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Fetal circulation + pregnancy Flashcards

(52 cards)

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1
Q

Ductus Venous

A

highly oxygenated blood comes from placenta to fetus via umbilical vein –> directed to IVC via this shunt (bypass liver)
Travels directly to heart to move to brain

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2
Q

Foramen ovale

A

cardiac ventricles work on parallel

Allow highly oxygenated blood to move from right atrium to left atrium –> supply brain/heart

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3
Q

Ductus arteriosus

A

lungs not needed for oxygenation
90% blood from RV bypassed via this shunt from pulmonary artery to descending aorta
RV pumps deoxygenated blood to lower body and back to placenta

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4
Q

Umbilical vein

A

from umbilicus to DV

becomes ligamentum teres hepatis

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5
Q

Ductus venosus

A

from umbilical vein to inferior vena cava

becomes ligamentum venosum

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6
Q

Foramen ovale

A

from RA to LA

becomes closed atrial wall

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7
Q

Ductus arteriosus

A

from pulmonary artery to descending aorta

becomes ligamentum arteriosum

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8
Q

Umbilical artery

A

from common iliac artery to umbilicus

becomes superior vesical arteries; lateral vesicoumbilical ligaments

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9
Q

Positive dx of pregnancy

A

fetal heart
fetal movement
visualization of fetus

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10
Q

probable Dx of pregnancy

A 
enlarged uterus
uterine/cervical changes
palpation of fetus
Braxton hicks contractions
pregnancy test
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11
Q

Presumptive Dx of pregnancy

A 
amenorrhea
breast changes
congestion of vagina
skin changes
common symptoms (nausea, fatigue, bladder irritability)
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12
Q

Naegle rule

A

LMP + 7 days - 3months + 1 year

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13
Q

Ultrasound dating

A

measurement of fetal size compared to normal curves
earlier scan more accurate ( LMP if within 1 week difference
if over >2 weeks difference: take note if fetal growth restricted

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14
Q

First prenatal visit

A 
confirm pregnancy
do not have to repeat pregnancy test if patient has already done one
medical history
risk assessment
full physical + pap and swabs
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15
Q

Prenatal care

A 
pregnancy recommendations
smoking cessation
alcohol/illicit drugs
physical activity
sexuality - semen may have prostaglandins; if prematurity risk high, advise against sexual intercourse
supplements (folate, iron)
work environment
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16
Q

Routine investigations during pregnancy

A 
weight, BP
urine dip for protein
SFH
Fetal HR
fetal growth - SFH +/- ultrasound
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17
Q

1st visit labs for pregnancy

A 
Blood type/screen (repeat at 26-28 wks esp important in Rh- women)
CBC - Hb electrophoresis if indicated
Rubella (can't vaccinate since live attenuated)
syphilis - can treat
HBsAg - can vaccinate if needed
HIV - counsel
\+/- HC
Swabs GC/CT
Pap if needed
\+/- TSH (common)
Ultrasound - dating
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18
Q

Ultrasound schedule during pregnancy (N)

A

Dating

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19
Q

Genetic screening

A

all pregnant women should be offered
blood test available in first/second trimester, combination produces a risk estimate
CVS 10-13 weeks
amnio >15 weeks

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20
Q

Gestational diabetes screen

A

24-26 weeks

75g OGT - do earlier if at risk (twins - hPL, ethnicity, previous DM)

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21
Q

GBS screening

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A

35-37 weeks

for risk of sepsis and meningitis

22
Q

Anemia in pregnancy

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A

Hb 100 = anemia
Physiologic anemia of pregnancy
check for Fe deficiency with ferritin

23
Q

Physiologic anemia of pregnancy

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A

due to 50% increase in plasma volume compared to only 20-30% increase in erythrocyte mass
generally normocytic, >105

24
Q

Risks of GDM

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A

maternal: operative delivery, 50% risk T2DM
Fetal: macrosomia (sugar crosses but insulin doesn’t; fetus produces insulin and insulin-like growth factor), stillbirth
Neonatal:hyperglycemia

