterine growth restriction, miscarriage, stillbirth, and premature delivery.
34
What are the risks associated with high levels of alcohol consumption during pregnancy?
High levels of alcohol consumption can result in fetal alcohol syndrome (FAS), which includes growth restriction, intellectual impairment, facial anomalies, and behavioral problems. ## Footnote Women are advised to avoid alcohol completely, especially during the first trimester.
35
What advice is given regarding body weight before pregnancy?
Women who are overweight or obese should lose weight before becoming pregnant to reduce risks of NTD, preterm delivery, gestational diabetes, and other complications. ## Footnote Underweight women may also face difficulties in conceiving and risk complications.
36
Fill in the blank: Women planning a pregnancy should avoid _______ due to the risk of miscarriage.
alcohol. ## Footnote There is no clear safe level of alcohol consumption during pregnancy.
37
What is the recommended daily intake of vitamin D for pregnant women?
10 micrograms/day. ## Footnote This is important for maintaining adequate vitamin D stores during pregnancy and breastfeeding.
38
What lifestyle factors should men consider in relation to preconceptual care?
Men should consider their lifestyle and health, as they can also affect pregnancy outcomes. ## Footnote Pre-conception counselling is relevant for both partners.
39
True or False: Herbal preparations are well-studied for safety during pregnancy.
False. ## Footnote There is little data on the safety of herbal preparations in pregnancy.
40
What is the recommended approach for women with a history of illicit drug use planning a pregnancy?
Advise to stop using illicit drugs and offer referral for support if needed. ## Footnote A multidisciplinary approach is essential.
41
What are the risks associated with varicella in pregnancy?
Congenital fetal varicella syndrome, which can cause limb hypoplasia, microcephaly, cataracts, and intrauterine growth restriction. ## Footnote Infection during the first 20 weeks can have severe outcomes for the fetus.
42
What dietary precautions should women take to avoid foodborne illness during pregnancy?
Avoid: * Uncooked or undercooked meat, fish, and eggs * Pâté * Unpasteurized milk * Raw shellfish * Unripened soft cheeses * Unwashed fruits and vegetables ## Footnote These foods can pose risks such as toxoplasmosis, salmonella, and listeriosis.
43
What is the association between caffeine consumption and pregnancy outcomes?
Caffeine may cause intrauterine growth restriction and miscarriage; recommended limit is no more than 200mg daily. ## Footnote Women should be cautious of substituting caffeinated drinks with herbal preparations, which may have unknown effects.
44
What are the recommendations regarding exercise for women planning a pregnancy?
Women who exercise regularly should continue, while inactive women should start a gentle exercise program. ## Footnote Certain activities, such as contact sports, should be avoided during pregnancy.
45
Who should receive varicella vaccines?
Healthy, susceptible, close household contacts of immunocompromised patients and patients due to start immunosuppressive treatment if time allows for two doses.
46
Who must not receive varicella vaccines?
Pregnant women.
47
What did the Joint Committee on Vaccination and Immunisation recommend in November 2023?
Universal varicella vaccination should be offered to children.
48
What is the risk of Down's syndrome related to maternal age?
Increases sharply with maternal age: 1 in 1,500 at 20 years, 1 in 800 at 30 years, 1 in 270 at 35 years, 1 in 100 at 40 years, 1 in 50 or more at over 45 years.
49
What should be done for women with three or more consecutive miscarriages?
Refer them to a gynaecologist for investigation.
50
What is essential for women with asthma during pregnancy?
High level of control and advised use of peak flow meters and inhalers.
51
What is the recommended blood glucose control target for women with diabetes during pregnancy?
HbA1c should be kept below 48 mmol/mol.
52
What should women with type 2 diabetes consider before pregnancy?
Metformin may be used as an adjunct or alternative to insulin, but other oral hypoglycaemics should be discontinued.
53
List the drugs of choice for managing chronic hypertension in pregnancy.
* Methyldopa * Beta-blockers (labetalol, propranolol, metoprolol) * Nifedipine
54
What is the contraindication for women with congenital heart disease regarding pregnancy?
Statins are contra-indicated and should be stopped prior to conception.
55
What is the recommendation for women on antiepileptic drugs (AEDs) who are planning pregnancy?
Referral to a specialist centre is required.
56
What is the advice for women with thyroid disease who are considering pregnancy?
Check TFTs, commence treatment for subclinical hypothyroidism, and review those on hypothyroid treatment for optimum control.
57
What should women with renal impairment do if planning a pregnancy?
Refer to a specialist for advice.
58
What should women with rheumatoid arthritis do before considering pregnancy?
Refer to a rheumatologist to review their medication.
59
What is the risk associated with warfarin during pregnancy?
Warfarin is teratogenic and must be stopped or replaced by heparin.
60
What should be the approach for women with a history of severe depression planning pregnancy?
Seek specialist advice regarding medication.
61
What should women with bipolar disorder consider before pregnancy?
Refer to a specialist for assessment and medication review.
62
What conditions should be screened for in women at high risk of genetic disorders?
* Huntington's disease * Neurofibromatosis * Tuberous sclerosis * Marfan's syndrome * Adult polycystic disease * Achondroplasia * Cystic fibrosis * Tay-Sachs disease * Gaucher's disease * Friedreich's ataxia * Congenital adrenal hyperplasia * Spinal muscular atrophy * Duchenne muscular dystrophy * Fragile X syndrome * Haemophilias A and B * Glucose-6-phosphate dehydrogenase deficiency

OBST GYN 712 (18 decks)

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