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Puerperium Flashcards

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1
Q

How many pregnancies end in miscarriage

A

15%

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2
Q

What are the 3 causes of whole chromosome aneuplodies

A

Malsegregation:
In the gonad during meiosis -> abnormal gametes
During mitosis in the germline -> mosaicism in the gonad
During mitosis in the early embryo -> mosaicism in the embryo

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3
Q

What is trisomy 18

A

Edwards

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4
Q

What is trisomy 13

A

Patau

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5
Q

What is 45, X

A

Turner

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6
Q

What is 47, XXY

A

Klinefelter

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7
Q

What are the two types of translocations

A

Robertsonian and reciprocal

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8
Q

What are Robersonian translocations

A

Result from fusion of two acrocentric chromosomes. Most common are der (13;14), and der (14;21) - balanced carriers phenotypically normal

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9
Q

What are reciprocal translocations

A

Exchange of material between two non-homologous chromosomes

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10
Q

What is Prader Willi Syndrome

A

Paternal deletion and maternal imprinting - chromsome 15

Leads to obesity and T2DM

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11
Q

What is Angelman syndrome

A

Maternal deletion and paternal imprinting

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12
Q

What is FISH

A

Fluorescence in situ hybridisation - in metaphase for confirmation of aCGH and fllow up segments

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13
Q

What is QF-PCR

A

Quantitative Fluorescene PCR

Microsatellites markers used to identify and count chromsomes 13, 18, 21 and X/Y

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14
Q

Who is rapid FISH test used for

A

Carriers of balanced chromosome rearrangements

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15
Q

What is parturition

A

Process of giving birth

Involves softening and effacement of the cervix and development of uterine contractions

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16
Q

What occurs in the initial phase of labour

A

Contractions develop, cervix softens and effaces (4cm)

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17
Q

What happens in the active phase of labour

A

Regular contractions (3 every 10 min) and steady dilation of the cervix (4cm). Progress normal if cervix dilates at least 0.5cm per hour

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18
Q

What happens in stage 2 of labour

A

Cervix fully dilated 10cm, strong propulsive contractions, 1-2 hours. Uncontrollable urge to push.
Diagnosis of delay: 2 hours in nulliparous and 1 hour in parous women

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19
Q

What happens in stage 3 of labour

A

Placental separation, descent to the lower segment and delivered (oxytocin important). Cord and placenta will contain about 1/3 of baby’s blood.

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20
Q

What are the inflammatory mediators in cervix ripening

A

iNOS, COX-s (produces PGE2), matrix metalloproteinases 2 and 9 (stop bacteria from entering), cytokines and immune cells

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21
Q

What instigates the inflammatory process of cervix ripening

A

Hormone changes - functional progesterone withdrawal - inflammation and influx of immune cells, increased corticotrophin releasing hormone and oestrogen, plus cervical distension -> oxytocin -> Ferguson reflex (fetal movement stretches cervix)

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22
Q

What is PGE2 used for

A

Ripen cervix and induction of labour

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23
Q

What contraction associated proteins are induced in the myometrium in labour

A

Prostaglandin receptor, COX-2, oxytocin receptor, gap junctions, calcium signalling proteins

