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Lucy Knox - Year 2.5 > 235 - Pregnancy 2 > Flashcards

235 - Pregnancy 2 Flashcards

1
Q

What is pre-eclampsia?

A

A pregnancy specific multi-system disorder - diffuse vascular endothelial dysfunction with circulatory disturbances. Involving renal, hepatic, cardio, CNS and coagulation systems.

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2
Q

What are the key signs seen in pre-eclampsia?

A

Hypertension
Proteinurea
HEadaches
Oedema

+visual disterbances, epigastirc + RUG pain, nausea, vomiting.

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3
Q

What happens to the kidneys in pre-eclampsia?

A 
Reduced GFR
proteinurea
Increased serum creatinine
Raised uric acid
Oliguria
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4
Q

What is HELLP syndrome?

A

Serious complication of pre-eclapsia

Haemolysis, elevated liver enzymes, low platelet count

  • bleeding risk + DIC
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5
Q

What is eclampsia?

A

A tonic-clonic seizure - can be fatal to mother + child

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6
Q

What can happen to the placenta in pre-eclampsia?

A

Higher abruption risk
Placental ischaemia
IUFD - fetal death
IUGR - growth restriction

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7
Q

What are the differentials for high blood pressure in pregnancy?

A 
Pre-existing (due to chronic renal issues, essential high BP)
Pregnancy induced hypertension
Super-imposed pre-eclampsia
Transient hypertension
Pre-eclampsia
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8
Q

Why does pre-eclampsia occur?

A

Not fully known - some genetic risk (8x risk if sister had it, 4x risk if mum did)

? Issue with placentation in 1st half of preg .
? abnormal placentation + trophoblast invasion - poor implantation + under perfusion.
? Lack of vascular adaption to pregnancy - can’t optimise blood supply - spiral arterioles cant adapt to become high capacitance low resistance vessels.

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9
Q

How can you manage pre-eclampsia?

A
  • Monitor - deliver baby
  • Labetalol
  • Magnesium sulphate to reduce risk of seizure
  • Steroid? To increase surfactant production in baby in case of early delivery
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10
Q

What can cause bleeding early in pregnancy?

A

Miscarriage

Ectopic

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11
Q

What can cause bleeding late in pregnancy?

A

Anterpartum heamorrhage

  • Placenta previa
  • Placental abruption (contained or revealed)
  • Placenta Accreta (firmly adherant)
  • Placenta Increta (invades myometrium)
  • Placenta Percreta (invades throught serosa)
  • Vasa Praraevia (vessels overlie cervix)
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12
Q

What is a post-partum haemorrhage?

A

> 500ml blood from GU tract
5% of vaginal births

  • Primary if 24hrs to 6 weeks after delivery (endometriosis)
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13
Q

What can cause PPH?

A

4 Ts

Thrombin - bleeding disorder, pre-eclampsia
Trauma - C/S, episiotomy, macrosomia
Tissue - Retained placenta, placenta accretia
Tone - Overdistention can cause atony

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14
Q

What puts you at risk of PPH?

A

Previous PPH, placenta previa, twins, nulliparity, obesity, pre-eclampsia

In delivery: C/S (emergency or repeat) operative birth, macrosomia

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15
Q

How do you manage PPH?

A

Check clotting + replace factors
Empty uterus
Empty bladder and rub improve tone of uterus - bimanual compression + oxytocics useful.
Repair any tears

If bleeding continues - hysteroscopy, tamponade (blow up baloon to compress outside), haemostatic sutures, arterial ligation.

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16
Q

When is opperative delivery needed?

A

Presumed fetal distress on CTG or foetal scalp sample
Maternal reasons - if valsalva manouver needs to be avoided (cardiac disease)
Inadequate progress

17
Q

What specific criteria must be fulfilled to do an operative delivery?

A 
Valid reason
Head NOT palpable abdominally - must be at/below ischial spines. 
Cervix fully dilated
Head in known position
Analgesia
Empty bladder
ability to do c/s if needed
18
Q

What are the 2 methods of operative vaginal delivery/

A

Ventouse - cap suctioned onto head 3cm from posterior fontanelle. complications: failute, cephalohaematoma, retinal haemorrhage and maternal worries.

