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UROGENITAL > 13. Pregnancy, Parturition and Delivery > Flashcards

13. Pregnancy, Parturition and Delivery Flashcards

1
Q

what does PRIMIPAROUS/PRIMIP mean

A

FIRST pregnancy

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2
Q

what does MULTIPAROUS/MULTIP mean

A

SUBSEQUENT pregnancy (not first)

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3
Q

what does GRAVIDITY refer to

A

the NUMBER OF TIMES been PREGNANT

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4
Q

what does PARITY refer to

A

the NUMBER of PREGNANCIES BEYOND 20 WEEKS

(could have miscarried,termination)

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5
Q

eg what would G3P1 mean

A

Gravidity 3 - pregnant for 3rd time
Parity - 1st time pregnant beyond 20 weeks

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6
Q

times for the 3 TRIMESTERS

A

1st trimester: UPTO 12 weeks

2nd trimester: 12-24 WEEKS

3rd trimester: OVER 24 WEEKS

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7
Q

when is referred to as TERM

A

37-40 WEEKS

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8
Q

when is PRETERM

A

BEFORE 37 WEEKS

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9
Q

when is POST TERM

A

AFTER 40 WEEKS

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10
Q

NHS aims to have all women delivered by … weeks

A

42 WEEKS

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11
Q

how to calculate an ESTIMATED DUE DATE (EDD)

A

LMP: date from LAST MENSTRUAL PERIOD
NOT conception

can subtract 3 months from LMP + 7 days

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12
Q

MORE ACCURATE way of calculating ESTIMATED DUE DATE

A

CRL - CROWN RUMP LENGTH
(from viability scan)

reliable +/- 7 days

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13
Q

other forms of calculating EDD

A
  • TIMED COITUS (used for conception, can be very reliable)
  • EMBRYO TRANSFER (IVF)
    usually performed on day 3 or 5 of blastocyst development
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14
Q

approx how many women will deliver on DUE DATE

A

5%

(7-12% deliver preterm
10% beyond DD)

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15
Q

what is DUE DATE useful for

A
  • REGULARISING PREGNANCY
  • GUIDING INTERVENTION
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16
Q

MORNING SICKNESS is related to..

A

hCG LEVELS (PEAK)

nausea and vomiting common in 1st trimester
(50% or more women)

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17
Q

what is Hyperemesis Gravidarum

A

variant of MORNING SICKNESS

extreme nausea and vomiting

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18
Q

PHYSIOLOGICAL CHANGES of PREGNANCY on RESPIRATORY:

A
  • INCREASED TIDAL VOLUME
  • INCREASED RESPIRATORY RATE
  • MILD RESPIRATORY ALKALOSIS (from high CO2)
  • REDUCED MAX INSPIRATORY VOLUME in 3rd Trimester
    (lead to hypoxia - low oxygen levels)
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19
Q

PHYSIOLOGICAL CHANGES of PREGNANCY on GASTROINTESTINAL:

A
  • DELAYED GUT MOTILITY
  • CONSTIPATION
  • INCREASED ALKALINE PHOSPHATASE
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20
Q

PHYSIOLOGICAL CHANGES of PREGNANCY on
RENAL:

A
  • 60% INCREASED BLOOD FLOW
  • 50% INCREASED GFR
  • LOW CREATININE & UREA
  • minimal GLYCOSURIA is normal (glucose in urine, due to increased filtration and so less reabsorption)
  • minimal PROTEINURIA, LESS than 30mg is NORMAL
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21
Q

PHYSIOLOGICAL CHANGES of PREGNANCY on SKELETAL:

A
  • OSTEOPENIA (weaker bones, less proteins and minerals)
  • INCREASED OSTEOBLAST ACTIVITY
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22
Q

PHYSIOLOGICAL CHANGES of PREGNANCY on
CARDIAC:

A

(early effect)
- INCREASED HEART RATE
- INCREASED STROKE VOLUME
- INCREASED CARDIAC OUTPUT

-INCREASED PLASMA VOLUME (by 15%)
- INCREASED TOTAL BLOOD VOLUME (by 1.5L)

