Abstract
AKT Answer Relating to Bleeding in Early Pregnancy
Answer 2 — Advise normal activity. There is no evidence that bed rest and avoidance of sex (advised yesteryear) influence outcome. Anti-D is only required for ‘threatened’ miscarriage if the bleeding is repeated and heavy or associated with abdominal pain. Vaginal examination is not going to influence management.
AKT Answer Relating to Hypertension in Pregnancy
Answer 4. A repeat pre-eclampsia assessment should be carried out within a week. Ideally, the proteinuria should be quantified with an early morning protein creatinine ratio. If the blood pressure between 90 and 100 diastolic with no symptoms, the patient should be assessed within 48 hours. Small cuffs tend to overestimate blood pressure. Guidelines vary on the frequency of blood pressure assessment. Pre-eclampsia community guideline suggests measurement every 3 weeks from 24 to 32 weeks and every fortnight from 32 weeks as a routine. Blood pressure (as in the non-pregnant patient) should be measured to the point at which sounds disappear.
AKT Answer Relating to Post-Partum Haemorrhage
Answer 4 — Intravenous saline. This patient requires volume replacement as indicated by her tachycardia. The midwife could attempt to rub up a contraction and exert bimanual uterine pressure.
AKT Answer Relating to Gastro-Intestinal Haemorrhage
Answer 4 — Pulse rate. Typically the first sign of decompensation in an otherwise fit patient is a tachycardia (rate > 100 beats per minute). An otherwise fit patient could lose up to 15% of their blood volume before this becomes apparent. Blood pressure is preserved until much later — but an earlier sign will be a postural drop. In this context (in primary care), blood tests are not of immediate relevance.