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Pregnancy Flashcards

(85 cards)

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1
Q

Which macromolecules increases in the pregnant mother’s circulation?

A

Lipids

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2
Q

Why is there increased loss of electrolytes like Ca from the pregnant mother?

A

Increased GFR

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3
Q

What is involved in insulin resistance in gestational diabetes?

A

Placental lactogen

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4
Q

What is DHA?

A

The precursor of all oestrogens pregnancy

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5
Q

Functions of oestrogens?

A 
Increase the liver synthesis of lipids and cholesterol
Growth and priming of the uterus
Anti-insulin
Cervical ripening
Stimulated of RAAS
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6
Q

Functions of progesterone?

A

Maintains endometrium (D0-60 is c. luteum then placenta)
Suppresses mat immune response to fatal antigens
Partuition
Substrate for fetal adrenal production
Inhibits uterine contractility and ripening
Inhibits over breathing
Stimulates RAAS
Growth of mammary glands

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7
Q

Function of hCG:

A

Binds to TSH receptors and increases metabolic rate

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8
Q

Function of hPL:

A 
Lipolysis
Anti-insulin
Protein synthesis
Gluconeogenesis
Neovascularisation
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9
Q

Cortisol?

A

Increases

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10
Q

Cardio changes:

A

Heart rate increases
Cardiac output increases
Total peripheral resistance decreases
Blood pressure decreases early in the pregnancy

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11
Q

What causes increased secretion of aldosterone?

A

Oestrogen
Progesterone
Prostaglandins

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12
Q

What causes increased sympathetic tone and renin release in pregnancy?

A

Shunting of blood to the uterine circulation

Also increased GFR resulting in Na loss as well as hCG increases renin secretion

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13
Q

GFR pattern in pregnancy:

A

GFR rises sharply over pregnancy until the 26th week where it decreases (renal plasma flow mirrors)

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14
Q

Renal changes in pregnancy:

A

Reduced plasma concentration of urea and creatinine
Glycosuria
Calciuria
Frequency
Stasis due to dilatation of the collecting system

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15
Q

Pulmonary changes in pregnancy:

A 
FRC decreases 20% by term 
Expiratory reserve volume down 30% by term
Tidal volume increases 30-40% by term
Residual volume reduces 20% by term - SOB
pCO2 decreases (progesterone)
Increase in pO2
pH unchanged
Decrease in bicarbonate
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16
Q

Vascular changes in pregnancy:

A 
Slight increase in coagulability - for delivery
Increase in Factors VII, VIII and X
Increase in plasma fibrinogen
Increased ESR
Decreased fibrinolytic activity
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17
Q

Smooth muscle changes in pregnancy:

A

Decreased tone causing biliary stasis, reflux and increased absorption

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18
Q

Gas exchange in the pregnancy:

A

Maternal uterine artery: mmHg
pO2 = 95, pCO2 = 35
Fetal umbilical artery: mmHg
pO2 = 24, pCO2 = 50

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19
Q

Where does the fetus get insulin?

A

It produces its own fetal insulin from weeks 9-11 - doesn’t not get in from the mother

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20
Q

What is the ductus venosus?

A

Duct bypassing the liver

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21
Q

What is the foramen ovale?

A

Opening from the right to the left heart

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22
Q

What is the ductus arteriosus?

A

Duct from the pulmonary artery to the descending aorta

only 20% of the fetal circulation reaches the lungs

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23
Q

What is the fatal circulatory response to hypoxia?

A

Heart rate falls
Resistance in the umbilical cord increases
Resistance in the MCA decreases to protect fetal brain
Blood flow to the heart and adrenals increases
Blood flow to the kidneys decreases (reduced amniotic fluid vol)

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24
Q

What effects on foetal physiology does delivery have?

A

Cord occlusion decreases right atrium pressure so f. ovale closes
Inspiration causes vasodilation of the pulmonary artery and decreased resistance through f. ovale and ductus a.
Increased PaO2 leads to closure of ductus a.

