2 Case One 18 yr old primip at 28/40 Feels generally unwell. Epigastric pain.Reduced fetal movements.What should you do?
3 Case One History Examination Investigation Diagnosis and plan? Uneventful pregnancy so far.Can’t remember any fetal movements todayExaminationTemp 36, HR 70, B/P 145/100Symphisis fundal height 26cm, FH heardInvestigationUrine dip, protein ++Diagnosis and plan?
4 Pre-eclampsiaMore common in young/old, primip, family history, new partner, multiple pregnancy, medical problems (renal disease, diabetes, antiphospholipid).SymptomsSevere headacheBlurred visionEpigastric painVomitingSudden swelling of face and hands
5 ManagementAlways remember to check b/p and urine dip in any pregnant woman who is vaguely unwell.Need same day referral to PDC if:-Diastolic >90 AND any proteinuria.Normal b/p with >2+ protein (for 1+ reassess in 1 week)No protein, but diastolic >100 (if >90, reassess in 24hrs and refer if stays up)
6 Secondary Care Management Control blood pressureMethyldopa or labetalol 1st line.Atenolol, ACEi, ARBs and diuretics all contraindicated.DeliverySolves the problem by removing placenta.If <34 weeks will try and give steroids 1st
7 Eclampsia Any seizure in pregnancy = eclampsia until proven otherwise. Need ABC and 999.Remember left lateral/recovery position.Give 5-10mg PR/IV diazepam.Secondary care use IV magnesium sulphate infusion.
8 Case Two 28 yr old, G2P1 at 29 weeks. 2 days of central abdominal pain Several episodes of vomiting.No diarrhoea.Fetal movements as normal.
9 Case Two Examination Diagnosis? Temp 37.7, B/P 110/60. HR 90. Uterus measures for dates and FH heard.Tender and guarding in right flank.Diagnosis?
10 Appendicitis 1/1000 pregnancies. Due to gravid uterus, appendix is displaced.Pain may be in flank, subcostal or periumbilical areas.Fetal mortality 5% and higher risk of perforation (15-20%).Low index of suspicion and refer.
11 Case Three35 yr old G4P3, 34/40.Gradual onset of suprapubic, groin and thigh pain.Getting worse over the last week.Worse on walking.Has a waddling gait.Cause?
12 Symphisis Pubis Dysfunction Due to ligament laxity.More common in multips and increased gestation.Usually settles within 6 mths of birth.TreatmentSimple analgesia (paracetamol).Physio – for brace, crutches and exercises.
13 Case Four 29yr old primip at 34 weeks. Smoker Sudden onset constant central abdo pain.No PV bleeding.Not felt fetal movements
14 Case Four Examination Diagnosis? B/P 100/50, HR 100, temp 35.5. General uterine tenderness.FH heard, rate 200.Diagnosis?
15 Placental Abruption Detachment of all or part of placenta. Risk factors – hypertension, smoking, cocaine, trauma.Presents with abdo pain and fetal distress.May not be vaginal bleeding in a concealed abruption (blood collects behind placenta).Need ABC, 999 and urgent delivery.
16 Case Five 22 yr old, primip at 32/40. Abdominal pain, urinary frequency.No loin pain or temps.No PV bleeding, baby moving well.Urine dip leuc ++, nitrites ++Diagnose UTI. Which abx?
17 UTI in Pregnancy Usually due to E-coli. Cefalexin 500mg bd or amoxicillin 250mg tds for 7 days.Avoid trimethoprim (esp 1st trimester) due to teratogenicity.Avoid nitrofurantoin (esp 3rd trimester) due to neonatal haemolysis.