Clinical: Normal Pregnancy and Ante-Natal Care Flashcards Preview

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

Flashcards in Clinical: Normal Pregnancy and Ante-Natal Care Deck (64):
1

3 sources of hormone secretion during pregnancy

  • Placenta
  • Maternal pituitary
    • Maternal adrenal
    • Maternal thyroid
  • Fetal Adrenal

2

4 hormones secreted by the placenta

  • hCG
  • hPL
  • Estrogens
  • Progesterone

3

2 main components of the placenta

  • Cytotrophoblast
  • Syncytiotrophoblast

4

Function of Hc GnRH in cytotrophoblast

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

5

When and where is hCG produced

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

6

Structure of hCG

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

7

Where is hCG secreted to?

Maternal and fetal circulation

8

Describe the hCG levels throughout gestation

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

9

Important of hCG test (2 reasons)

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

10

2 conditions that higher than normal [hCG] may indicate

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

11

Maternal role of hCG

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

12

Fetal function of hCG

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

13

Alternative name for hPL (human placental lactogen)

Chorionic somatotomammotropin

14

Where is hPL produced?

syncytiotrophoblast

15

Describe hPL levels throughout gestation

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

16

Where is hPL secreted?

Mainly into maternal circulation

17

3 maternal effects of hPL

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

18

4 effects of estrogens

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

19

Describe the uterus in pregnancy

50g pre-pregnancy --> 950 g term

Initially hypertrophy, then distension

20

Describe the changes in the cervix during pregnancy

Softer (ripening)

21

Describe the changes in the vagina during pregnancy

Mucosa thickens, stretches more easily

22

5 effects of progesterone that enable implantation of blastocyst

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

23

2 effects of progesterone that protect from hypertension

  • Decreased angiotensin II responsiveness
  • Smooth muscle relaxation

24

Causes of varicosities in pregnancy

  • Distended veins
  • Higher pressure of uterine venous return
  • Uterine mechanical pressure

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)