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24
Q

What are gap junctions made from

A

Connexin proteins

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25
What Cx are unregulated during labour
Cx43 and Cx26
26
What happens with increased gap junctions
Intercellular communication, more powerful contractions
27
What initiates labour
Fetal HPA axis involvement, but progesterone drop not apparent. Increasing oestrogen concentrations.
28
What is the estradiol level through gestation
Steady rise
29
What is the progesterone level through gestation
Steady rise with plateau at term
30
What is the role of oxytocin during labour
Uterine contraction: Important for cervical dilation before birth, oxytocin causes contractions during the second and third stages of labor
31
What are important signals in human parturition
Fetal hypothalamus increase CRH production -> increase ACTH production Fetal adrenal increase cortisol and DHEAS Reduced progesterone responsivenss Increased fetal membrane COX-2 and prostaglandin Increased placental CRH and oestrogens
32
Where is milk produced
Milk produced in epithelial - surrounded by myoepithelial which can contract to release milk
33
Why is breast tissue unresponsive to prolactin before birth
Prolactin secreted from 16 weeks - but steroid block | Withdrawal of oestrogen and progesterone are essential
34
How does suckling ensure milk produciton
Neuroendocrine reflex Suckling: stimulates production of vasoactive intestinal peptide, reduces dopamine release Strength and duration of suckling determines amount of prolactin released from the anterior pituitary Milk transported from alveoli to nipple Suckling stimulates paraventriculuar and supraoptic nuclei to produce and release oxytocin Oxytocin causes contraction of myoepithelial cells surrounding alveoli full of milk
35
What occurs in stage I of fetal growth
Hyperplasia 4-20 weeks | Rapid mitosis and increase of DNA content
36
What occurs in stage II of fetal growth
Declining mitosis with increase in cell size 20-28 weeks
37
What occurs in stage III of fetal grwoth
Hypertrophy - rapid increase in cell size, accumulation of fat, muscle and connective tissue 28-40 weeks
38
When does the most weight gain ocur
95% in second half of pregnancy
39
What is the crown rump length at 8 weeks
3cm
40
What is the crown rump length at 32 weeks
30cm+
41
What is the weight at 12 weeks
90g
42
What is the weight at 26 weeks
1200g
43
What is the weight at 38 weeks
3350g
44
What is measured at 12 weeks from LMP
Viability - crown rump length | 45-84mm=11-14 weeks
45
What is measured at 18-20 weeks
``` Anomaly scan, assess fetal growth, anomalies, placenta site Head circumference Biparietal diameter Abdominal circumference Femur length ```
46
What is difference between SGA and FGR
SGA still follows growth curve
47
What causes growth restriction
Insufficient nutrient delivery gas exchange maternal vascular disease e.g. HP, PET< DM Decrease in maternal O2 capacity (sickle cell) Placental damage (smoking)
48
What causes intrinsically small foetus
Chromosomal/abnormality Infectious e.g. CMV Environmental e.g. fetal alcohol syndrome
49
How is SGA defined
Birth weight < 10th centile EFW <10th centile
50
What is severe SGA
EFW < 3rd centile | Higher chance of FGR
51
What is PAPP-A
Pregnancy associated plasma protein A Low levels associated with poor placentation Give aspirin 75mg
52
What is uterine artery doppler
Maternal artery measurement Low resistance to flow = reassuring High resistance to flow at 24 weeks = PI >1.4 Increase risk of SGA/PET
53
How are risks different for twins
Dichorionic (two placenta) lower risk of problems
54
What is the management for FGR
Early delivery with steroids
55
What is the management for SGA
Consider induction at 37 weeks
56
What is normal birth
Infant born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy
57
What is used as pain relief in labour
Breathing and relaxation, massage, water Entonox, opioids Epidural
58
What is the puerperium
Time from the end of the third stage through the first few weeks after delivery. 6 weeks in duration
59
What are signs of postpartum haemorrhage
Sudden and profuse blood loss or persistent increased blood loss Faintness, dizziness or palpitations
60
What are signs of infection
Fever, shivering, abdo pain
61
What are signs of pre-eclampsia
Headaches with: | Visual disturbances, nausea, vomiting
62
What are signs of thromboembolism
Unilateral calf pain, redness or swelling | Shortness of breath
63
What are metabolic and adaptive responses in pregnancy
Increase absorption from GI tract, decreased excretion via kidney, increased bone turnover, amenorrhoea (preserves Fe)
64
What happens with excessive GWG
Adverse maternal and neonatal outcomes, postpartum weight retention
65
What is the mean optimal birth weight
3.3kg
66
What is the total estimated energy cost over 40 weeks
322 MJ
67
What is the blastogenesis stage
Weeks 0-2 - zygote rapdily divides and embded into endometrial lining uterus wall
68
What is the recommendation for oral folate
All women planning pregnancy 400 ug per day until 12 weeks post conceptually
69
Vit A requirements
RNI=600, but high intakes teratogenic in the pre-conceptual period.
70
Vit D requirements
Primarily met via sun exposure Vit D deficiency in pregnancy associated with congenital rickets, impaired fetal/infant skeletal growth. 10 ug/day Vit D supplement
71
Ca requirements
RNI=700mg, required for calcification of fetal skeleton
72
Fe requirements
Consider Fe supplement if Hb < 110 in the first trimester or <105 in the 2nd trimester
73
What are the breastfeeding recommendations
Exclusively breastfed for the first six months, infant formula only recommended an alternative to breastfeeding for infants <12 months
74
When should solid food be introduced
6 months
75
What are signs of readiness for solids
Can stay in sitting position Can co-ordinate eyes, hands and mouth Can swallow food
76
What is DiGeorge Syndrome
Microdeletion of chromosome 22q11.2 | Presents with palatal abnormlaities, cardiac problems, hypocalcaemia, renal anomalies

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