38 Questions
What may be indicated by symptoms such as tenesmus, mucus, blood mixed with stool and back passage discomfort?
Rectal carcinoma
What is thought to be the cause of varicose veins in pregnancy?
All of the above
What is a potential complication of a large superficial varicose vein?
Bleeding profusely if traumatized
What is a potential underlying cause of severe oedema?
All of the above
What is the best way to deal with oedema?
Frequent periods of rest with leg elevation
What is a symptom that may be aggravated by hot weather?
Oedema
What is the percentage of women who have a retroverted uterus?
15%
What is the main complication of fibroids in pregnancy?
Red degeneration
What may cause considerable bleeding during delivery?
All of the above
What is the treatment for red fibroid degeneration?
Potent analgesics and intravenous fluids
What is a rare complication of varicose veins?
Thrombophlebitis
What is the differential diagnosis for red fibroid degeneration?
Acute appendicitis, pyelonephritis, and placental abruption
What is the location of intramural fibroids?
Within the uterine muscle
What is the effect of a large fibroid at the cervix?
It can prevent descent of the presenting part and obstruct vaginal delivery
What happens to a retroverted uterus in pregnancy?
It flips forward and fills the abdominal cavity
What can a subserous pedunculated fibroid do?
Tort in the same way as a large ovarian cyst
What is a possible complication of a retroverted uterus in pregnancy?
Urinary retention
At what gestation is urinary retention likely to occur in a retroverted uterus?
12-14 weeks
What is the treatment for urinary retention in a retroverted uterus?
Catheterization
What is the embryological origin of uterine anomalies?
Fusion of Müllerian ducts
What is a complication of a bicornuate uterus?
Preterm labour
What is the most common type of ovarian cyst in pregnancy?
Serous cyst
What is the indication for surgical intervention in a pregnant woman with an ovarian cyst?
Size > 8 cm
What is a potential complication of a large ovarian cyst in pregnancy?
All of the above
What is the primary reason for the difficulty in dealing with cervical abnormalities in pregnancy?
The cervix is harder to visualize during colposcopy
What is the significance of family history in the assessment of ovarian cysts?
It is crucial in determining the risk of ovarian or breast malignancy
What is the primary reason for performing surgery in late second and third trimester of pregnancy through a midline or paramedian incision?
Easier access to the ovary
Which of the following is NOT a symptom of cervical carcinoma?
Fatigue
Why is it challenging to diagnose abdominal pain in pregnancy?
All of the above
What is the primary concern in managing cervical carcinoma in pregnancy?
Balancing the risk of treatment to the mother and fetus
What is the purpose of tumour markers in the assessment of ovarian cysts?
To provide additional information, although of limited value in pregnancy
Why is a low transverse suprapubic incision not suitable for ovarian cyst surgery in late pregnancy?
It does not provide adequate access to the ovary
What is the potential risk of delayed diagnosis of abdominal pain in pregnancy?
Inadequate treatment of potentially serious conditions
Which of the following is not an obstetric condition that may cause abdominal pain in early pregnancy?
Acute pancreatitis
What is the name of the condition that may cause abdominal pain in pregnancy due to the abnormal breakdown of hemoglobin in sickle cell disease?
Abdominal crisis
Which of the following is a medical condition that may cause abdominal pain in pregnancy?
Malaria
What is the name of the condition that may cause abdominal pain in pregnancy due to the breakdown of fatty acids in diabetic ketoacidosis?
Diabetic ketoacidosis
Which of the following is a gastrointestinal disorder that may cause abdominal pain in pregnancy?
Acute gastroenteritis
Study Notes
Symptoms to Be Aware Of
- Warning symptoms of rectal carcinoma: tenesmus, mucus, blood mixed with stool, and back passage discomfort
- Importance of rectal digital examination if these symptoms are present
Varicose Veins
- Causes: relaxant effect of progesterone on vascular smooth muscle and dependent venous stasis caused by the weight of the pregnant uterus on the inferior vena cava (IVC)
- Symptoms: worsened by standing for prolonged periods
- Treatment: support stockings, avoidance of standing for prolonged periods, and simple analgesia
- Complications: thrombophlebitis, bleeding if traumatized
Oedema
- Common in approximately 80% of all pregnancies
- Causes: generalized soft-tissue swelling and increased capillary permeability
- Symptoms: fingers, toes, and ankles are usually worst affected, worsened by hot weather
- Treatment: frequent periods of rest with leg elevation, support stockings if necessary
- Important to rule out pre-eclampsia and underlying cardiac or renal impairment
Other Common "Minor" Disorders
- Itching
- Urinary incontinence
- Nose-bleeds
- Thrush (vaginal candidiasis)
- Headache
- Fainting
- Breast soreness
- Tiredness
- Altered taste sensation
- Insomnia
- Leg cramps
- Striae gravidarum and chloasma
Problems Due to Abnormalities of the Pelvic Organs
Fibroids (Leiomyomata)
- Description: compact masses of smooth muscle in the uterus
- Types: submucous, intramural, and subserous
- Complications: enlargement in pregnancy, obstruction of vaginal delivery, and red degeneration
- Symptoms of red degeneration: acute pain, tenderness, and frequent vomiting
- Treatment of red degeneration: potent analgesics and intravenous fluids in hospital
Other Abnormalities
- Retroversion of the uterus: 15% of women, may cause retention of urine
- Congenital uterine anomalies: abnormalities of fusion of Müllerian ducts, may cause miscarriage, preterm labour, and other complications
- Ovarian cysts in pregnancy: common, often asymptomatic, but may cause torsion, haemorrhage, or rupture
- Cervical cancer: difficult to diagnose in pregnancy, may require termination of pregnancy for treatment
Abdominal Pain in Pregnancy
- Distinguishing pathological from physiological pain is challenging
- Causes: obstetric conditions, pregnancy-related conditions, medical causes, and others
- Importance of early diagnosis and treatment to avoid serious consequences
This quiz covers the symptoms and importance of rectal digital examination for rectal carcinoma, as well as the causes and treatment of varicose veins in pregnant women.
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