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Pregnancy Flashcards

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1
Q

What does Laxin do?

A

Relaxes joints

This includes non-mobile joints like the pubic symphysis

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2
Q

Why is anaesthesia dangerous in pregnancy?

A

It often leads to aspiration

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3
Q

Why are pregnant women likey to get oedema?

A

They are less likely to secrete sodium ions, leading to accumulation of fluid

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4
Q

What is oedema associated with in pregnancy?

A

Preeclampsia

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5
Q

How much weight do women tend to gain in pregnancy?

A

10-14kg

Split in to 2kg in first semester, 5kg in second/third

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6
Q

Why are pregnant women more susceptible to thyroid issues?

A

Relative iodine pregnancy as actively transported to child
Thyroid often increases in size
Note - if already deficient, can lead to goitre

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7
Q

What are the changes in breast in pregnant women?

A 
Increased size and vascularity
Increased pigmentation of areola/nipple
Secondary areola ppears
Montogomery tubercles appear on areola
Fluid can be secreted from 3rd month
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8
Q

What was the biggest cause of maternal death in pregancy in previous years?

A

Cardio vascular diseasecomplications

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9
Q

What are the cardiovascular changes in pregnant women?

A

Increased circulating blood volume (50-70%)
Systemic vascular resistance falls (prostaglandins partially responsible)
Increased blood flow
Increase Cardiac output, and heart rate (upto 10-20)
Increase oxygen consumption

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10
Q

Why is it dangerous to be in the supine position when pregnant?

A

Can compress IVC

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11
Q

Why are epidurals the preferred pain reduction method?

A

Anaesthesia can cause regurg

Also reduces peripheral resistance so decreases cardiac problems

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12
Q

What are the intrapartum cardiovascular changes?

A

Autotransfusions of contractions
Pain due to increasing catecholamines
Cardiac outputs increase by 10% in labour
By 80% in post delivery hour although not safe until after 3 months

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13
Q

What are the respiratory changes in a pregnant woman?

A

Increase in oxygen demand
Increase in ventilation/resp rate
Increased tidal volume
PEFR + PEV1 unchanged
PCO2 decreases (like mild respiratory alkalosis)
Work harder, but reduced expansion potential

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14
Q

What are the renal changes in a pregnant woman?

A

Dilation or urinary collecting system, more dramatic on right
Increased renal plasma flow
Increased GFR + creatine clearance (up to 50%)
Protein excretion increased
Microscopic haematuria may be present
Glycosuria common
Decreased urea, increased urate, decreased ceatinine

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15
Q

How does uric acid change in pregnancy?

A

Increases with gestational age
Almost 10x per gestational week

Also rises in preeeclampsia
Above 600 risk of neonatal death

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16
Q

What are the haematological changes in pregnancy?

A 
Plasma volume increases
Decreased haemoglobin (dilutional)
Decreased platlet count
Increased need of iron (iron def. anaemia common) + folate
WCC increases (although relative immunocompromised)
Hypercoagulable (DVT ~1%)
Albumin drop (oedema common)
Alk phos up (placenta, within thousands)
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17
Q

What is labour?

A

The process where the placenta, foetus and membranes are expeled into the birth canal

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18
Q

What is normal labour?

A

Wher labour occurs spontaneously at term(37-42 weeks)
WIth foestus presenting by vertex and resulting in spontaneous vaginal birth
May not feel normal to mother

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19
Q

What must occur for labour to happen?

A

Cervix softening
Myometrial tone changes to allow for co-ordinated contractions
Progesterone decreases whilst oxytocin increases to initiate labour

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20
Q

What are the subcategories of the first stage of labour?

A

Latent stage

Established stage

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21
Q

What is the latent part of the first stage of labour?

A

Stage of intermittent, often irregular, painful contractions
Bring some cervical enlargement up to 4 cm
Can last a long time

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22
Q

What is the established part of the first stage of labour?

A

Regular, painful contractions resulting in progressive effacement and dilation of cervix from 4cm

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23
Q

When is the first stage of labour complete?

A

At 10 cm dilation

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24
Q

What is the anticipated progress of the first stage of labour?