Forceps: pair lock together. Non rotational. DOA is best position for this - try to rotate round to it first.
- complications: significant maternal perianal trauma.

Both carry risk of needing a c/s, low 5min apgar, phototherapy

19
Q

What sort of Caesarean section is done usually?

A

LSCS - lower section c/s, using a Pfannesteil incision

20
Q

What are some absolute indications for c/s?

A

Placenta previa
Abnormal lie
Pelvic deformity
Previous classical C/S - vertical scar

21
Q

What increases the chances of a multiple pregnancy?

A

Increasing maternal age
Family history
Race
IVF

22
Q

What is meant by : monozygous?

A

identical twins
Single zygote spolits
same genetic material

23
Q

What is meant by : Dizygous?

A

non-identical twins
2 egg and 2 sperm = 2 zygotes
different genetic material

24
Q

What is chorinicity?

A

Whether they share a placenta

25
Q

What is amniocity?

A

Whether they share the same amniotic membranes

26
Q

What chorionicity and amniocity can monozygous twins be?

A

MCDA
MCMA
DCDA

27
Q

MCDA, MCMA, DCDA twins:

Which are at a high risk and of what?

A

MCDA and MCMA are at higher risk of misscarriage, congenital issues, IUGR and twin to twin transfusion syndrome.

28
Q

When and how are multiple pregnancies delivered?

A

If uncomplicated DCDA: 37-38 weeks
If MCDA: 36-37 weeks

How depends on leading twin presentation + complications
Sometimes can have insufficient uterine action for twin 2
Can have foetal distress, cord prolapse or PPH

29
Q

What cardiovascular changes occur during pregnancy?

A

Big increase in CO (30-50%)
- by increasing blood volume by 50% and increasing HR.
- uterus uses = O2 demand as kidneys
During labour CO increases by 15-50%
Post-partum CO increases by 80% as suddenly redistributed away from uterus.

Bp - varies on position more

  • Peripheral vascular resistance is reduced due to progesterone effect
  • Systemic Bp low in 1st 24 weeks, then increases back to normal by delivery
30
Q

What haematological changes occur in pregnancy?

A

Blood vol increases to 5000ml due to progesterone and RAAS.
Neutropenia, low platelets, low cell mediated immunity.
RBC mass increases by 30% but blood vol by 50% - so hct and hb decrease overall in concentration.

  • Alk phos, B globulin and fibrinogen increase.
  • total protein, albumin and y-globlin decrease
  • > abnormal LFTs and ESR and oedema.
  • Prothrombotic state - increase in factors O. VII, VIII, IX, X and XII.
  • protective against PPH.
  • reduced pro-thrombin times as resistant to APC and protein S.
  • In 3rd trimester, increase in platelet aggregation and factor VII.
31
Q

What endocrine changes occur during pregnancy

A

Increase in RAAS - retail wanter and Na
Thyroid - Increase in Thyroid binding globulin (so less free T4, so more TSH, so more total T3 and T4)
Increased iodine requirement

In hyperemesis gravidarium - lots of hCG which binds to the TSH receptor, can cause hypothyroid.

32
Q

What GI changes occur in pregnancy?

A 
Early - nausea and vomiting common
Increased appetitie, PICA, cravings
Progresterone weakens LOS - reflux
Reduced GI motility
Gallbladder dilates and loses tone - at risk
33
Q

What MSK effects happen in pregnancy?

A

Increased weight on joints
Softened connective tissue
Oedema - can cause carpel tunnel

34
Q

What respiratory changes occur in pregnancy?

A

Increase in foetal O2 requirements so women increase tidal volume by 30% and reduce residual volume by 20%.
RR and capacity unchanged.

Have a compensated respiratory alkalosis to help foetal-maternal blood transfer.

Progesterone makes women feel short of breath

35
Q

What urinary changes occur during pregnancy?

A

Kidney size increases + ureteric dilatation - increased UTI risk.
Increased renal blood flow and GFR
Altered tubular function
Increase in glycosuria, proteinuria, Ca and bicarb and creatinine clearance.

Reduced bladder capacity.

Lucy Knox - Year 2.5 (15 decks)

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