  • OVER 1L/min to uterus and placenta
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23
Q

PHYSIOLOGICAL CHANGES of PREGNANCY on
BLOOD:

A
  • RED CELL MASS INCREASES
    but FALL in HAEMOGLOBIN due to PERIPHERAL VASODILATION
  • FALL in Hct (HEMATOCRIT - percentage red blood cells), RCC (RED CELL COUNT)
    Hb (HAEMOGLOBIN)
  • IRON DEFICIENCY is common
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24
Q

HORMONAL CHANGES of pregnancy:

A
  • INCREASED PROGESTERONE
  • INCREASED OESTROGEN
  • RELAXIN
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25
Q

why is high PROGESTERONE important in PREGNANCY

A
  • PROMOTES UTERINE QUIESCENCE (inactivity/ relaxation)
  • THICKENS CERVICAL MUCUS
26
Q

why is high OESTROGEN important in PREGNANCY

A
  • CERVICAL DEVELOPMENT (cervical ectropian)
  • THICKENS VAGINAL EPITHELIUM and INCREASED vaginal DISCHARGE (acidic)
  • MYOMETRIAL HYPERTROPHY (increase muscle size)
  • INCREASES PROSTAGLANDIN PRODUCTION and OXYTOCIN RECEPTORS
  • INCREASE in MYOMETRIAL GAP JUNCTIONS for ELECTRICAL CONDUCTANCE
27
Q

role of RELAXIN in PREGNANCY

A
  • SOFTENS LIGAMENTS and JOINT INSTABILITY
    (especially Pubic Symphysis)
  • VASODILATOR
28
Q

what is their RISK of during PREGANCY due to HIGH OESTROGEN and PELVIC MASS

A

THROMBOSIS (blood clots block veins/arteries)

(addition 4-6x increase, 22x higher postpartum)

Treatment:
can be given Prophylactic LMWH (low molacular weight Heparin) (does not cross placenta so safe)

Investigations:
- D-dimer
- USS leg Doppler
- VQ
- CT

29
Q

THROMBOSIS RISK during PREGNANCY is due to..

A
  • HIGH OESTROGEN
  • PELVIC MASS
30
Q

TREATMENT for THROMBOSIS (safe in pregnancy)

A

PROPHYLACTIC LMWH
(HEPARIN)

does not cross placenta

31
Q

when LABOUR STARTS what happens

A
  • REGULAR PAINFUL UTERINE CONTRACTIONS (more than 1 every 10 minutes)
  • DESCENT of PRESENTING part of FETUS
  • CERVICAL DILATION and EFFACEMENT (thins out)
  • RELEASE of MUCUS PLUG
32
Q

what causes the smooth muscle CONTRACTIONS

A

OXYTOCIN RECEPTOR for intracellular promotion of CALCIUM CHANNEL

  • CALCIUM INFLUX and intracellular release causes smooth muscle contraction

(Repeated and prolonged exposure of myometrium to oxytocin may lead to reduced response)

33
Q

what are critical for smooth muscle CONTRACTIONS in labour

A

OXYTOCIN RECEPTORS

  • CALCIUM INFLUX
34
Q

what is the 1st STAGE of LABOUR

A

from ONSET of labour to FULL DILATATION (10cm)

  • LATENT PHASE - up to 3cm
  • ACTICE PHASE - from 3cm to 10cm
35
Q

what is 2nd STAGE of LABOUR

A

from FULL DILATATION to DELIVERY of fetus

36
Q

what is 3rd STAGE of LABOUR

A

from BIRTH of fetus to DELIVERY of PLACENTA

37
Q

which STAGE of LABOUR is usually LONGER

A

1ST
average 8 hours (usually less than 18)

