Pregnancy Flashcards
(144 cards)
1
Q
What is a blastocyst?
A
- a ball of rapidly diving cells
- 200-300 cells
- what implants onto the uterus wall
2
Q
When does the blastocyst attach to the uterus lining?
A
- day 5-8
3
Q
When does the blastocyst implant on the uterus?
A
- by day 12
4
Q
The outer cells of the blastocyst form what?
A
- The placenta
5
Q
What is the role of the placenta?
A
- oxygen transport
- nutrient and waste transport
6
Q
What is the placenta derived from?
A
- trophoblast and decidual tissue?
7
Q
Explain how maternal and fetal blood doesn’t mix?
A
- trophoblast cells -> multinucleate cells -> invade decidua -> breakdown of capillaries
- formation of cavities filled with maternal blood (intervillous space)
- foetal umbilical veins and arteries penetrate into intervillous space
- villus filled with foetal blood
8
Q
At what stage is the placenta functional?
A
- by the 5th week
9
Q
HCG causes what?
A
- the corpus luteum to secrete progesterone in early pregnancy
- doubles every 48hrs until week 12-14
10
Q
Maternal oxygen rich blood enters what?
A
- umbilical veins
11
Q
What increases the oxygen transport to the foetus?
A
- fetal Hb = greater affinity for o2
- Increased Hb in foetus
- Bohr effect
12
Q
Explain the Bohr effect?
A
- foetal Hb can carry more O2 in lower PCO2 than high
13
Q
CRH causes??
A
- acth -> Aldosterone + cortisol
- leading to gestational diabetes and hypertension
14
Q
Increased HCG may cause?
A
- hyperthyroidism
15
Q
What does HCG stand for?
A
- human chorionic gonadotrophin
16
Q
Role of HPL
A
- Human placental lactogen
- growth hormone
- decreases insulin sensitivity in mum
17
Q
Role of progesterone in pregnancy?
A
- reduces contraction
- preparation of lactation by development of lobular-alveolar system
18
Q
Role of oestrogens in pregnancy?
A
- uterus enlargement
- breast development by growth of ductile system
- relaxation of ligaments
- increase in oxytocin receptors
19
Q
Explain cardiovascular changes in pregnancy?
A
- increased cardiac output
- increased heart rate
- decreased BP in 2nd trimester
20
Q
Explain haematological changes in pregnancy?
A
- Increase in plasma volume (can cause increased oedema)
- increased RBC
- Decreased Hb
21
Q
How is anaemia defined in pregnancy?
A
- 1st trimester Hb< 110
- 2nd or 3rd Hb < 105
22
Q
Respiratory changes in pregnancy?
A
- increased respiratory rate
- increased o2 consumption
- decreased pco2
23
Q
Urinary changes in pregnancy?
A
- GFR and renal plasma flow increases
- increased urine formation
24
Q
Why is there an increased risk of VTE in pregnancy?
A
- hypercoaguable state to reduce risk of haemorrhage
25
Average weight gain in pregnancy?
11 kg
26
What causes maternal insulin resistance?
- HPL
- CORTISOL
- GROWTH HORMONES
27
The 2 metabolic phases of pregnancy?
- 1st trimester = anabolic
| - 2nd/3rd = catabolic
28
Special nutritional needs in pregnancy?
- folic acid
- vitamin D
- high protein
- iron supplementation
- vitamin b
29
What may be given to induce labour?
- prostaglandins
| - oxytocin
30
Role of prostaglandins in labour?
- ripen cervix
31
Role of oxytocin in labour?
- increased contraction
| - stimulation of prostaglandins (ripen cervix)
32
Role of oestrogen in labour?
- increases oxytocin receptors?
33
3 stages of labour?
- cervical dilation
- passage of foetus from birth canal
- passage of placenta
34
Oxytocin role in lactation?
- milk let down reflex
35
What hormone stimulates milk?
- prolactin
36
Define sensitivity?
sensitivity = true positives / (positive + false negatives)
37
When is the booking scan usually performed?
