Overview At least 80% of women experience nausea and vomiting. Hyperemesis gravidarum is a condition of pregnancy characterized by intractable nausea, vomiting and dehydration and is estimated to affect ~2% of pregnancy women.
| Definition Morning sickness: early pregnancy nausea/vomiting usually disappearing after the first trimester Hyperemesis Gravidarum: Unlike morning sickness, hyperemesis gravidarum is a complication of pregnancy characterised by persistent uncontrollable nausea and vomiting that persist beyond the 20th week of pregnancy |
Signs and Symptoms
| Remember that hyperemesis gravidarum tends to begin somewhat earlier in the pregnancy and last significant;y longer than morning sickness. 10-20% of cases may last the entire pregnancy. |
Investigations
Diagnosis is considered by exclusion of the other things
| Think In the second half of pregnancy, nausea nad vomiting may be symptom of labour, preeclampsia, gallstones, appendicitis or acute fatty liver of pregnancy |
Management
Complications
Overview Defined as any degree of glucose intolerance with onset or first recognition during pregnancy
More info on Gestational Diabetes
| Definition Diabetes Mellitus: metabolic condition characterised by chronic hyperglycaemia as a result of defective insulin secretion, insulin action or both Gestational Diabetes: Defined as any degree of glucose intolerance with onset or first recognition during pregnancy Pre-gestational Diabetes: Diabetes diagnosed BEFORE pregnancy |
Risk factors
Diagnosis
| Remember Screen for GDM in high risk patients at 24 and 28 weeks gestation |
Management
Timing of delivery (Parturition)
Why treat GDM?
Overview Pregnancy is a hypercoagulable state that returns to normal 4 week after delivery. The hypercoagulability is particularly relevant at delivery, with placental seperation. Pregnancy is a risk factor for venous thromboembolism because of:
Epidemiology
Risk Factors for VTE postpartum
Thromboembolism in Pregnancy
Signs and Symptom
Diagnosis of acute DVT/PE
Prevention (Prophylaxis)
Mechanical methods
Pharmacological
Overview Anaemia is the commonest medical disorder in pregnancy. It is responsible for significant high maternal and fetal mortality, more so in developing nations.
Pathophysiology
| Definition Anaemia: Anaemia in Pregnancy: Haemoglobin <10.5g/dL Post Partum anaemia: |
Aetiology
Signs and Symptoms (also depends on the type of anaemia)
Investigations
Management
| High Risk of Fetal Neural Tube Defect |
| On anticonvulsants |
| Previous child with neural tube defect |
| Folate deficiency |
| Diabetes |
| BMI >35 |
| Sickle cell disease |
Complications
Normal Pregnancy
Hypertension in Pregnancy
Classification
Chronic hypertension
Gestational Hypertension
Preeclampsia superimposed on chronic hypertension
In women with pre-existing proteinuria, diagnosis is difficult
| Watch Video Preeclampsia - Overview |
Clinical Presentation
Clinical Examination
| Think Oedema is not used for diagnosing Pre-eclampsia as this can be normal in pregnancy |
Diagnosis Hypertension >20 weeks + one of more of
Renal involvement
Neurological involvement
Risk Factors
| Side note Smoking is said to be a protective factor. Smoking is also protective against Ulcerative colitis and Parkinson's Disease. |
Pathophysiology
Investigation Help distinguish pre-eclapmsia from chronic hypertension and gestational hypertension and to assess extent of condition.
Management
| Indications for Delivery |
| Progressive Maternal organ dysfunction |
| Inability to control Blood pressure |
| Fetal well-being concerns. |
| Remember ACE inhibitors and Angiotensin Receptor blockers are teratogenics and should be avoided. Diuretics are generally avoided in Pre-eclampsia . |
Complication
If Eclampsia
| CAUSES OF VAGINAL BLEEDING IN PREGNANCY | ||
| 1st Trimester | 2nd Trimester | 3rd Trimester |
| Miscarriage | Miscarriage | Pregnancy "Show" |
| Trophoblastic disease | Trophoblastic disease | Vasa praevia |
| Ectopic Pregnancy | Abruptio placentae | Abruptio placentae |
| Placenta praevia | Placenta praevia | |
| Remember: Other non-pregnancy related include infection, vaginal ulcers, vaginal inflammation, cervical erosions, cervical polyps, coagulation disorders, trauma | ||
| Side note Miscarriage is common, occurring in at least 15-20% of pregnancies |
For more information on PV bleeding in Pregnancy
Overview Antepartum haemorrhage is per vaginal bleeding during/associated with pregnancy after 20 weeks gestation. Antepartum haemorrhage is usually associated with the placenta.
| Definition Antepartum Haemorrhage: Any bleeding from the genital tract after the 20 th week of pregnancy and before the onset of labour Placenta Praevia: Low-lying placenta – inserts wholly or partially into the lower uterine segment and can cover the internal os Placental Abruption: The premature separation of a normally sited placenta from the uterus Vasa Praevia: Rare condition in which the umbilical vessels, unsupported by either the umbilical cord or placental tissue, traverse the fetal membranes of the lower segment above the cervix. Postpartum Haemorrhage: a blood loss exceeding 500ml after delivery of the infant. It is divided into Primary (<24hours of delivery) or Secondary (>24hours - 6weeks) |
Aetiology
| Remember Never perform a vaginal examination in presence of PV bleeding without first excluding a placenta praevia. |
| Side note Women with an placental abruption will usually present in pain with a tense uterus. 70% of placental abruption occurs in low-risk pregnancies |
Severity
| Risk Factors |
| Abnormal placental insertion |
| Vasa praevia |
| Abnormal cord insertion into the placenta |
| Trauma |
| Substance use |
| Hypertension |
| Past history of APH |
| Multiple pregnancy |
| High parity |
| Polyhydramnios |
| Uterine anomalies or tumours |
| Side note 60% of women who experience an antepartum haemorrhage have no identified risk factors |
Clinical Presentation
Clinical Examination
| Remember Never do a digital vaginal examination until ultrasound has confirmed it is not placenta Pravia |
Investigations
Management Either active or expectant management
Maternal Complications of Antepartum Haemorrhage
Foetal Complications of Antepartum Haemorrhage