38
Q

SUBSEQUENT LABOURS average length

A

5 hour active 1st stage
usually less than 12 hours

39
Q

ACTIVE PHASE average length in LABOUR

A

Primip: 1cm every 2 hours

Multip: >1cm every 2 hours

40
Q

what is CERVICAL EFFACEMENT

A

softness
- INFLUX of WATER into cervix to DISRUPT COLLAGEN FIBRES

thins

41
Q

what is DILATION

A

OPENING of the CERVIX

42
Q

what is checked in VAGINAL/CERVICAL ASSESSMENT

A
  • EFFACEMENT
  • DILATION
  • POSITION of FETAL HEAD
43
Q

What is the Quantitative Tool from Cervical ASSESSMENT used to assess favourability for labour (used for induction of labour)

A

BISHOP SCORE

(More than 6 then favourable for labour)

44
Q

what happens to FETUS during LABOUR (steps)

A
  1. ENGAGEMENT
    Presenting part enters PELVIS
  2. DESCENT
    presenting part moves down BIRTH CANAL
  3. FLEXION
    of fetal HEAD to NARROW DIAMETER
  4. INTERNAL ROTATION
    HEAD rotates to direct OA (OCCIPUT ANTERIOR)
  5. EXTENSION
    CROWNING
  6. EXTERNAL ROTATION
    to allow shoulders to pass through pelvic inlet
45
Q

BIRTH consists of 3:

A

POWER
(uterine, anterior abdominal wall and diaphragm muscle contractions)
PASSAGE
(birth canal, pelvic inlet, pelvic cavity, pelvic outlet)
PASSENGER
(fetus, presentation and position)

46
Q

how long is the THIRD STAGE of LABOUR usually (from delivery of baby to delivery of Placenta)

A

usually 30 MINUTES

47
Q

During pregnancy and After BIRTH what does OESTROGEN PROMOTE

A

FAT DEPOSITION and development of GLANDULAR DUCTS in BREAST DEVELOPMENT

48
Q

during pregnancy and after birth what do PROGESTERONE and hPL INCREASE for BREAST DEVELOPMENT

A

ALVEOLI in BREASTS

49
Q

what hormone INCREASES in PREGNANCY and promotes breast development but is ANTAGONISED by OESTROGEN

A

PROLACTIN

50
Q

PROLACTIN is ANTAGONISED (inhibition) by..

A

OESTROGEN

51
Q

what happens to OESTROGEN levels at BIRTH

A

RAPID FALL
(removes inhibition to Prolactin)

52
Q

what does SUCKLING on breast stimulate release of

A

PROLACTIN & OXYTOCIN

53
Q

what does PROLACTIN PROMOTE

A

BREAST ENGORGEMENT
- ALVEOLI FILL with milk

54
Q

what does OXYTOCIN cause in breasts

A

MILK EJECTION

55
Q

how does OXYTOCIN cause MILK EJECTION

A

causes CONTRACTION of MYOEPITHELIAL CELLS AROUND ALVEOLI

56
Q

BENEFITS of BREAST FEEDING

A
  • BONDING
  • good NUTRITION
  • PASSIVE IMMUNTIY (less asthma and infections)
  • LESS DIABETES
  • LESS SIDS
57
Q

what do you get BEFORE BREAST MILK comes in

A

COLOSTRUM
- thick
- yellow
- rich in Immunoglobulins

58
Q

POSTPARTUM RISKS

A
  • THROMBOSIS
  • INFECTION
  • CONTRACEPTION (periods usually commence after 6 weeks)
  • BLEEDING
  • VAGINAL SORENESS
  • BLADDER weakness
59
Q

PSYCHOLOGICAL WELLBEING after birth

A
  • immediate feelings
  • Baby Blues (3-10 days after)
  • POSTNATAL DEPRESSION
  • PUERPERAL PSYCHOSIS
60
Q

PSYCHOLOGICAL WELLBEING after birth

A
  • immediate feelings
  • Baby Blues (3-10 days after)
  • POSTNATAL DEPRESSION
  • PUERPERAL PSYCHOSIS
61
Q

when do PERIODS usually RECOMMENCE after birth

A

after 6 WEEKS

62
Q

during 3rd stage labour (birth to placenta delivery) active management CORD TRACTION REDUCES RISK of..

A

Haemorrhage

UROGENITAL (19 decks)

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