GUM 235 Pregnancy 2

Question 1

What increase in CO output is required in pregnancy and why?

Answer 1

30-50%

Due to the increased preload

Question 2

What happens to HR in pregnancy?

Answer 2

Increases due to increase SV / preload

Question 3

Why is the CO post-partum increased by nearly 80%?

Answer 3

Due to sudden increase in vascular resistance to prevent haemorrhage yet still increased blood volume

Question 4

Why is there dyspnoea in pregnancy?

Answer 4

Rising fundus

Progesterone effect

Question 5

What do you see on ECG in pregnancy?

Answer 5

sinus tachy and left axis deviation

Question 6

What liver function test is raised normally in pregnancy?

Answer 6

ALP x1.5-2

Question 7

What happens to protein levels in pregnancy

Answer 7

decreased: total protein, albumin and gamma globulin

Question 8

What happens in a FBC in pregnancy?

Answer 8

neutrophillia,
decreased PLT,
increased RBC mass due to increase volume th. decreased hct / hb

Question 9

Why is the female in a pro-thrombotic state during pregnancy?

Answer 9

To protect against post-partum haemorrhage

Question 10

Why is there a compensatory respiratory alkalosis in pregnancy?

Answer 10

due to increased alveolar ventilation which facilitates fetomaternal oxygen transfer

Question 11

What happens to kidney size and blood flow in pregnancy?

Answer 11

increased

therefore increased GFR - decreased urea and creatinine

Question 12

What may altered tubular function in pregnancy result in?

Answer 12

glycosuria, proteinuria, calcium and bicarb in ?urine

th, UTI and pyelonephritis

Question 13

Why can there be a transient hyperthyroidism in pregnancy?

Answer 13

B-HCG binds to the TSH receptor = increased T3 and T4

Question 14

Why is there reflux in pregnancy?

Answer 14

prog decreases LOS tone

Question 15

What are the RF’s for multiple pregnancy?

Answer 15

increased maternal age, fhx, race and assisted conception

Question 16

monozygotic twins

Answer 16

identical - one zygote splits into two

Question 17

dizygotic twins

Answer 17

non-identical - 2 different zygotes

Question 18

dichorionic diamniotic (DCDA)

Answer 18

each twin has own chorion, placenta and amnion (always dizygotic)
Can be fused or separate

Question 19

monochorionic diamniotic (MCDA)

Answer 19

one placenta and chorion but two amnions

Question 20

monochorionic monoamniotic MCMA

Answer 20

one of everything between two!

Question 21

What are the risks of multiple pregnancy?

Answer 21

miscarriage, congenital abnormalilties,pre-term, IUGR

Question 22

What is the ABC before instrumental delivery?

Answer 22

A= adequate analgesia
B = empty bladder
C = dilated cervix

Question 23

Where do you place the ventouse suction cap?

Answer 23

2-3cm anterior to posterior fontanelle

Question 24

What are the main causes of bleeding in early pregnancy?

Answer 24

ectopic or miscarriage

Question 25

What do you see in a threatened miscarriage ?

Answer 25

baby alive, os closed

Question 26

What do you see in inevitable miscarriage?

Answer 26

os is open

Question 27

How do you manage incomplete miscarriage?

Answer 27

Conservative Medical : misoprostol and anti-D Surgical

Question 28

What are some causes of bleeding in late pregnancy/ labour?

Answer 28

placental abruption - separation of placenta placenta praevia - placenta covers LOS ruptured uterus

Question 29

What are some causes of post-partum haemmorhage?

Answer 29

ruptured uterus, uterine artery bleeding trauma retained placenta

Question 30

What is primary PPH?

Answer 30

bleeding occurs

Question 31

What is secondary PPH?

Answer 31

bleeding occurs >24-6 weeks post partum

Question 32

What are some risk factors for post-partum haemmorhage?

Answer 32

previous history, smoking, increased age, previous TOP, IVF, defective endometrium

Question 33

How would you managed PPH?

Answer 33

empty bladder, bimanual contraction, give oxytocis, repair surgically, before delivery: group and save blood, IV access

Question 34

What are the three features of pre-eclampsia?

Answer 34

proteinuria, HTN and oedema

Question 35

What other features can you get with pre-eclampsia?

Answer 35

headache, vision distubrances, RUQ pain, N&V placental ischaemia = decreased GFR and increased creat/urea

Question 36

What is HELLP syndrome in pre-eclampsia?

Answer 36

haemolysis, elevated liver enzymes, low platelets | = emergency - must deliver!

Question 37

What is the pathophysiology behind pre-eclampsia?

Answer 37

diffuse vascular endothelial dysfunction with circulatory disturbances involving multiple systems affected by genetics placental ischaemia in 1st half of pregnancy abnormal placentation and trophoblast invasion lack of vascular adaptation to pregnancy