Maternal And Foetal Wellbeing

Question 1

What weeks is an embryo at most risk from teratogens?

Answer 1

3-14/40 (when they don’t know they’re pregnant)

Question 2

What’s structural and functional abnormality?

Answer 2

Due to teratogens

Structural abnormality = problem with body part development eg cleft lip or neural tube defect

Functional abnormality = problem with how a body part/system works eg developmental disabilities

Question 3

During which trimester is the embryo most susceptible to teratogens?

Answer 3

First trimester (first 12 weeks/3 months)

Question 4

What’s toxoplasmosis?

Answer 4

Can cause miscarriage
Teratogens
Cat poo found in soil/cat litter

Question 5

What food can be a teratogen?

Answer 5

Mould ripened cheese eg blue cheese

Listeria bacterium -> miscarriage/stillbirt

Question 6

What are common symptoms in the first trimester of pregnancy?

Answer 6

Morning sickness due to rising hCG levels
Hyperemesis gravidarum (hospitalised morning sickness)
Increased frequency of micturition

Question 7

Why is there increased frequency of micturition during pregnancy?

Answer 7

Due to increased vascularity of the bladder (lasts until 16/40 when the uterus rises out of the pelvic girdle)

Question 8

What are 3 ways to date a pregnancy?

Answer 8

From the last menstrual period (first day)
Crown rump length at early sonogram
Fundus-symphysis height from week 24

Question 9

What are symptoms during the later stages of pregnancy?

Answer 9

Periodontal disease
Heartburn
Constipation (rising progesterone = reduced gastric motility)
Haemorrhoids
Vaginal discharge (leucorrhoea = normal)
Hyperpigmentation of skin
Backache
Symphysis pubis dysfunction
Leg cramp
Carpal tunnel syndrome + oedema in the carpal tunnel

Question 10

What are some basic recommendations to improve health of childbearing women and their infants?

Answer 10

Improve maternal nutrition
Reduce levels of smoking
Reduce alcohol consumption
Increase exercise
Reduce incidence of premature births
Increase incidence of healthier neonates

Question 11

What’s Gravidity and Parity?

Answer 11

Gravidity = total number of pregnancies including the current one

Parity = number of live/still births after 24 weeks gestation (anything else counted as +1)

Question 12

What’s the obstetric history of a woman with a GPA of G3 P3

Answer 12

Has been pregnant 3 times

Given birth 3 times

Question 13

How is GPA expressed to a woman with one child and twins, who has never been pregnant another time

Answer 13

G2 P3

Question 14

How many births will be premature? What’s stillbirth thought to be related to?

Answer 14

10%

Stillbirth thought to be linked to intrauterine growth restriction

Question 15

What are 3 potentially modifiable factors for reducing stillbirths?

Answer 15

Obesity
Smoking
Foetal growth restriction

Question 16

What are the 3 categories of birth weight?

Answer 16

Average 3.2 kg
Small under 2.5 kg
Large over 4.5 kg

Question 17

Define prematurity - what are the 3 categories?

Answer 17

A baby that is born before 37 weeks

Extremely preterm less than 28 weeks
Very preterm 28-32 weeks
Moderate-late preterm 32-37 weeks

Question 18

What are two drugs that can be used if there is a risk of prematurity?

Answer 18

Magnesium sulphate = neuroprotectant role in cerebral palsy

Steroids (Betamethasome) = prevents bleeding on the brain; lower risk of necrotising enterocolitis; stimulates synthesis of lung surfactant

Question 19

When do you have a steroid injection during pregnancy?

Answer 19

24-34 weeks double dose

34-37 weeks

Question 20

What’s the difference between biometric and biophysical tests?

Answer 20

Biometric tests predict size at a point in gestation

Biophysical tests predict foetal wellbeing (eg Doppler)

Question 21

What are foetal biometric parameters during the first and second trimesters?

Answer 21

First trimester: crown rump length used in early pregnancy

Second trimester scans onwards:
Biparietal diameter
Head circumference
Abdominal circumference
Femur length

Question 22

What are risks of intra-uterine growth restriction?

Answer 22

Low birth weight
Decreased O2 levels
Hypoglycaemia
Hypothermia
Less resistant to infection
Difficulty handling vaginal delivery

Question 23

What are types 1 and 2 IUGR and their causes?

Answer 23

Type 1 = all foetal biometrics less than expected
Caused by infection or chromosome abnormalities

Type 2 = disproportion between parameters, abdominal circumference classically affected
Caused by placental insufficiency, pre-eclampsia

Question 24

What’s biophysical profiling?

Answer 24

Combines non-stress test with ultrasound to check health of foetus - measures foetal heart rate in response to foetal movements

Question 25

What can biophysical profiling assess?

Answer 25

``` Foetal heart rate Foetal breathing Foetal movements Foetal tone Amniotic fluid volume ```

Question 26

At what weeks does swallowing start in the foetal GI system? What does foetal swallowing regulate?

Answer 26

10-12 | Amniotic fluid volume is regulated by swallowing

Question 27

What’s meconium?

Answer 27

Baby’s first stool = dark green black gut debris as it accumulates in foetal gut

Question 28

How is foetal waste excreted?

Answer 28

Via the placenta

Question 29

How is the foetal urinary system monitored?

Answer 29

Foetal kidney number/size/structure Amniotic fluid volume Bladder activity

Question 30

When does foetal urine add to the amniotic fluid?

Answer 30

After week 20 (in latter pregnancy majority of amniotic fluid volume is foetal urine)

Question 31

How does the volume of amniotic fluid change throughout pregnancy?

Answer 31

10ml at 8 weeks 1L at 38 weeks Falls to 300ml at 42 weeks

Question 32

What’s polyhydramnios and oligohydramnios?

Answer 32

Too much and too little amniotic fluid

Question 33

What are 3 additional structures in the foetal circulation?

Answer 33

Ductus arteriosus Ductus venosus Foramen ovale

Question 34

Via which vessel does oxygenated blood get from the placenta to the foetus?

Answer 34

Umbilical vein

Question 35

What’s the normal foetal heart rate?

Answer 35

110-160 bpm

Question 36

How can you monitor foetal cardiovascular system?

Answer 36

Umbilical artery flow Doppler

Question 37

What’s a cardiotocography?

Answer 37

Technique to record foetal heartbeat and uterine contractions during pregnancy

Question 38

How does foetal circulatory system adapt after birth?

Answer 38

Onset of breathing as pulmonary vascular resistance decreases Increased blood flow to the lungs increases volume of pulmonary venous blood returning to the left atrium so left atrial pressure exceeds right atrial pressure = foramen ovale closure Ductus arteriosus constricts as flow through pulmonary circulation increases and O2 tensions rise

Question 39

What causes the ductus arteriosus to close and when?

Answer 39

Within 1 day postnatal Due to constriction of ductus arteriosus (as O2 tensions rise due to increased flow through pulmonary circulation) (Ductus venosus closes within 2-3 months after birth)