- 8-12weeks
38
What does the booking exam incorporate?
- medical hx, surgical hx, social and family hx
- examination
- bloods
- USS
39
Explain how gestation can be calculated before a scan?
- Naegele's rule = add 280 days onto LMP
40
Pseudo sac on USS may indicate?
- ectopic pregnancy else where
41
Placenta previa?
- condition where the placenta lies over the cervix
| - c-section will be required
42
Trisomy 18?
- Edward's syndrome
| - almost always seen on 20 week scan due to multiple abnormalities
43
Trisomy 21?
- Down syndrome
| - may not always be seen on USS as a spectrum disease
44
Trisomy 21 is also associated with what conditions?
- duodudenal atreasia
| - cardiac defect
45
Trisomy 13?
- Patau's syndrome
- multiple physical abnormalities
- generally fatal
46
When is trisomy screening performed and what does it include?
- first trimester
- trisomy 13, 18, 21
- nuchal translucency test and bloods
47
Explain nuchal translucency?
- volume of fluid behind the fetal neck
| - increased volume associated with increased risk of foetal abnormality
48
If a pregnancy is deemed high risk of trisomy what test can be done?
- NIPT
- Non-invasive parental testing
- screening only
49
What diagnostic antenatal tests can be performed?
- amniocentesis
| - chorionic villus sampling
50
Maternal anaemia may be due to what?
- iron, folate, B12 deficiency
51
When is Anti-D injections given to a mother with rhesus negative status?
- 28 weeks
| - any sensitising event
52
Risk factors for gestational diabetes?
- BMI > 30
- Previous macrosomic baby
- previous gestational diabetes
- 1st degree relative with diabetes
- minority ethnic family origin
53
How is fetal growth assessed?
- from 24 weeks
| - SFH (Symphysis fundal height)
54
How is pre-eclampsia screened for?
- urinalysis and BP
| - High risk advised to take 150mg aspirin
55
Urinalysis is performed in pregnancy to screen for what>
- UTI
- Asymptomatic bacteria
- pre-eclampsia
- diabetes
56
Define pharmacokinetics?
- what the body does to the drug
57
How might absorption of a drug differ in pregnancy?
- morning sickness
- increased plasma volume
- increased fat stores
58
Folic acid recommendation?
- 400mg daily for 3 months prior and first 3 months
59
Name some teratogenic drugs?
- ACEi
- ARB
- Lithium
- Antiepileptics
- methotrexate
- androgens
60
What should be used to treat diabetes in pregnancy
- insulin
| - off sulphonyureas
61
Epilepsy medication has a risk of?
- congenital abnormalitiy
| - increase folic acid to 5mg
62
Drugs used for hypertension in pregnancy?
- labetolol
| - methyldopa
63
Amiodarone in breast feeding?
- neonatal hypothyroidism
64
Prophylaxis for high risk VTE in pregnancy
- LMWH
65
Tetracyclines in pregnancy?
- may cause teeth or bone staining
| - avoid
66
Alcohol in pregnancy may cause
- fetal alcohol syndrpme
67
Phenytoin is what drug, and why should it be avoided in pregnancy?
- antiepileptic
| - cleft lip and palate
68
Valproate may have what affect on feotus
- neural tubal defects
| - avoid
69
What is performed in a 1st trimester trisomy screening test?
- nuchal translucency
| - serum markers
70
What is a normal nuchal translucency?
- less than 3.5mm
71
If a pregnancy is deemed high risk for trisomy 21 after trisomy screening what is performed?
- NIPT
72
Explain NIPT
- Screening test
- placental DNA in maternal blood
- predictive value > 90%
73
Disadvantage of microarray?
- may highlight many polymorphisms
74
When is a foetal MRI used?
- foetal brain abnormalities
75
What is a TORCH screen?
- looking for foetal infections
- toxoplasosis
- rubella
- cytomegalovirus
- herpes simplex
HIV
76
What defines a large for date baby?
- Symphyseal-fundal height > 2cm for gestational age
77
Causes of large for dates?
