Flashcards in 8.2.2 Deck (12)
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
Describe anatomical changes and physiological changes in GI system in pregnancy.
• Alterations in the positions of viscera
o E.g. appendix moves from RLQ to LUQ as the uterus enlarges
• Smooth muscle relaxation by Progesterone
o GI – Delayed emptying
o Biliary tract – Stasis
o Pancrease – Increased risk of pancreatitis
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
How does anaemia occur in pregnancy?
Plasma volume increases
RBC mass increases but not to same extent.
Haematorit volume mismatch.
Anaemia due to folate deficiency
Pale skin, lips, nails
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.
What is measured in antenatal screening?
o History and examination
• Risk factors – E.g. for gestational diabetes
o Blood test
• Blood group
What is pre-exlampsia?
• Disorder of pregnancy characterised by high blood pressure and a large amount of protein in the urine.
Proteinuria > 0.3g
When does pre-eclampsia/eclampsia occur?
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.
Risk factors for pre-eclampsia?
Treatment of pre-eclampsia?