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25
What modulates ductus arteriosus closure?
Prostaglandin E2 + prostacyclin delay duct closure | NSAIDs accelerate duct closure
26
What stimulates the synthesis, specialisation and release of surfactant as well as lung lipid resorption and epithelial cell differentiation from 30 weeks?
Cortisol
27
How is foetal PaO2 only 30mmHg?
Compensated by high binding affinity of HbF for O2 | (switch to HbA happens at 28 weeks
28
What can be used to clear liquid from the lung?
Opening of ENaC with ADH or adrenaline - reverses osmotic gradient
29
What is partuition?
Birth in labour Softening and effacement of the cervix Contractions
30
Stage 1 of labour:
3 contractions every 10 minutes
31
Stage 2 of labour:
Cervix fully dilated at 10cm | Strong contractions
32
Stage 3 of labour:
Placenta delivered due to oxytocin (oxytocin and ergometrine can be given artificially)
33
What can stimulate contraction?
Baby moving | Giving PGE2 and oxytocin
34
Effect of cortisol in pregnancy:
``` Increases placental CRH Increases oxytocin Increases prostaglandins Increases fatal membrane production Stimulates conversion of DHEAS to oestrogen ```
35
How do suckling stimulate prolactin secretion?
Increase in VIP resulting in decreased dopamine release
36
How does suckling stimulate milk ejection?
Paraventricular and supraoptic nuclei release oxytocin
37
First trimester:
Week 1 to (end of) 12
38
Second trimester:
Week 13 to (end of) 26
39
Third trimester:
Week 27 to the end of the pregnancy
40
Cardio changes in the first trimester:
``` SVR down BP down (110/60 is normal) CO up (110 is not normal) SV up ```
41
Cardio changes in the second trimester:
SVR down BP down CO up SV up
42
Cardio changes in the third trimester:
SVR is beginning to rise by term BP rises back to where it was before the pregnancy CO is variable SV is up
43
Cardio changes intrapartum:
SVR down BP variable CO up SV up
44
Cardio changes early post-delivery:
SVR up BP up CO up SV up
45
Cardio changes late > 2/52
SVR up BP variable CO Down SV down
46
ABGs:
Respiratory alkalosis is normal with no change in base excess and reduced bicarbonate
47
Pregnant woman with chest pain - investigation?
CT or perfusion lung scan to find a clot
48
Why does ADH release decrease?
Placental vasopressin
49
LH and FSH in pregnancy?
Virtually undetectable | Suppressed by high levels of oestrogen and progesterone
50
GH in pregnancy?
Increases | Placental growth factors
51
ACTH in pregnancy?
2-fold increase in the first trimester | No change in pituitary production but there is placental production of cortisol releasing factor
52
IGF-1 in pregnancy?
Increases | Stimulated by hPL (human placental lactogen)
53
ADH in pregnancy?
Reduction in circulation | Production of placental vasopressinase
54
Prolactin in pregnancy?
Progressive increase Stimulated by oestrogen Little enters circulation from decidual tissue
55
Renin in pregnancy?
Increase 4-fold by 20 weeks then plateaus | RAAS activation results from the drop in TPR and resultant drop in after load
56
Aldosterone in pregnancy?
Increase 3-fold in 1st trimester and 10-fold by the third | Response to increased renin and angiotensin II
57
Thyroid hormones in pregnancy?
Higher total levels of T4 and T3, mother needs to make 50% more Increased renal iodine clearance and fatal iodine uptake 1st trimester there is increased T4 which suppresses TSH hCG also activates TSH receptors Heamodilution also helps explain why more is made
58
Cortisol in pregnancy?
Increase 3-fold Suppression by exogenous corticosteroid is blunted Due to increase in cortisol binding globulin, cortisol releasing hormone and progesterone
59
How is pre-eclampsia defined?
Gestational hypertension past 20 weeks (sys or dia over 140/90) With one of: 1) Proteinuria 2) Systemic involvement (e.g. renal indicated by elevated creatinine) 3) Foetal growth restriction