A

0.5-1cm/hour

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25
How long does the first stage of labour take?
In a primagravida (first time pregnant) around 8 hours | In a multigravida (more than once) around 5 hours
26
What are the parts to the second stage of labour?
Passive phase | Active phase
27
What s the second stage of labour?
From full cervical dilation to the birth of the baby
28
What is the passive phase of the second stage of labour?
Finding of full dilatation of cervix before (or in abscence of) inv9oluntary expulsive contractions Allow for further foetal descent
29
What is the active phase of the second part of labour?
Presenting part is visible Expulsive contractions with finding of full cervix Active maternal effort following confirmation of full cervix dilatation in absecen of expulsive contractions
30
How long is birth expected within the second (active phase) of labour starting?
2 hours in primagravida | 1 hour in multigravida
31
What is the third stage of labour?
From after birth of baby, to expulsion of placenta/membranes
32
What does the active management of the third stage of labour entail?
Routine use of uterotonic drugs Deferred clamping/cutting of the cord Controlled cord traction after signs of seperation of placenta
33
What does the physiological management of the third stage of labour entail?
No routine use of uterotonic drugs No clamping of cord until pulsation has stopped Delivery of placenta by maternal effort
34
When do you diagnose a prolonged 3rd stage of labour?
30 minutes if active management | 60 minutes if physiological management
35
What investigations should be used to monitor labour + its progress?
Stats (BP, HR, temp, RR, O2, urine output + urinalysis) Abdominal palpation Vaginal examination Monitor of liquor after rupture of membrane Foetal heart auscultation (intermittent/continous) Palpation of uterine muscle contractions External signs
36
What are the external signs of labour?
Rhomboid of michaelis (sacrum pushing outwards) | Anal cleft line restlesness
37
What are you looking for in a vaginal examination during labour?
``` Assessing presentation Engagement + station (how far down) Position Cervical effacement + dilatiation Membranes (present/absent?) ```
38
What are you monitoring with abdominal palpitations?
Foetal lie Presentation Attitude (posture of foetus - flexion, deflexion, extension) Denominator (a bony landmark used to denote position, differs by lie) Position Engagement
39
What are the different foetal lies?
Longitudinal (cephalic, breech) Oblique Transverse
40
What is the presentation that has the smallest diameter of the baby's head through the pelvis?
Subocccipitobregmatic | Where baby has chin on chest, with back/top coming first
41
What determines the position in labour?
It is in relation to the occiput (posterior fontanelle)
42
What are the mechanisms of labour?
``` Descent Flexion Internal rotation of head Crowning/extension of head Restitiution Internal rotation of shoulders External rotation of head Lateral flexion ```
43
What analgesia is used in labour?
``` Breathing, massage, tens, parecetamonl, dihydrocodeine Water Entonox Opioids Epidural Maternal position ```
44
What are the risks of induction?
Too many contractions (stresses baby) | More pain relief may be needed
45
What are the indications of induction?
Dibates (usually earlier than due date) Post dates Maternal health problem necessitating it Foetal reasons (growth concerns etc)
46
What is induction?
Artificially instigating labour through medications and/or devices Followed by artifical rupture of uterine membranes
47
What is used to determine if induction will be successful?
Bishop's score
48
What tools are used to "ripen" the cervix?
``` Prostaglandin pessarie (pharmacological opening) Cook baloon (mechanical opening) ```
49
How do you rupture the foetal membranes?
With a sharp device - amniohook
50
When should you adminster Oxytocin IV?
After water has been brken | Does not give as good a response if unbroken water
51
What are the benefits of the baloon to the pessary?
Only takes 12-24 hours (instead of 2-3 days) | No risk of hyperstimulation of uterus (contractions)
52
What is meant by powers, passage and passenger?
Powers - contraction Passage - birth canal Passenger - baby
53
What can lead to inadequate progress?
``` Cephalopelvic disproportion (rare!) Malposition Malpresentation Inadequate uterine activity Other obstruction ```
54
What is the risk of an obstructed uterus?
Uterine rupture
55
What is used to determine the progress of labour?
Cervical effacement + dilation | Descent of foetal head through maternal pelvis
56
What is inadequate uterine activity?
Where contractions are inadequate resulting in no descent of the foetal head through the pelvis Cervix does not dilate
57
What is presentation?
Is the part of the baby heading towards the vagina
58
Why is cord prolapse an obstetric emergency?
The cord vasospams when it hits cold air and starves child of oxygen Needs immediate delivery
59
What is malposition?
Where cervic presentation isn't Occiptal anterior
60
What positions can be birthed?
OA | OP (with some difficulty)
61
How do you monitor the foetus during labour?
Austlation of heart (intermittent/continuous) Foetal blood sampling Foetal ECG
62
When would you take a foetal blood sample?
When there is an abnormal CTG
63
What does a goetal blood sample provide?
pH + base excess | pH = hypoxia? (if acidic)
64
How do you interpret a CTG?
Deceleration = stress Multiple changes is good Flat, long to change bad
65
When do you advise against labour?
``` Obstruction to birth canal Malpresentations (transverse, shoulder, hand) Some medical conditions Specific previous labour complications Foetal conditions ```
66
What are the two types of instruments used to help birth?
Forceps | Vacuum cup
67
What are the benefits/negatives of a c section?
Carries risk of bleeding, visceral injury + VTE Reduced risk of perniela injury
68
What are the 4ts of post partum haemorrhage?
Tears (trauma) Tone Tissue Thrombin
69
What are the complications of the 3rd stage of labour?
Retained placenta | Post partum haemorrhage
70
What is the puerperium?
A post partum period where you bleed after giving birth
71
How is the mother managed after giving birth?
Midwife looks after for first 9-10 days GP checks after 6 weeks Look for signs of abnormal bleeding Evidence of infection
72
What are teh common problems with mothers after birth?
Problems with infant feeding Problems with bonding Social issues
73
What are the common post natal problems?
``` Post partum haemorrhage Venous thromboembolism Sepsis Psychiatrid disorders Pre-eclampsia ```
74
What is primary post partum haemorrhage?
Blood loss great than 500mls within 24 hours of delivery
75
What is secondary post partum haemorrhage?
Blood loss more than 500ml from 24hours post partum to 6 weeks
76
What can cause secondary post partum haemorrhage?
Retained tissue Endometritis Tears/trauma
77
When should you suspect thromboembolic disease?
Women with unilateral leg swelling/pain SOB/chest pain Unexplained tachycardia C-section/immobilisation Retain high index of suspicion in pregnant/post natal woman as hypercoaguable state
78
How do you investigate thromboembolic disease in pregnancy/post partum?
ECG Leg gopplers CXR / VQ scan NOT D-dimer
79
How do you treat thromboembolic disease in pregnant women?
LMWH (heparin) | Warfarin in breast feeding okay, but teratogenic
80
What is the leading cause of maternal death?
Sepsis
81
How should you treat sepsis in a pregnant woman (or suspicion of)
IV antibiotics ASAP
82
What are the types of psychiatric problems post natally?
``` Baby blues (normal) Post-natal depression (classical depressive symptoms - treat) Puerperal psychosis (dangerous to baby/mum should be detained) ```
83
When do most eclamptic periods occur?
In post natal period | May worsen several days following delivery, or develop post natally

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