Antenatal
Complaints
Nausea and
vomiting in
pregnancy
Quiz
Nausea and vomiting in
pregnancy
1. Symptoms manifest before 9 weeks of gestation in almost all affected women. [T/F]
2. Nausea and vomiting most commonly occurs only in the morning [T/F]
3. Symptoms usually resolve by how many gestational weeks?
4. How many associated factors can you name for the development of nausea and vomiting during pregnancy?
Nausea and vomiting in
pregnancy
6. What is hyperemesis gravidarum?
7. What proportion of pregnancies are affected by hyperemesis gravidarum?
8. What are the maternal potential complications of nausea and vomiting in pregnancy?
9. Are there any recognised foetal complications?
Management- conservative
Reassurance Eat like a bird Ginger.
Acupressure.
Avoiding any foods or smells that trigger symptoms Avoiding drinking cold, tart, or sweet beverages
Rest
Family support
Management- medical
First Line: Antihistamines – Promethazine & Cyclizine
Second Line: Phenothiazines – Prochlorperazine (Stemetil)
Third Line: Dopamine antagonists – Metoclopramide & Domperidone
Thiamine supplementation with thiamine hydrochloride tablets 50mg TDS
Management- admission
Reassess 24 hours after starting anti-emetics Consider referral if:
- symptoms are persistently severe -signs of clinical dehydration
-urinary ketones >2+ -weight loss
Headache in
pregnancy
Doctor scenario
You are a newly qualified GP at a Birmingham City Centre walk in centre.
Your next patient is Akello Okafor, a 41 year old lady. When boking in for the appointment she reported that she had a headache, was currently pregnant and has no other medical problems. This is the only information you have available at present.
Itching in
pregnancy
Obstetric cholestasis
• ‘Pruritus in the absence of a skin rash with abnormal liver function
tests (LFTs),neither of which has an alternative cause and both of which resolve after birth’2
•Itching classically of the palms and soles, often worse at night. •Evidence of pale stool, dark urine and jaundice should be sought. •Important foetal risks including spontaneous preterm birth,
iatrogenic preterm birth and foetal death.
Pruritus: other causes
Eczema
Polymorphic eruption of pregnancy Pemphigoid
Abdominal pain
and PVB in
pregnancy
Questions to ask
SOCRATES- within this enquire specifically about how frequently the pain is felt and whether it is associated with tightenings or
contractions.
Any PVB? If so, quantify.
Any SROM (a gush of fluid which soaks underwear and clothes then continues to trickle)
Bowel/ urinary symptoms
Case 1
32 year old primip, 37/40. Otherwise fit and well. Presents with lower abdominal pain. The pain started a couple of months ago and initially didn’t bother her too much but has been getting worse over the past few weeks and is making walking difficult. No PVB or SROM. No other symptoms.
O/E: observations within normal range. Abdomen soft and non-tender, uterus lax. Some tenderness over the symphysis pubis. Examination otherwise unremarkable.
1. Any thing else you’d ask/ like to know?
2. What are your differentials? What is the most likely differential and what what do you know about the condition?
Case 2
28 year old female, 25/40, para 2+1. Presents with crampy lower abdominal pain for the past 4 hours, getting worse. She looks
uncomfortable. Not settled with paracetamol. Feels like period pain. The patient is very concerned about the pain and asks if her baby is OK?
1. Anything else you’d ask/ like to know? 2. What are your differentials?
Case 3
You are called by the receptionist to say that your patient, a 32 year old primip, 34/40 has just walked into the surgery requesting to be seen urgently. She has constant severe abdominal pain for the last hour and is bleeding. She has not felt the baby move since this
morning.
1. Anything else you’d ask/ like to know? 2. (What are your differentials?)
Case 4
24 year old diabetic woman, 12/40 with her second pregnancy (previous C/S for failed induction of labour). Presents with mild
lower abdominal pain since yesterday. Associated with dysuria and urinary frequency.
1. Anything else you’d ask/ like to know? 2. What are your differentials?
Indications for aspirin in
pregnancy- NICE
Advise women at high risk of pre-eclampsia to take 75mg aspirin
OD from 12/40 pregnancy. This includes women with a history of the following:
hypertensive disease during a previous pregnancy chronic kidney disease
autoimmune disease such as systemic lupus erythematosis or antiphospholipid syndrome
Indications for aspirin in
pregnancy- NICE
Advise women with more than one moderate risk factor for
pre-eclampsia to take 75mg aspirin OD from 12/40. Moderate risk factors include:
first pregnancy
age 40 years or older
pregnancy interval of more than 10 years
body mass index (BMI) of 35 kg/m2 or more at first visit
Case 5
A 41 year old 21/40 primip presents with right sided abdominal
pain. The pain is constant and severe. She has tried co-codamol for the pain to no relief. Stools have been slightly looser today but
there is no PVB/ SROM. Good foetal movements.
O/E: HR 125, BP 110/72, RR 22, sats 99% OA. Tender RIF with guarding.
1. Anything else you’d ask/ like to know? 2. What are your differentials?
Decreased foetal
movements
References
1. http://cks.nice.org.uk/nauseavomiting-in-pregnancy
2. Green to guideline No. 43: Obstetric cholestasis, RCOG, 19/5/11 3. CG107 Hypertension in pregnancy, NICE, August 2010.
