Paediatrics - Pregnancy and Perinatal Health

Question 1

What are fertility issues linked to

Answer 1

age
smoking
BMI
exercise
drugs
folate
alcohol

Question 2

What does low levels of folic acid put an unborn child at risk of

Answer 2

spina bifida

Question 3

Describe the stages of early pregnancy

Answer 3

ovulation happens and then fertilization happens while the oocyte is in the fallopian tube
the embryo/zygote spends first week of life transitioning own the fallopian tube before implanting onto the uterus at approximately day 8 or 9
lots of development has taken place by this stage
once the embryo has implanted there are development changes and beginning of maturity

Question 4

What are the 3 trimesters

Answer 4

first is 12 weeks
second is 12-28 weeks
third is 28-40 weeks

Question 5

What are the changes that occur across the diff trimesters

Answer 5

1st - structures of embryos forming and differentiating
2nd - more specialization and further differentiation
3rd - all that happens is growth and changes necessary for successful birth

Question 6

What are the maternal changes in pregnancy

Answer 6

physical changes
hormonal changes
hematological changes
CV changes
coagulation changes

Question 7

What are the hematological changes

Answer 7

large blood volume produced to protect from death from blood loss at birth

Question 8

What are the hormonal changes in pregnancy

Answer 8

increased estrogen and progestogen

Question 9

What does the increased estrogen and progestogen do

Answer 9

act on kidney to increase renin secretion
increased salt and water retention
increased plasma volume by 45%

Question 10

Why does plasma volume increase

Answer 10

protects against hemorrhage at birth

dilution effect makes Hb fall from 15-12g/dL

Question 11

How do hormonal changes cause diabetes

Answer 11

reduce insulin sensitivity

Question 12

Why does the lower esophageal sphincter relax

Answer 12

increase abdominal pressure gives increased GORD

Question 13

What are the hematological changes in pregnancy

Answer 13

increased production of RC< WC, platelets
20% increase in RC mass
increased platelet consumption makes platelets normal to low

Question 14

What is the issue with increased WC in pregnancy

Answer 14

increased WC makes diagnosing infection difficult

Question 15

What are the CV changes

Answer 15

relaxation of vascular smooth muscle

vascular compression by uterus

Question 16

What is the effect of relaxation of vascular smooth muscle

Answer 16

reduced peripheral resistance
reduced systolic and diastolic BP
compensatory increase in HR by 25%

Question 17

What is the effect of vascular compression by the uterus

Answer 17

compresses vena cava and aorta
results in difficult with venous return when supine so ensure there is a pillow under one side or sit slightly to the side so no pressure on vessels

Question 18

What are the coagulation changes in pregnancy

Answer 18

clotting factors production increases
fibrinolysis increases
increased system sensitivity with increased DVT risk

Question 19

What should pregnant women not eat

Answer 19

raw/slightly cooked meat and raw fish
raw eggs
non pasteurized milk and milk cheeze
spicy grilled and fried food
marlin, tuna and shark
liver and other entrals and internal organs of a slaughtered animal during the first 3 months

Question 20

Why should they avoid raw /slightly cooked meat and raw fish

Answer 20

danger of infection with toxoplasmosis

Question 21

Why should they avoid raw eggs

Answer 21

salmonella

Question 22

Why should they avoid non pasteurized milk and milk cheese

Answer 22

listeria

Question 23

Why should they avoid spicy, grilled and fried food

Answer 23

dyspesia and GORD

Question 24

Why should they avoid tuna etc

Answer 24

mercury

Question 25

What does development start

Answer 25

at 4 weeks | zygote becomes embryo

Question 26

What happens in week 6

Answer 26

start of embryonic circulation | weeks 6-10 embryonic development and growth

Question 27

When do embryo stages stop

Answer 27

week 10 it is a fetus from 10-14 weeks features and limbs become developed and active

Question 28

When is miscarriage rate highest

Answer 28

first trimester

Question 29

From week 14-18 what happens

Answer 29

hair, nails, toenails and eyelids start to form and movement may be felt

Question 30

What happens weeks 18-20

Answer 30

toes and fingers formed and hearing starts to respond

Question 31

What happens weeks 20-26

Answer 31

final development of vision and senses | brain development and body fat increase

Question 32

What are foetal changes from week 27

Answer 32

growth and NS maturation

Question 33

What is placenta

Answer 33

interlinking mesh of VS so maternal and fetal circulation do not mix but are in close proximity and nutrients can diffuse some infections and toxins can diffuse through fetus

Question 34

What are the stages of labour

Answer 34

induction first stage second stage third stage

Question 35

What is looked at in screening pregnancy in first trimester

Answer 35

establish dates of pregnancy determine the number of fetuses and identify placental structures to diagnose an ectopic pregnancy or miscarriage to examine the uterus and the other pelvis anatomy in some cases to detect foetal abnormalities

Question 36

What are the mothers screened for

Answer 36

chronic diseases | infectious disease

Question 37

What are the fetus screened for

Answer 37

genetic and developmental abnormalities

Question 38

What are chronic diseases that are screened for

Answer 38

hypertension | diabetes

Question 39

What are infections that are screened for

Answer 39

rubella syphilis hep C HIV

Question 40

What is screen for at weeks 18-20

Answer 40

confirm pregnancy dates determine number of fetuses and examine placental structures assist in prenatal tests such as amniocentesis examine the foveal anatomy for presence of abnormalities to check the amount of amniotic fluid examine blood flow patterns to observe foetal behavior and activity to examine the placenta to measure the length of the cervix to monitor foetal growth

Question 41

Whta is FAST

Answer 41

foetal abnormalitiy screening programme

Question 42

What is screen for in FAST in see 1

Answer 42

``` neucheal translucency (ultrasound) maternal hCG (blood) PAPP-P blood ``` looking for chromosome abnormality from combined result

Question 43

What do we test in the fetus in second trimester

Answer 43

alpha foetus protein

Question 44

What is the abnormality follow up after AFP

Answer 44

CVS and amniocentesis - genetic changes | ultra sound - spina bifida

Question 45

What are the birth testing

Answer 45

physical exam hearing test blood spot

Question 46

Whats tested in bloods put

Answer 46

``` PKU hypothyroidism CF sickle cell mCADD ```

Question 47

What does the APGAR score consist of

Answer 47

``` activity pulse grimace appearance respiration rate done at 1 min and 5 min ```

Question 48

What does activity look at

Answer 48

muscle tone

Question 49

What should pulse be

Answer 49

>100/min

Question 50

What does grimace test

Answer 50

reflex irritability

Question 51

What does appearance look at

Answer 51

colour

Question 52

What are considerations of pregnancy in dentistry

Answer 52

``` cost of dental care drugs in pregnancy pregnancy gingivitis periodontal health in pregnancy position of mother ```

Question 53

Why is pregnancy gingivitis a thing

Answer 53

hormone levels change | immune response heightened to plaque