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Pregnancy Flashcards

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1
Q

In what conditions is morning sickness worse?

A

-Where Human Chorionic Gonadotrophin (hCG) is higher - twins, molar pregnancies

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2
Q

What can morning sickness progress to?

A

Hyperemesis gravidarum

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3
Q

What happens to cardiac output during pregnancy?

A 
It increases (by 30-50%)
(SV and HR both increase - can cause palpitations)
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4
Q

What happens to blood pressure in the second trimester?

A

Bloop pressure drops

(Expansion of the uteroplacental circulation
A fall in systemic vascular resistance
A reduction in blood viscosity
A reduction in sensitivity to angiotensin)

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5
Q

What happens to urine output in pregnancy?

A

Increased urine output

Increase in Renal plasma flow/GFR, decrease in serum urea and creatinine

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6
Q

What happens to risk of UTI in pregnancy?

A

Increase in UTI risk - due to urinary stasis

Increased risk of pyleonephritis (risk of preterm labour!)

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7
Q

What happens to the percentage of haemoglobin in the blood with pregnancy?

A

It drops

despite a rise in RBC, due to a bigger rise in plasma volume

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8
Q

When should iron supplements be given in pregnancy?

A

If Hb < 110 at booking appointment, or less than 100 at routine testing at 28 weeks.

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9
Q

What happens to respiratory rate in pregnancy?

A

Increases

Increased Tidal Volume and plasma pH

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10
Q

What happens to peristalsis in pregnancy?

A

Peristalsis is slowed (due to ^progesterone and reduced motilin)

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11
Q

What sort of things may be explored in pre-pregnancy counselling?

A 
Diet
Obesity (BMI)
Reducing alcohol
Smoking cessation
Folic acid (400mcg)
Risk Assessment - including age, parity, occupation, substance misuse,
known medical problems
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12
Q

What kind of things should be considered with known medical problems during pregnancy?

A

Optimise maternal health

Psychiatric health is important

Stop/Change any unsuitable drugs

Advise regarding complications associated with maternal medical problems

Occasionally advise against pregnancy

Particular considerations for diabetes, epilepsy and renal problems

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13
Q

What would take place during an antenatal examination?

A

Identify problems w mother, fetus, social

Routine enquiries - feeling well, feeling fetal movements
Blood pressure
Urinalysis
Abdominal Palpation

(Checks for pre-eclampsia, diabetes, UTI)

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14
Q

What would be assessed in abdominal palpation during antenatal examination?

A
  • Assess symphyseal funsal height (SFH)
  • Estimate size of baby
  • Estimate liquor volume
  • Determine fetal presentation/position
  • Listen to fetal heartbeat
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15
Q

What types of infections mat be screened for antenatally?

A 
Rubella
Hepatitis B
Syphilis
HIV
MSSU

(Other screened conditions include iron deficiency anaemia and isoiummunisation (Rhesus disease etc)

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16
Q

What can a screening first visit ultrasound scan reveal?

A

Ensure pregnancy viable
Multiple pregnancy
Identify abnormalities incompatible with life
Offer and carry out Down’s syndrome screening
Estimated Due Date

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17
Q

What factors increase Down’s Syndrome risk?

A

Maternal age

Personal/family history of chromosomal abnormality

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18
Q

When is a first trimester screening carried out?

A

10-14 weeks

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19
Q

What is measured in a first trimester screening?

A

Maternal risk factors,
Serum beta-human chorionic gonadotrophin (beta-hCG)
Pregnancy associated plasma protein A (PAPP-A)
Fetal nuchal translucency (NT) measurement

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20
Q

What aspect of nuchal translucency is related to incidence of chromosomal abnormalities?

A

Size of NT

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21
Q

What other testing may be offered if chance of Down’s Syndrome is >1 in 150

A

CVS (chorionic villus sampling >10-14wks)
Amniocentesis (>15wks)
Non-invasive Prenatal testing

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22
Q

What neural tube defects may be detected in first trimester ultrasound?

A

Anencephaly

Spina Bifida

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23
Q

What is a second trimester ultrasound used to detect?

A

Soft markers for chromosomal abnormalities

Major structural abnormalities (eg exomphalos, cleft lip)

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24
Q

What is screened for in second trimester biochemical screening?