60
What can be the systemic complications of pre-eclampsia? | Signs
Cerebral or visual disturbance Impaired renal function (creatinine >1.1mg/L or doubled) Pulmonary oedema Liver dysfunction (transaminase twice normal amount) Thrombocytopenia - platelets <100,000/uL
61
What is HELLP?
It is a non-hypertensive subtype of pre-eclampsia H - Haemolysis EL - Elevated liver enzymes LP - Low platelets
62
Risk factors for pre-eclampsia?
``` Primiparity Multiple pregnancy Previous occurence/FH Pre-gestation diabetes PCOS AI conditions Renal disease Chronic hypertension or gestational hypertension BMI >30, age >35 ```
63
Symptoms of pre-eclampsia?
``` Headache (frontal) Right upper quadrant pain Visual disturbances (photopsia, retinal vasospasm, scotomata) Breathlessness Seizures Oliguria ```
64
Investigations to be done in pre-eclampsia:
Urinalysis for protein Foetal ultrasound Umbilical artery Doppler velocimetry Coagulation screen if platelets <100,00/uL
65
Differentials for pre-eclampsia:
Other forms of hypertension Epilepsy Anti-phospholipid antibody syndrome (Hx of repeated early pregnancy loss)
66
Management before delivery:
``` 1) Admission and monitoring + decision regarding monitoring Adjunct: corticosteroid + (w/ BP >160/110) anti-hypertensive + (w/ seizures) magnesium sulfate ```
67
Management after delivery:
1) Close monitoring of fluid balance | + continue anti-hypertensives and magnesium sulphate
68
Appropriate management for a woman with 3 risk factors for thromboprophylaxis?
LMWH from 28 weeks to 6 weeks post natal
69
Risk factors for thromboprophylaxis in pregnancy:
``` Age>35, BMI>30, Parity>3 Smoker, gross varicose veins Current pre-eclampsia, immobility FH of unprovoked VTE Low risk thrombophilia Multiple/IVF pregnancy ```
70
Appropriate management for a woman with >3 risk factors for thromboprophylaxis?
Immediate LMWH
71
Which thrombolytic drugs should be avoided in pregnancy?
DOACs and warfarin
72
Diagnosis of DVT shortly before pregnancy management?
Continue anticoagulation treatment for 3 months postpartum
73
Causes of primary postpartum haemorrhage?
``` The 4 T's: Tone (uterine atony) Tissue (retained products of conception) Trauma (to the genital tract or perineum) Thrombin (coagulation abnormalities) ```
74
Secondary PPH?
24 hours-12 weeks | Due to retained placental tissue or endometritis
75
Risk factors for shoulder dystocia?
Fetal macrosomia Diabetes mellitus Premature labour High maternal BMI
76
What can happen as a result of shoulder dystocia?
Brachial plexus injury in the newborn such that they cannot move their arm properly and it is fixated medially Perineal tears to the mother
77
Effect of maternal diabetes mellitus on fetus?
Insulin resistance Polyuria Polyhydramnios Macrosomia
78
Effect of rhesus incompatibility of newborn?
Hydrops fetalis (effusions, loss of oncotic pressure as liver is trying to primarily produce for RBCs) Jaundice, anaemia, hepatosplenomegaly HF Kernicterus (brain damage from jaundice)
79
Treatment for rhesus incompatibility:
Anti-D Ig | For the baby: transfusions and UV phototherapy
80
When is the baby at risk of rhesus incompatibility?
If the mother is rhesus negative and the baby is rhesus positive
81
Effect of gestational diabetes?
Macrosomia (child is large) and infant hypoglycaemia as the child will have developed large amounts of insulin to deal with the high glucose concentrations in the mothers blood
82
Determinant of foetal growth?
Insulin
83
Determinant of infant growth (0-2 years)?
Nutrition and insulin
84
Determinant of childhood growth (3-11 years)?
Growth hormone and thyroxine
85
Determinant of growth in puberty (12-18 years)?
Growth hormone and sex steroids

Human development (7 decks)

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