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Block 5- Kim > Maternal and Foetal Health & Wellbeing > Flashcards

Maternal and Foetal Health & Wellbeing Flashcards

1
Q

What is a strucutral abnormality?

A

Problem with the body part eg: cleft palate, NTD

(Production of congenital malformation)

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2
Q

What is a functional abnormality?

A

Problem with how a body part or system works ie: developmental disability

(direct toxic effect on cells of embryo either lethal or reduction in growth

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3
Q

When is the embryo most susceptible to teratogens?

A

When you don’t know you’re pregnant

3-14/40

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4
Q

What can alcohol cause?

A

Foetal Alcohol Syndrome (most severe)

Foetal Alcohol Spectrum Disorder = LBW, Small head, Cerebral Palsy, ADHD

Heart defects

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5
Q

What can folic acid defiency lead to?

A

NTD eg: meningocele

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6
Q

What can rubella lead to?

A

Cataract, heart defects, mental retardation

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7
Q

What foods should be avoided?

What is the bacteria associated?

What are the symptoms

A

Soft cheese, blue cheese

Listeria bacterium

Associated w/ miscarriage, stillbirth & sick neonate

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8
Q

What does toxoplasmosis cause?

How can you avoid this?

A

Miscariage

Don’t change the cat litter

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9
Q

What are the common symptoms in the first trimester?

What week does this ususally occur?

Why?

A

Morning sickness (often 8/40) due to rising hCG levels

  • Hypermesis Gravidarium

Frequency of mictuition (due to vascularity frequency)

  • Lasts until 16/40 until uterus rises out pelvis
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10
Q

What are some of the symptoms later on in pregnancy?

A
  • Heartburn
  • Peridontal
  • Constipation (progesterone reduces gastric motility)
  • Haemorrhoids
  • Leucorrhoea (white vaginal discharge- non irritant or ofensive)
  • Hyperpigmentation- areola, nipple, vulva, perianal region
  • Backache
  • Sympysis Pubis Dysfunction
  • Carpal Tunnel syndrome
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11
Q

Give some example of how to improve maternal and foetal wellbeing

(think very general)

A
  • Nutrition
  • Decrease smoking
  • Reduce alcohol
  • Increase exercise
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12
Q

What is Gravidity?

A

The total number of pregnancies regardless of an outcome

Mutiple gestation counts as a single event

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13
Q

What is parity?

A

The total number of times a women has given birth to a foetus with a gestational age of greater than 24 weeks

Mutiple births count as a single parous event

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14
Q

The patient is currently pregnant they have had one child & a miscariage what is the notation?

A

G3 P1 +1

(+1 symbolises the miscarriage- not carried to 24 weeks)

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15
Q

The patient is not pregnant, they have had one live birth and one stilbirth- what is the notation?

A

G2 P2

The stillbirth was carried over 24 weeks thus it is P2

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16
Q

The patient is not pregnant- but had twins. What is the notation

A

G1 P1

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17
Q

How many births are premature

A

Up to 10%

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18
Q

What are stillbirths generally linked to?

What should you do in order to try and prevent this?

A

intrauterine Growth Restriction

2) Monitor growth to identify interuterine growth restriction

Identify anomolies

Prevent, Intervene, Deliver, Be prepared

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19
Q

What is a small, normal and large baby weight in kg

A

Small <2.5kg

Normal: About 3.5kg

Larger: 4.5kg

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20
Q

Define prematurity

What are the catagories?

A

Born before 37 weeks

Extremley preterm: <28weeks

Very preterm: 28-32 weeks

Moderate to Late preterm: 32-37 weeks

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21
Q

What can you do if there is a prematuirty risk?

