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Flashcards in 8.2.2 Deck (12):
1

Describe changes in thyroid hormones in pregnancy?

• hCG has a direct effect on the Thryoid, stimulating T3 and T4 production
o TSH can be decreased in normal pregnancies as a result of negative feedback from T3 and T4 produced due to hCG secretion

2

Describe anatomical changes and physiological changes in GI system in pregnancy.

Anatomical Changes
• Alterations in the positions of viscera
o E.g. appendix moves from RLQ to LUQ as the uterus enlarges

Physiological Changes
• Smooth muscle relaxation by Progesterone
o GI – Delayed emptying
o Biliary tract – Stasis
o Pancrease – Increased risk of pancreatitis

3

Why is pregnancy a pro-thrombotic state? Why can warfarin not be administered?

• High amount of fibrin deposition at the site of implantation
o Increased fibrinogen and clotting factors
o Reduced fibrinolysis
• Stasis, venodilation
• Results in Thromboembolic disease in pregnancy
o Cannot give warfarin – Crosses the placenta and is teratogenic

4

How does anaemia occur in pregnancy?

Plasma volume increases
RBC mass increases but not to same extent.
Physiological anaemia
Haematorit volume mismatch.

Anaemia due to folate deficiency
Symptoms:
Pale skin, lips, nails
Tiredness
SOB
Dizziness

5

Significance of immune system in pregnancy?

• Fetus is an allograft
o Genetically different to the mother
• Non-specific suppression of the local immune response at the materno-fetal interface
• Transfer of antibodies
o IgG crosses the placenta
• Haemolytic disease
o Antibodies for ABO do not cross
o Antibodies of Rhesus do cross
• Graves disease and Hashimoto’s Thyroiditis
Antibodies will cross the placenta and either stimulate TSH receptors on or destroy developing fetal thyroid respectively.

6

What is measured in antenatal screening?

o History and examination
• Risk factors – E.g. for gestational diabetes
o Blood test
• Blood group
• Haemoglobin
• Infection
o Urinalysis
• Protein

7

What is pre-exlampsia?

• Disorder of pregnancy characterised by high blood pressure and a large amount of protein in the urine.
BP>140/90
Proteinuria > 0.3g

8

When does pre-eclampsia/eclampsia occur?

T3

9

What happens in severe pre-eclampsia? When is it known as eclampsia?

o RBC breakdown
o Low platelet count
o Impaired liver function
o Kidney dysfunction
• If untreated, it may result in seizures at which point it is known as eclampsia.

10

Risk factors for pre-eclampsia?

Obesity
DM
Hypertension.

11

Treatment of pre-eclampsia?

Aspirin
Calcium
BP meds

12

Give the differences in CVS of normal and pre-eclampsia.

Normal Pregnancy
• Vasodilated
• Plasma-Expanded
• Blood pressure not raised in normal pregnancy

Pre-Eclamptic Pregnancy
• Vasoconstricted
• Plasma-Contracted
• Raised blood pressure
• Proteinuria
• Pitting oedema