- wrong dates
- fetal macrosomia
- polyhdramnios
- diametes
- multiple pregnancy
- obesity
78
What is foetal macrosomia?
- USS EFW > 90th centile
| - > 4.5kg
79
Risks associated with foetal macrosomia?
- labour dystocia
- shoulder dystocia
- PPH
80
When would a c-section be recommended in Fetal macrosomia?
- EFW > 5kg
81
Define polyhydramnios?
- excess amniotic fluid
- amniotic fluid index > 25cm
- deepest pool > 8cm
82
Causes of polyhydramnios?
- diabetes
- gi atresia
- hydrops fetalis
- viral infection
- idiopathic
83
Investigations for polyhydroamnios?
- OGTT
- Serology
- antibody screening
- USS
84
Management of polyamniohydros?
- induced labour by 40weeks
85
Monozygotic?
- one egg divides
86
Dizygotic?
- 2 eggs 2 stem
87
Monochorionic?
- twins share 1 placenta
88
How often should monochorionic twins be USS?
- 2 times per week after 16 weeks
89
How often should dichoronic twins be USS?
- Every 2 weeks after 16 weeks
90
Symptoms of a multiple pregnancy?
- increased symptoms
- increased AFP
- Large for dates
91
What should be given to multiple pregnancy?
- iron supplements
- folic acid
- low does aspirin
92
Complications of a multiple pregnancy?
- single fetal death
- twin-to-twin transfusion syndrome
- twin anaemia polycthaemia sequence
93
Explain twin-to-twin transfusion syndrome? And its treatment
- anastomosis of arterial and venous
- one twin is the donor (olgiohydraminos)
- one twin is the receipt (polyhydraminos)
- treatment < 26weeks = fetoscopic laser ablation
- treatment > 26 weeks = aminoreduction
94
Complication of fetoscopic laser ablation in twin-to-twin transfusion syndrome?
- twin anemia polycthaemia sequence
95
Complication of diabetes in pregnancy?
- pre-eclampsia
- polyhyfdramnios
- macrosomia
- neonatal hypoglycaemia
96
What additional antenatal care should be given to a diabetic mum?
- folic acid 5mg (3 months before to 12weeks)
| - low dose aspirin (12weeks to delivery)
97
Risk factors for gestational diabetes?
- previous gdm
- BMI > 30
- 1st degree relative
- polyhydraminos
- glycosuria
98
Labour risk in gestational diabetes
- labour dystocia
- shoulder dystocia
- neonatal hypoglycaemia
99
Hormones that can cause gestational diabetes?
- human placenta lactogen
- cortisol
- growth hormone
100
How is Gestational diabetes diagnosed
- screening at 24-28 weeks for all
- high risk screening in 1st trimester
- Fasting BG > 5.1
- 2hr BG > 8.5
101
Folic acid supplementation
- 400mmg 12weeks-12weeks
| - 5mg in
obese, diabetics, history of NTD, on anti-epileptics
102
Typical vitamin D supplementations?
- 10mg supplementation
103
Pre-pregnancy risks associated with obesity?
- menstrual disorders
| - subfertility
104
Obesity management in pregnancy?
- Gestational diabetes screening
- Hypertension screening
- folic acid 5mg
- Vitamin D 10mg
- aspirin 150mg
- Serial growth scans
- VTE risk assessment
105
Obesity effect on the foetus?
- congenital anomaly
- macrosomia
- shoulder dystocia
- still birth
- neonatal death
106
Symptoms of a dural venous sinus thrombosis?
- severe headache
| - can cause brain damage
107
What is Virchow's triad?
- hypercoaguble state
- venous stasis
- vascular damage
108
What is used in the prophylaxis and treatment of VTE?
- LMWH
109
Warfarin in pregnancy?
- should be avoided
- teratogenic
- crosses the placenta
110
Symptoms of DVT
- Swelling
- oedema
- groin pain
- fever
- increased leg temperature
111
Symptoms of obstetric cholestasis?