A
  • MgSO4
    • Neuroprotectant to reduce cerberal palsy risk
  • Steroids (Betamethasome)
    • Stimulates surfactant synthesis- lubricates lungs so air sacs can glide without sticking
    • Prevents brain bleedings
    • Lower risk necrotizing entercolitis

24-32 weeks -double dose 24hrs apart

34-37 weeks- single dose

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22
Q

How can you establish EDD

A

LMP: (Naegele’sRule) Assume 28 day cycle & use First Day LMP

  • Add 12 mnths
  • Minus 3 mnths(or simply add 9)
  • Add 7 daysto first day of LMP
  • (+/- days resulting EDD for differing cycle length)

2) Early Sonogram: CRL

  • UK standard = Crown Rump Length @ early scan
  • If > 84mm, gestation age should be estimated using head circumference

3) Symphysio-Fundal Height:

  • From 24/40
  • Separate Growth Chart
  • Measure: TOP DOWN
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23
Q

What is a biometric test?

A

Predict foetal size @ point in gestation

Indicates growth but not foetal wellbeing

24
Q

What is a biophysical test?

A

Predict foetal wellbeing but not growth

25
Q

Foetal biometric tests:

How do you measure the baby size via Early sonogram?

What weeks?

A

CRL (top of head to bottom of torso)

6-13 weeks - used as there is little biological variabilty

26
Q

Foetal biometric tests:

What measure ments are used in scans from 2nd trimester onwards?

A
  • Biparietal Diameter
  • Head circumference
  • Abdominal Circumference
  • Femur length
27
Q

With interuterine Growth Restrictions

a) What is it?
b) What are the risks?

A

Small for gestational age

Risks:

  • Stillbirth
  • LWB
  • Decrease resistance to infection
  • Hypoglycaemia
  • Hpothermia
  • Decrease O2 levels
  • Difficulty handling vaginal delivery
28
Q

How do you diagnose IUGR?

What are the types? What are the causes?

A

Centile charts = below 10% for gestational age

Type I: ALL Biometric less than expected

Usually presents earlier

Cause: Infection, Chromosome abnormality

Type II: Disproportionate between diameters

AC classically affected

Foetal head sparing (increased brain: liver)

Cause: Placental insufficiency, Pre-eclampsia

(Foetal tachy may be present in 50%)

29
Q

What are Biophysical Profiling main area and additional areas of assessment?

When is it usually carried out?

A

Measures foetal heart rate in response to foetal movements

Also Measures: Foetal breathing, movements, tone and Amniotic fluid volume

Carried out in 3rd trimester

30
Q

Foetal GI system:

When does swallowing take place?

What are they swallowing?

Where does what they swallow go through? (think GI tract areas)

What does it permit?

What happens if no swallowing takes place?

A

Swallowing developed in 10-12wk

Swallowing Amniotic fluid

Goes through stomach & SI

Fluid movement in GI tract permits growth and development of GI tract

Polyhydramnios occurs if foetus does not awallow enough amniotic fluid?

31
Q

Foetal Urinary System:

How is most waste excreted?

How often does the bladder empty into amniotic fluid?

At ____ weeks foetus produces ___ml urine p/d

At term it rises to?

Debris accumulates in foetal gut forming what?

A

Most waste excreted via placenta

Bladder empties –> Amniotic fluid every 40-60mins

At 25 Weeks foetus produces 100ml urine p/d

Rising to 500mls at term

Absorbs water and electrolyte

Debris forms meconium (first foetal stool)

32
Q

What is the function of the amniotic fluid?

How much @ 8 weeks

How much at 38 weeks?

How much @ 42 weeks?

What does it contain in early pregnancy

What does it contain in second trimester?

After 20 weeks what else does it contain?

A

Mechanical protection and Mosit environment

8 weeks = 10mls

38wks = 1L

42 weeks = 300mls

Early pregnancy: Ultra filtrate of maternal plasma

Second trimester: + ECF (which diffuses through foetal skin) - composition: foetal plasma

After 20w: Foetal urine

33
Q

What does amniotic fluid contain?

A

Cells from foetus, Amnion, Proteins

by 20wk = foetal urine

34
Q

How is the foetal urinary system monitered?

