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Block I: Reproduction & Sexuality > Clinical: Normal Pregnancy and Ante-Natal Care > Flashcards

Clinical: Normal Pregnancy and Ante-Natal Care Flashcards

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1
Q

3 sources of hormone secretion during pregnancy

A
  • Placenta
  • Maternal pituitary
    • Maternal adrenal
    • Maternal thyroid
  • Fetal Adrenal
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2
Q

4 hormones secreted by the placenta

A
  • hCG
  • hPL
  • Estrogens
  • Progesterone
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3
Q

2 main components of the placenta

A
  • Cytotrophoblast
  • Syncytiotrophoblast
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4
Q

Function of Hc GnRH in cytotrophoblast

A

Increase placental steroidogenesis and release of prostaglandins and hCG (similar in structure and action to GnRH)

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5
Q

When and where is hCG produced

A

Produced by syncytiotrophoblase immediately after implantation (~8 day after ovulation)

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6
Q

Structure of hCG

A

Similar to LH: consists of (common) alphha and (specific) beta subunit

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7
Q

Where is hCG secreted to?

A

Maternal and fetal circulation

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8
Q

Describe the hCG levels throughout gestation

A

Rapid rise in first trimester of pregnancy; maximum at 8-10 weeks of gestation

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9
Q

Important of hCG test (2 reasons)

A
  • Pregnancy test
    • Normal rate of rise = indication for fetal well-being
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10
Q

2 conditions that higher than normal [hCG] may indicate

A

indication for trophoblastic disease (choriocarcinoma or hydatidiform mole) or ectopic pregnancy

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11
Q

Maternal role of hCG

A

Maintenance of corpus luteum to ensure continued progesterone secretion before placenta takes over

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12
Q

Fetal function of hCG

A

Increase testosterone production by Leydig cells in fetal testes (as does LH in the adult). Also has TSH activity on fetal thyroid

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13
Q

Alternative name for hPL (human placental lactogen)

A

Chorionic somatotomammotropin

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14
Q

Where is hPL produced?

A

syncytiotrophoblast

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15
Q

Describe hPL levels throughout gestation

A

Rises throughout pregnancy proportional to placental mass (very high synthesis rates: 1-3 g/day)

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16
Q

Where is hPL secreted?

A

Mainly into maternal circulation

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17
Q

3 maternal effects of hPL

A
  • Increase glucose levels
  • Increase lipolysis (to increase free fatty acids) = fuel for fetus
  • Decrease insulin action (diabetogenic effect)
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18
Q

4 effects of estrogens

A
  • Increase uterine blood flow and growth
  • Increase prostaglandin synthesis
  • Increase prolactin secretion
    • other effects important for the maternal adaptation to pregnancy
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19
Q

Describe the uterus in pregnancy

A

50g pre-pregnancy –> 950 g term

Initially hypertrophy, then distension

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20
Q

Describe the changes in the cervix during pregnancy

A

Softer (ripening)

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21
Q

Describe the changes in the vagina during pregnancy

A

Mucosa thickens, stretches more easily

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22
Q

5 effects of progesterone that enable implantation of blastocyst

A
  • Induces decidualization
  • Decreased uterine contractions
  • Decreased prostaglandin formation
  • Decreased T-lymphocyte response
  • Decrease graft rejection and immune reaction
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23
Q

2 effects of progesterone that protect from hypertension

A
  • Decreased angiotensin II responsiveness
  • Smooth muscle relaxation
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24
Q

