Flashcards in 235 - Pregnancy 2 Deck (23):
what is the definition of preeclampsia?
hypertension after 20wks plus:
*proteinuria - >300mg in urine in 24hrs
*renal insufficiency - Cr > 0.09 mmol/L or *oliguria
*liver disease - raised transaminases or *RUQ pain
*neurological symptoms -convulsions or *hyperreflexia or *severe headaches or visual disturbances
*haematological disturbance - thrombocytopaemia or DIC or haemolysis
*foetal growth restriction
what is the definition of sever preeclampsia?
*SBP>160 DBP >110
what are the risk factors for pre-eclampsia?
*some mother-father combo incr risj
what causes pre-eclampsia?
*impaired trophoblastic invasion of maternal spiral arteries
*placenta pre-disposed to hypoxia
*renal injury through thrombus
how would pre-eclampsia be managed?
*monitor - aim for mean art P of
what are the requirements for am operative delivery?
*head not palpable, cervix fully dilated, adequate analgesia, bladder empty, CS facilities available
what available operative delivery techniques and how does position affect this
*ventouse - cap and suction and Forceps
*OA - either
*OTventouse for descent forceps to rotate
* OP - rotate 190 deg with either
what are the indications for CS
placenta praevia, uncorrectable normal lie, prolonged labour, foetal distress
Done with pfannesteil incision
what is the antepartum haemorrhage severity scale?
*spotting - streaks
*minor - 1000ml +/- shock
what are the causes of bleeding in early pregnancy?
miscarriage and ectopic pregnancy
what are the types of miscarriage?
*threatened - bleed, foetus alive os closed
*inevitable - heavy bleed, foetus maybe alive os open
*incomplete - bleed some foetus passed os open
*complete - all tissue passed bleed settled os closed
*missed - foetus not develop os closed
*septic - infected uterine contents, tender uterus
give mifepristone or prostaglandin (misoprostal) to enduce labour
what is placental abruption and risks?
*premature separation of placenta from uterus with vaginal bleeding, abdo/back pain, uterine tenderness and irritable woody hard, foetal distress, abnormal contractions and premature labour
*risks - preeclampsia or HTN, trauma, previous abruption, smoking/drink/drug, multiparity, assisted conception, low BMI
*treat -rapid delivery
what is placenta praevia and risks?
*implantation of placenta over or near the internal os (total, marginal, low lying). Lower uterine segment disrupts causing shear and bleed. contractions promoted >more bleed. Painless bright red vaginal bleeding
*risks - previous praevia, previous caesarian, smoke, older, assisted conception
*treat - CS at 36-37 wks
what is vasa praevia?
blood vessels communicatinf between 2 regions of placenta pass over internal os
what are the causes of post partum haemorrhages?
more than >500ml blood loss after vaginal delivery
*atonic uterus - blood vessels not compressed
how is post partum haemorrhages treated?
*empty uterus of placenta
*give oxytocics -prolong uterine contraction
*fluids and clotting factors
*bimanual compression of uterus
*laparotomy to compress aorta and suture uterus
what are the haematological changes in pregnancy?
*incr blood vol 2.5L to 5L
*incr red cell mass (incr iron demand), haematocrit and Hb decr (physiological anaemia) - decr blood viscosity and resistance reduces cardiac workload
*incr WCC - neutrophilia but cell mediated immunity supressed by incr corticosteroid secretion
*decr platelet count and protein
*incr coagulation factors (1,7,8,9,10,12) to produce prothrombotic state (less haemorrhage in labour but inc thromboembolism risk
what are the CV changes in pregnancy?
*incr cardiac output due to hypervolaemia and O2 demand Cause 30% incr in SV, 15% incr in HR and 30-50% incr in CO. compensated by decr systemic vascular resistance and blood viscosity
*water and Na retention (more angiotensin 2) - oedema
*decr plasma osmolality
*IVC occlusion in supine
*murmurs - 3rd heart sound (passive ventricular filling)
*ECG changes - L axis deviation, sagging ST, inverted T vwave in lead 3 /avf
what are the BP changes in pregnancy?
falls by 10mmHg in 2nd trimester but returns to normal in 3rd
what are the renal changes in pregnancy?
*incr renal blood flow and GFR - incr Cr and urine clearance, mild proteinuria and glycosuria
*uteric dilation due to progesteron and stasis > obstruction and UTI
what are the respiratory changes in pregnancy?
*inc O2 demand
*reduced maternal PaCO2 to help gas exchange with foetus causes compensated resp alkalosis
*incr tidal vol, decr residual vol, RR and VC unchanged
*decr total lung capacity in late pregnancy as abdo muscles pushed into diaphragm
what are the GI changes in pregnancy?
*LOS relaxation - reflux, aspiration
*reduced GIT motility for incr absorp
*gall bladder dilation and poor emptying - cholesterol gall stones