A

-Alpha fetoprotein

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25
What happens to metabolism during pregnancy?
Hypermetabolism | Geared towards fat metabolism
26
List some general health changes in pregnancy?
- Mechanical (^ Spine curvature) - Metabolism (^) - Fatigue – particularly early pregnancy - Heartburn/reflux - Oedema (retain salt/water) - Breasts - Thyroid - General state of immunosuppression - Weight gain
27
List some breast changes during pregnancy?
- Increase size/vascularity - Increased pigmentation of areola/nipple - Secondary areola appears - Appearance of montgomery tubercles on areola - Colustrum from end of 3rd month
28
Roughly how much does circulating blood volume increase by during pregnancy?
~50-70%
29
What happens to systemic vascular resistance during pregnancy?
It falls
30
What happens to cardiac output in pregnancy when in the supine position?
It reduces (25%)
31
What position must a pregnant woman be in during resuscitation?
Left lateral tilt
32
What happens to cardiac output during labour?
Increases by 10%
33
What happens to cardiac output in the first hour post delivery?
Increases by 80%
34
How long do cardiovascular pregnancy changes take to return to normal?
3 months
35
What happens to respiratory rate in pregnancy?
Increases
36
What happens to tidal volume in pregnancy?
Increases
37
What happens to functional residual capacity in pregnancy?
Decreases
38
What happens to PEFR and FEV1 during pregnancy?
Unchanged
39
What happens to PCO2 in pregnancy?
Decreases
40
What happens to renal plasma flow in pregnancy?
Increases
41
What happens to GFR in pregnancy?
Increases
42
What happens to creatinine clearance in pregnancy?
Increases
43
What happens to protein excretion in pregnancy?
Increases
44
What happens to plasma urea in pregnancy?
Decreases
45
What happens to WCC in pregnancy?
Increases
46
What happens to Platelets in pregnancy?
Decreases/Unchanged
47
What happens to CRP in pregnancy?
Unchanged
48
What happens to ESR in pregnancy?
Increases
49
What happens to plasma creatinine in pregnancy?
Decreases
50
What happens to Urate in pregnancy?
Decreases, but increases with gestation
51
What happens to 24 hr protein in pregnancy?
Increases
52
What happens to Total protein in pregnancy?
Decreases
53
What happens to Albumin in pregnancy?
Decreases
54
What happens to AST/ALT/GGT in pregnancy?
Decreases/Unchanged
55
What happens to Alk Phos in pregnancy?
Increases (Placental production)
56
What happens to Bile acids in pregnancy?
Unchanged
57
What happens to D dimer in pregnancy?
Increases
58
What substances are addictive to the fetus and can cause withdrawals at birth?
Heroin Methadone Benzodiazepines
59
In phenylkutoneria, the metabolism of what essential amino acid is affected?
Phenylalanine
60
What needs to happen to pregnant women with type 2 diabetes on oral hypoglycaemic medication?
Switch to insulin
61
What pregnancy complications are diabetic patients more at risk of?
Pre-eclampsia Stillbirth Macrosomia
62
What is sodium valproate associated with in pregnancy?
Spina bifida
63
What is customary for delivery after two previous caesarean sections?
Elective caesarean
64
What actions can be taken to reduced recurrence risk of DVT/Pre-eclampsia in a subsequent pregnancy?
Thromboprophylaxis | Low dose aspirin
65
What actions can be taken to reduced recurrence risk of pre-term delivery/growth restriction/abnormality in a subsequent pregnancy?
Treatment of infection High dose folic acid Low dose aspirin
66
When may External Cephalic Version (ECV) be offered in pregnancy?
If the baby remains in breech position after 36 weeks | If declined or failed, usually delivered by caesarean
67
What can congenital rubella syndrome cause in pregnancy?
Mental handicap Blindness Deafness Heart defects
68
What is the natural rate of twinning in pregnancy?
1 in 90
69
Why is the natural rate of twinning increasing?
Assisted reproduction techniques (ARTs) | Ovulation Induction
70
What factors increase chance of dizygotic twins?
``` Age Parity Weight Height Family history ```
71
What features increase suspicion of diagnosis of multiple pregnancy?
- Large for date uterine size - Multiple fetal heart rates are detected - Multiple fetal parts are felt - HCG + maternal serum alpha-fetoprotein is elevated for gestational age - Pregnancy with ART - Confirmed by ultrasound
72
What type of twins are most common?
Diamniotic/Dichorionic Dizygotic twins
73
What are possible complications of multiple pregnancy?
- High perinatal mortality + morbidity - Abortion - Nausea + Vomiting - Preterm labour - IUGR - PET - Polyhydramnios - Congenital anomalies - Postpartum haemorrhage - Placental abruption, placenta previa - Discordant twin growth - Malpresentation, cord prolapse, operative delivery
74
How does twin-twin transfusion occur?
Monochorionic twins (20-25%) - one fetus donates blood to the other due to vascular anastomosis Recipient will have heart failure, Polyhydramnios, Hydrops Donor will have IUGR + Olgiohydramnios
75
What is involved in management of twin-twin transfusion?
- Amnio-reduction of recipient twin - Intra-uterine blood transfusion for donor twin - Selective fetal reduction - Fetoscopic lase ablation of placenta; anastomosis
76
What is involved in antenatal management of multiple pregnancy?
- Adequate nutrition - Prevent anaemia - Frequent antenatal visits - Ultrasound - Multifetal reduction may be offered in first trimester - Preterm labour risk
77
What happens to mortality and cerebral palsy rates with increased multiple pregnancy?
Increases
78
What is the average pregnancy length for twins?
36-37 weeks
79
How would a dichorionic diamniotic multiple pregnancy present on scan?
Two separate placenta and two sacs | Lamda sign
80
How would a monochorionic monoamniotic multiple pregnancy present on scan?
One sac, and one placenta | T sign
81
How should symphysiofundal height be interpreted?
Should usually be + or - 3cms of gestational age in weeks
82
What investigations should be used in suspicion of a baby that is small or large for dates?
Ultrasound scan
83
What measurements would be used on scan of a baby that is large/small for dates?
- Abdominal circumference - Femur length - Head circumference - Liquor volume (Amniotic fluid index)
84
What factors are associated with small for dates babies?
``` Low BMI, maternal build Age Ethnicity, familial/genetic Social class Smoking Substance misuse Alcohol use - Fetal Alcohol syndrome Maternal disease (Preeclampsia, chronic hypertension, severe asthma, autoimmune disorders eg SLE, repeated antepartum haemorrhages) Infections (Toxoplasma, CMV) Fetal abnormality, chromosoal abnormality (Turners) ```
85
What factors are associated with large for dates babies?
``` Parity (multiparity) Ethicity/familail/genetoc/social class Maternal diabetes Polyhydramnios Multiple pregnancy ```
86
What tests can be used to confirm fetal wellbeing?
``` Confirm good fetal movement Fetal Cardiotocograph (CTG) Good doppler blood flow in umbical artery ```

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