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Flashcards in 235 - Pregnancy 2 Deck (23):
1

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

2

what is the definition of sever preeclampsia?

pre-eclampsia with
*SBP>160 DBP >110
*proteinuria >500
*pulm oedema/cyanosis
*oliguria
*seizures
*pailloedema
*thrombocytopaenia
*liver pain

3

what are the risk factors for pre-eclampsia?

*35
*FH
*Primagravida
*some mother-father combo incr risj
*multiple gestation
*pre-existing HTN
*renal disease
*diabetes
*obesity

4

what causes pre-eclampsia?

*impaired trophoblastic invasion of maternal spiral arteries
*placenta pre-disposed to hypoxia
*widespread coagulation
*renal injury through thrombus

5

how would pre-eclampsia be managed?

*monitor - aim for mean art P of

6

what are the requirements for am operative delivery?

*head not palpable, cervix fully dilated, adequate analgesia, bladder empty, CS facilities available

7

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

8

what are the indications for CS

placenta praevia, uncorrectable normal lie, prolonged labour, foetal distress
Done with pfannesteil incision

9

what is the antepartum haemorrhage severity scale?

*spotting - streaks
*minor - 1000ml +/- shock

10

what are the causes of bleeding in early pregnancy?

miscarriage and ectopic pregnancy

11

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

12

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

13

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

14

what is vasa praevia?

blood vessels communicatinf between 2 regions of placenta pass over internal os

15

what are the causes of post partum haemorrhages?

more than >500ml blood loss after vaginal delivery
*atonic uterus - blood vessels not compressed
*trauma
*retained placenta
*coagulation failure

16

how is post partum haemorrhages treated?

*empty uterus of placenta
*give oxytocics -prolong uterine contraction
*empty bladder
*fluids and clotting factors
*bimanual compression of uterus
*laparotomy to compress aorta and suture uterus

17

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

18

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

19

what are the BP changes in pregnancy?

falls by 10mmHg in 2nd trimester but returns to normal in 3rd

20

what are the renal changes in pregnancy?

*incr renal blood flow and GFR - incr Cr and urine clearance, mild proteinuria and glycosuria
*kidneys grow
*uteric dilation due to progesteron and stasis > obstruction and UTI

21

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

22

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

23

what is chorionicity and amniocity?

*chorionicity - placentation
*amniocity - amniotic membrane between twins