Complications of Pregnancy Flashcards Preview

WEEK 3 SEM 4 > Complications of Pregnancy > Flashcards

Flashcards in Complications of Pregnancy Deck (37)
Loading flashcards...
1
Q

What complications can happen in the first trimester?

A

miscarriage (15% of preggo)
ectopic pregnancy
hyperemesis gravidarum

2
Q

What is hyperemesis gravidarum?

A

severe vomiting

3
Q

What MATERNAL complications can occur in the second and third trimester?

A
UTI
anaemia
pre-eclampsia
gestational diabetes
antepartum haemorrhage
4
Q

What foetal complications can occur in the second and third trimester?

A

premature labour

macrosomia

5
Q

Why do mothers have high risk of UTI?

A

bc of urinary stasis

immune suppression during pregnancy

6
Q

Why can urine get static?

A

because of the progesterone causing smooth muscle to relax

and uterus pushes down on uterus

7
Q

Why is there immune suppression during pregnancy?

A

because the placenta is seen as a foreign object

8
Q

Why is Urine tested at every visit of the mother?

A

bc UTI are associated with obstetric problems especially pre-term delivery.

9
Q

What are the haemoglobin levels in pregnant and non-pregnant women?

A

non pregnant Hb is 12 - 16g/dl

pregnant Hb is 10.5 - 13g/dl

10
Q

Why is the Hb in women seen as less than a non-pregnant woman?

A

this is normal
bc the circulating blood volume in a pregnant woman increases from 4.5l to 6l.
the increase in plasma volume is more than the increase of red cells in the blood
so it is diluted
so ANAEMIA LOL

11
Q

How long does the dilutation last?

A

28 weeks- 30 weeks

12
Q

What are the main causes for having low Hb?

A

Fe deficiency (important in Hb synthesis)
sickle cell or thalassaemia
vitamin B12 and folate deficiency (both are important in Hb synthesis)
blood dyscrasias ie disorders of the blood

13
Q

How do you manage anaemia in pregnancy?

A
  1. keep monitoring Hb levels INITIAL, 28 WEEKS AND at 36 weeks.
  2. find the cause of the anaemia: serum ferritin, B12 levels,folate levels, and electrophoresis (to check for
    sickle cell and thalassaemia) is done
  3. transfuse blood if Hb is less than 7
14
Q

What are the 2 types of diabetes in pregnancy?

A

gestational- diabetes FIRST seen between 20-40 weeks of pregnancy
pre-existing- diabetes before preggo or diagnosed before 20 weeks of pregnancy

15
Q

Why does gestational diabetes occur?

A

PLACENTA releases hormones:
human placental lactogen, cortisol, oestrogen, glucagon
all the hormones lead to insulin resistance in the mother
insulin resistance increases the ability of the mother to provide carbohydrates to the foetus (as less carbohydrates are taken into the tissue
as insulin does not work effectively)

16
Q

What is polycystic ovary syndrome?

A

cysts in ovary

produce more than normal levels of male androgens

17
Q

When are sugar levels of pregnant women checked?

A

Susceptible and show risk factors for diabetes: checked at booking INITIALLY when reported preggo, 28 weeks, 34 weeks, 40 weeks

Women not susceptible: 28 weeks and 40 weeks

18
Q

What is the normal risk of congenital malformation in a pregnant woman without diabetes?

A

2-3%

19
Q

How do HbA1 levels affect the risk of congenital malformation?

A

If HbA1c levels are 5-8% preconception then 4-5% risk
If HbA1c levels are 8-10% (periconceptually) then 9% risk
If HbA1c levels are over 10% (periconceptually), then 25% risk

20
Q

Does gestational diabetes pose a problem to the foetus?

A

no- only pre existing diabetes

21
Q

How does the baby get affected if the mother has diabetes?

A

mother diabetic so mother is hyperglycaemic

so the baby is hyperglycaemic

22
Q

What happens if the baby is hyperglycaemic?

A
  1. foetus has excess insulin secreted
    so there will be abnormal growth of B cells in the pancreas which secrete insulin
  2. this leads to macrosomia and hyperplacentation (both things bigger than normal)
  3. inhibition of surfactant secretion in lungs
  4. foetus has glucose in urine
  5. can get hypoglycaemia
23
Q

What does macrosomia and hyperplacentation lead to?

A
  • prolonged labour
  • operative methods for delivery
  • can get shoulder dystocia = shoulder gets stuck in cervix
  • get pre-eclampsia
  • antepartum haemorrhage (bleeding 20 weeks after pregnancy)
  • postpartum haemorrhage (bleeding after delivery)
24
Q

What is surfactant secreted by?

A

Type II pulmonary cells

25
Q

What does hyperglycaemia in the foetus do to the lungs?

A

Inhibits surfactant secretion in the lungs

26
Q

Why can a baby develop hypoglycaemia from hyperglycaemia?

A

when baby is born
the cord is clamped
this cuts off glucose supply but the foestus has lots of insulin
so reduces glucose

27
Q

What is polycythemia?

A

when haematocrit is elevated

leads to jaundice which is yellow discolouration of the skin because of bilirubin build up.

28
Q

What condition can the foetus get if it has glycosuria?

A

polyhydramnios = high glucose in filtrate pulls water out of interstitium
baby pees alot
so lots of amniotic fluid

29
Q

What can happen because of polyhydramnios?

A

baby align itself in different way

can get cord prolapse= where umbilical cord comes our of cervix before baby does

30
Q

If a mother has pre-existing diabetes, what problems could this lead to (for the mother)?

A

high UTI risk
nephropathy
retinopathy
develop type II diabetes

31
Q

What does metformin do?

A

suppress glucose production in liver (gluconeogenesis)

32
Q

What symptoms defines pre-eclampsia?

A
  1. BP higher than 140/90 on 2 separate readings
    (take 4-6 hours apart after 20 weeks gestation)
  2. if lady already has hypertension, increase in systolic pressure of more than 30 and increase in diastolic pressure of more than 20
  3. PROTEINURIA
  4. severe oedema (in face lol)
33
Q

What are the theory causes of pre-eclampsia?

A

placentation disorder
vasospasm (arteries of mother constrict)
small vessel abnormalities
increased capillary permeability
mineral and vitamin deficiency e.g. selenium
immunological - wierd response to trophoblasts (placenta cells)
vasospastic substance- NO, TNF, free radicals

34
Q

What is IUGR?

A

Intrauterine growth restriction (IUGR) = unborn baby is not growing at the rate it should be in the womb.
can’t reach its growth potential= under 5th percentile and less than 2.5kg.

35
Q

Women with pre-existing hypertension need to consult physician before getting pregnant. Why?

A

Because Hyperglycaemia at conception is toxic for the foeture- can increase risk of sacral agenesis (Sacral doesnt form, CHD ans skeletal malformation.

36
Q

What are normal glucose levels?

A

fasting of less than 5mmol/l and 1hr post-prandial of less than 7-7.5mmol/l.

37
Q

How is the large placental flow accomodated for?

A

BP= CO X TPR
IN NORMAL PREGNANCY:
CO increases by 40% due to increased plasma volume! However TPR is reduced massively due to progesterone causing widespread vasodilatation and thus BP decreases. This helps accommodate the large placental flow.
Remember high volume low pressure!

IN PET:
Vasodilation doesnt happen so TPR increases