- disease of pregnancy
- diagnosis of exclusion
- severe puritis on palms and soles of feet
112
Investigations for obstetric cholestasis?
- LFTs deranged
- viral serology
- autoantibodies
113
1st line investigation for a pregnant woman suspected of having a PE?
- V/Q scan (less radiation)
| - CTPA can be done but higher risk
114
Risks of epilepsy in pregnancy?
- maternal abdo trauma
- PPROM
- Pre-term birth
- hypoxia
- childhood epilepsy
115
Considerations of anti-epileptic drugs in pregnancy?
- teratogenic
- lowest effective dose should be used
- sodium valproate, teratogenic!
116
Management of an intra-partum seizure?
- continuous fetal monitoring
- left lateral tilt
- IV lorazepam
- PR diazepam
- may require c-section
117
Increased MI in pregnancy?
- 3 or 4 times risk of MI
118
Potential cause of orthopnea in pregnancy?
- peri-partum cardiomyopathy
| - presents with orthopnoea (inability to lie flat)
119
Cardiac changes in pregnancy?
- increased plasma volume
- increased cardiac output
- increased stroke volume
- decreased peripheral resistance
120
How is hypertension in pregnancy diagnosed?
- 2 readings of > 140/90
| - 1 reading of > 160/110
121
Types of hypertension in pregnancy?
- pre-existing
- pregnancy induced
- pre-eclampsia
122
Triad in pre-eclampsia
- hypertension >140/90
- proteinuria uPCR > 30
- oedema
123
Early vs late pre-eclampsia?
- early = diagnosed before 34 weeks, associated with greater placental damage
- late = diagnosed after 34 weeks
124
Explain the pathogenesis of pre-eclampsia?
- abnormal placental perfusion due to failure of trophoblastic invasion of spiral arteries
- leading to low capacity - high resistance arterial supply
- placental hypoperfusion
125
Investigations for pre-eclampsia?
- bp
- urinalysis
- colour doppler of uterine artery
- CTG of fetous
126
Consequences of pre-eclampsia?
- HELLP syndrome
- eclampsia
- pulmonary oedema
- placental abruption
- cerebral haemorrhage
127
What is hellp syndrome and its symptoms?
- haemolysis, elevated liver enzymes, low platelets
- epigastric/RUQ pain
- abnormal enzyme,es
128
Symptoms of pre-eclampsia?
- headache
- visual changes
- epigastric pain
- nausea
- oedema
129
What drug should be given in pre-eclampsia and why?
- low dose aspirin between 16-36weeks
| - reduces risk of eclampsia
130
Cure for pre-eclampsia?
- deliver the baby
131
When should drug treatment for pre-eclampsia be commenced?
- when blood pressure> 150/100
132
Drugs used for hypertension in pregnancy>
- labetolol
- nifidipiene
- methylpoda (contraindicated in depression)
133
What is eclampsia?
- tonic colonic seizures occurring with features of pre-eclampsia
- commoner in teenagers
- 44% occur post-partum
134
Management of eclampsia?
- control BP (IV labtolol, IV hydralazine)
- prevent seizures (magnesium sulphate)
- delivery of baby
135
Magnesium sulphate dosage in eclampsia?
- loading dose 4g
| - infusion 1g/hrs
136
Define small for gestational age?
- infant born with birth weight < 10th centile
137
Causes of small for gestational age?
- placental infarction
- Maternal alcohol, drugs, smoking
- maternal height and weight
- maternal age
- chronic hypertension
138
What classifies low birth weight?
- infant born < 2500g
139
What is fetal growth restriction?
- failure to achieve genetic potential for growth
| - implies pathological restriction
140
Below 3rd centile delivery time?
- aim to deliver by 37weeks
141
Between 3rd and 10th centile delivery time?
- aim to deliver by 39 weeks
142
Why is magnesium sulfate given in pre-term labour
- reduce seizure risk
143
What should be seen on umbilical artery doppler?
- forward flow even in maternal diastole
144
How is SGA identified?
- GROW chart
- USS
- Symphysis fundal height