Causes of varicosities in pregnancy

A
  • Distended veins
  • Higher pressure of uterine venous return
  • Uterine mechanical pressure
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25
3 locations of varicosities during pregnancy
* Legs * Hemorrhoids * Vulvar varicosities
26
3 effects of pregnancy on the respiratory system
* Deeper breathing --\> increased tidal volume * Increased oxygen conumption (20%) * Increased ventilation rate (40%) (Subjective "air-hunger" or overbreathing)
27
2 reasons why deeper breathing occurs in pregnancy
* Reduced diaphragmatic movement * Flared ribs
28
4 effects of pregnancy on the gastro-intestinal system
* Hypertrophic gums * Nausea and hyper-emesis in early pregnancy * Acid reflux * Constipation
29
2 cause of nausea and hyper-emesis in early pregnancy
* hCG * E2 mediated
30
Reason for acid reflux in pregnancy
Relaxed cardiac sphincter
31
4 effects of pregnancy on the renal system
* Ureteric dilatation * Increased water excretion * Increased renal blood flow * Increased glomerular filtration rate (60%)
32
2 potential consequences of pregnancy-induced ureteric dilatation
Stasis and urinary infection
33
2 potential consquences of increase GFR in pregnancy
Occ. proteinuria and glycosuria
34
4 effects of E2
* Increases uterine size and blood flow * SOftens connective tissue * Breast development (PRL) * Water retention
35
Describe the regulation of placental ACTH
No negative feedback; inhibition by glucocorticoids
36
4 effects of increased corticosteroids in pregnancy
* Abdominal striae * Glycosuria * Hypertension * Heavier features
37
4 effects of pregnancy on the pituitary
* ACTH, TRH, PRL all increase * Melanocytic activity? * PRL rises progressively up to wk30 * FSH, LH secretion minimal (PRL effect and E2,P negative feedback)
38
5 effects of pregnancy on the cardiovascular system
* Increase in blood volume (4L to 5.5L) * Decrease in iron stores (BM, liver, spleen) * Increase in CO (SV 20% and HR 15%) * Decreased peripheral resistance * Redistribution of blood flow (kidneys, uterus)
39
2 effects of pregnancy on the hematological system
* Development of hypercoagulable state (estrogen mediated) * Increased leucocyte count
40
RIsk of hypercoagulable state in pregnancy
Increased risk of DVT and PE
41
3 risks of increased leucocyte count in pregnancy
* Increased risk of infection * Increased severity of infection * Decreased immunity
42
Mean weight gain in pregnancy
12 - 15 kg (9kg in final 20 weeks of pregnancy)
43
3 sources of weight gain from pregnancy itself
* Fetus (3000 to 3500 g) * Placenta (600 g) * Liqour (800 g)
44
5 sources of weight gainfrom mother in pregnancy
* Uterus (1000 g) * Breasts (500 g) * Blood (1500 g) * Fat (3500 g) * Fluid (2600 g)
45
Define low-risk pregnancy
Normal women undergoing a normal physiological event
46
3 criteria for high risk pregnancy
* Pre-existingdisease * Previous pregnancy complications * Current pregnancy complications
47
How often should physician visits be done when pregnant?
Every 3-4 weeks with increasing frequency towards date of delivery
48
When are initial tests and screening performed?
10 - 12 weeks
49
When is a detailed anomaly scan performed?
20 weeks
50
When is screening for gestational diabetes performed?
26 weeks
51
When should induction of labor be considered?
41 weeks
52
7 elements of standard antenatal check
* Obstetric assessment * Smoking history * BP check * Measurement in fundal height in cm * Fetal auscultation from 12 weeks * Fetal presentation from 30 weeks * Inspection of legs for edema
53
4 things to look for in fetal ultrasound
* First trimester screening * Nuchal translucency/nasal bone * Anencephaly * Other major defects
54
2 fetal anomalies with no chance of being detcted by USG
Cerebral palsy Autism
55
4 fetal anomalies with a very high chance of being detected by USG (\>90%)
* Spina bifida * Anencephaly * Exomphalos/gastroschisis * Major limb abnormalities
56
What does the symphyseal fundal height measurement in cm correspond to?
Weeks of gestation
57
9 initial recommended tests for a pregnant woman
* CBC * MCHC/MCV (Thal screen. Ferritin and Hb electrophoresis if low) * Blood group/antibody screen * HIV * Hep B (and C) * Syphilis (ideally prior 16 weeks) * Rubella antibodies * Urine microscopy * Pap (if due)
58
3 recommended tests at 26 weeks
* Gestational diabetes screening * Antibody screen on all women * Rhogam (Anti-Rh D antibodies) if Rh Neg
59
Recommended test at 36 weeks
Group B Streptococcus screen
60
When should screening be done for GDM
Between 24-28 weeks
61
Wen should RVH screening be done?
26 weeks (all women)
62
WHen should swabs be taken for prevention of early onset GBS
between 35 - 37 weeks
63
4 reasons intrapartum antibiotics may be recommended to prevent early onset GBS
* \<37 weeks * Ruptures membranes \>18 before delivery * Maternal temperture _\>_38 C * Previous GBS colonisation, bacteruria or infant with GBS
64
When should prophylactic Anti-D be administered?
28 and 34 weeks gestation (no level I evidence however)

Block I: Reproduction & Sexuality (23 decks)

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