25
Group B Strep - pregnancy
10-30% universal screening at 35-37 weeks don't screen too early - part of normal flora
26
GBS who to treat
treat GBS+ when membranes rupture GBS bacteriuria in this pregnancy - treat, don't need to swab Prior GBS affected child: treat, don't need to screen GBS unknown and ROM > 18 hours: treat GBS+, intrapartum: treat Don't need to treat: - elective C-section (if membranes don't rupture beforehand) - GBS+ 1st pregnancy and infected baby --> treat child, don't need to screen
27
GBS treatment
can't eradicate! IV penicillin if allergic: anaphylaxis: clindamycin/erythromycin at least 2 intrapartum doses to mom
28
Small SFH, lack of interval growth
ask about fetal movement broad differential maternal: HTN, chronic medical conditions, malnutrition, weight loss, medications, substance use, rupture membranes Fetal: chromosomal, growth restriction, infection Placental: poor implantation, chronic abruptio, oligohydramnios US if SFH >3cm behind GA Non-stress test: 20-45 min fetal heart rate tracing
29
Fetal Heart visualization
normal maternal BMI: 5-6 wk on transvaginal ultrasound 8 wk on transabdominal ultrasound
30
Fetal HR audio
10-12 wk with Doptone
31
Hypertension in pregnancy
single elevated BP: 30-70% of women with single elevated BP will be normal on repeat testing
32
Dx of gestational HTN
SOGC: diastolic > 90 based on average of >=2 measurements taken in same arm >15 min apart diastolic is a better predictor of adverse pregnancy outcomes Systolic > 160 diagnostic BUT keep an eye on systolic > 140
33
Preeclampsia
gestational HTN + proteinuria (>=2 2+ on dipstick, 0.3 g/day or 30 mg/mol on spot PCR)
34
GERD in pregnancy
more common due to: - progesterone affecting smooth muscle - delayed gastric emptying - mass effect from uterus Drugs in pregnancy: - some drugs cross placenta - ranitidine is okay
35
Postpartum blues
80% women, lasting
36
Postpartum depression
10-25% women = medical condition needing treatment
37
Contraception post-partum
Lactation Combined OCP can affect milk supply - progesterone less effect but also less effective as contraception IUD: wait 6 weeks postpartum to allow uterine involution
38
Lactation as contraception
Exclusive breastfeeding at 6 mo: 95% effective non-exclusive: 50% ovulate by 6 weeks non-BF: often resume by 45 d
39
Breast changes during pregnancy
early: tenderness/paraesthesias >2 mo: increase in size, delicate veins visible - nipples enlarge, more deeply pigmented/erectile Later: colostrum can be expressed from nipples by gentle massage - areolae become broader, more deeply pigmented some striations if breasts become large
40
Cervical changes during pregnancy
softening/cyanosis as early as 1 mo after conception - increased vascularity, edema, hypertrophy/hyperplasia of cervical glands Proliferation of glands: - produce mucus rich in Ig and cytokines, may act as immunological barrier mucus plug expelled at onset of labour/earlier --> bloody show Small amounts of smooth muscle, mostly CT collagen-rich CT rearranged = ripening - decreases collagen/Proteoglycan concentrations, increase water content - regulated by local E and P
41
Uterine changes during pregnancy
``` 500-1000x bigger - most marked in fundus increase in weight to 1.1 kg cavity ~5L or >20 L early: - hypertrophy/stretching of muscle cells stimulated by E, maybe P - production of new myocytes limited - accumulation of fibrous tissue, esp in external muscle layer - increase in elastic tissue content ``` Late: - relatively thin-walled muscular organ
42
Pulmonary changes during pregnancy
``` diaphragm rises ~4 cm thoracic circumference increases ~6 cm diaphragmatic excursion increases FRC decreases 20-30% inspiratory capacity increases 5-10% total lung capcity unchanged/decreases by ```
43
Oxygen delivery during pregnancy (maternal blood)
amount of O2 delivered to lungs by increased tidal volume exceeds O2 requirements total Hb mass increases maternal A-V O2 difference increased O2 consumption increases~20%
44
Acid-base equilibrium (maternal) during pregnancy
increased awareness of a desire to breathe - physiological dyspnea caused by increased tidal volume that lowers blood PCO2 slightly Respiratory alkalosis - to compensate: HCO3- decreases - blood pH increases only minimally - shift O2 dissociation curve to left: Bohr effect --> decrease O2 releasing capacity of maternal blood
45
Cardiovascular changes during pregnancy
Plasma volume increases by 45% - P and E on kidney --> Renin --> RAS --> Na retention (protection from hemorrhage) Increase renal EPO production: RBC mass increase 20% - hemoglobin falls White cell count rises, peaks after delivery Fall in peripheral vascular resistance by 20% - E & P --> vasodilation - systolic/diastolic BP fall --> reflex increase in HR by 25% - SV increased by 25%, CO increased by 50%
46
Coagulation during pregnancy
plasma concentrations of fibrinogen/all clotting factors gradually increase increase in platelet production (but relative thrombocytopenia because of increased activity and consumption) increase in fibrinolysis
47
Metabolic changes during pregnancy
insulin production rises increased insulin resistance caused by placental hormones (hPL) Any carbohydrate load will cause greater than normal increase in plasma glucose concentrations --> facilitates glucose transfer
48
GU changes during pregnancy
renal plasma flow, GFR increase urea/creatinine/urea clearance and excretion of HCO3- increased --> plasma concentration decrease Activities of RAS, aldosterone, progesternoe increase --> water retention, decreased plasma osmolality resorption of glucose falls progesterone-mediated ureteric smooth muscle relaxation --> urinary stasis --> increased risk for UTI, urinary incontinence
49
GI changes during pregnancy
``` Heartburn common - increased intraabdominal pressure - progesterone-mediated reduction in LES tone Pregnancy gingivitis - gums hyperemic, softened Hemorrhoids common More likely to develop gallstones ```
50
Immune tolerance during pregnancy
Semiallogeneic fetus allowed to growt within maternal uterus
51
MSK changes during pregnancy
progressive lordosis | sacroiliac/sacrococcygeal/pubic joints increased mobility
52
Skin/orofacial changes during pregnancy
abdominal wall: striae gravidarum Hyperpigmentation: - up to 90% of women - usually more accentuated in those with darker complexion - melanocyte-stimulating hormone level elevated - E and P - melanocyte-stimulating effects??? Vascular changes: - angiomas: esp on face, neck, upper chest, arms; palmar erythema (due to hyperestrogenemia??) increased cutaneous blood flow; dissipate heat generated by increased metabolism

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