A

Foetal kidney number, size & strucutre

Amniotic fluid volume

Bladder acitivty

35
Q

What is most of the AVF comprised of in late pregnancy?

What does this reflect?

What is too litle amniotic fluid called

A

Foetal urine

2) Renal function, Bladder, GI, Foetal metabolism
3) Oligohydramnios

36
Q

What is the role of the placenta?

A

Respiration, Nutrition, excretion

37
Q

What are the 3 shunts in utero?

A
  • Ductus Venosus
  • Foramen Ovale
  • Ductus arteriosus
38
Q

What are some of the modifications of the feto-placental circulation (aside from shunts)

A

Large & more RBC

Modified Hb to pick up max O2

39
Q

Oxygenated blood arrives from placenta in umbilical vein- Where can the blood go?

A

Hepatic micro circulation (later joints IVC via hepatic veins)

Directly to IVC through ductus venosus

40
Q

Blood to the IVC can come from?

A

Hepatic micro circulation

Abdo, pelvis & Lower limbs

Ductus venosus

41
Q

50% of blood from ____ is shunted into ____ ____

due to flow patterns in R atrium

A

50% of blood from Placenta is shunted into Left atrium due to flow patterns in R atrium

42
Q

How is the right to left flow maintained?

A

Larger quantity & greater speed of blood flow from IVC to right atrium compared to that entering blood left atrium from pulmonary veins

Goes through Foramen ovale

(Lungs are fluid filled, High pulmonary resitance, more blood entering R atrium compared to left atrium thus blood shunted through foramen ovale)

43
Q

Is the blood from the lungs entering the L atrium in foetal life high or low oxygenated and why?

A

Lung tissue extracts O2 from low circulating blood volume entering right ventrical & returns poorly oxygenated blood to L atrium

44
Q

What is the Ductus Ateriorsus?

A

Muscular artery connecting pulmonary trunk to descending aorta

45
Q

What does the DA allow?

A

Most blood leaving R ventricles to perfuse the lower body & placenta

(so the blood that hasn’t gone through foramen ovale, majority will pass through DA)

46
Q

What do the DA and FO allow?

A

Blood to bypass lungs and be directed to placenta

47
Q

During interuterine life the foetal- placenta circulation provides what?

What is it maintained by?

A

Operates as a single unit providing low resistance, high capacity reserviour in vascular bed of placenta.

Maintained by abscence of valves in umbilical veins

48
Q

What is the normal foetal HR?

A

110-160bpm with baseline variability of 5 beats or more and no decellerations

Monitor: Rate, Responsivneess, Timing, Flow

49
Q

What are the circulatory adaptations after birth?

A

Removal of low-resistance circulation of placenta

Onset of breathing: Pulmonary vascular resistance decreases (lungs drained of fluid)

Increased blood flow to lungs: Increases blood returing to left atrium so L atrium pressure > R atrium pressure

–> FO closure (fuses a few months after)

As flow through pulmonary circulation increases & arterial O2 tension rise DA begins to constrict

50
Q

When does the DA functionally constrict?

A

1 day postnatally

51
Q

What is required for permanent closure of DA? How long does this take?

A

Thrombosis & Fibrosis

Takes several weeks

52
Q

When does DV close?

A

Remains partially open but closes within 2/3 months after birth

53
Q

What is the notation for a pregnant women who has had one set of twins born at 28 weeks and a singleton born at term

A

G3 P2

54
Q

What is a structural abnormality?

When does this normally occur?

A

Production of congenital malformation by teratogen (most common between 3-8weeks) aka- problem w/ body parts

55
Q

What is a functional abnormality?

When does this normally occur?

A

Direct toxic effect on cells of embryo either lethal or reduction in growth (aka: how body parts or systems work)

Most common after 8 weeks

56
Q

What are common teratogens?

A

Alcohol

Dietary intake

Viruses

Medication during pregnancy

57
Q

What can anti-epileptic drugs cause?

A

Cleft lip & Palate

Block 5- Kim (12 decks)

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