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Flashcards in Reproductive pathophysiology Deck (30)
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1

WHO preterm definition

before 37 weeks

2

Why are lungs an issue?

Lack of surfactant

3

Layers of the pregnant uterus

Amnion, chorion, decidua, myometrium

4

Infections associated with preterm birth?

Gram positive (ureaplasma parvum, ureaplasma urealyticum, strep), salmonella typhirium, Gardenerella vaginalis (bac. vaginosis). Tox plasmosis and malaria in developing countries. Can have two hit mechanism with initial candida/adenovirus initial infection

5

How do infections stimulate labour?

Inflammatory pathways enable return to pre-preg. state, but bacterial LPS activate TLR4, stimulate IL-6/TNF alpha (via NFkB) - pro inflammatory) as well as IL-1beta

6

Fetal fibronectin

produced in decidua, reaches upper cervix. Possible indiciator of pre-term labour/short cervix

7

Tocolysis

medical therapy to delay labour. Includes CCBs (L type), atosiban (oxytocin receptor antagonist), COX-2 inhib (inhibi prostg), NO donors (promote relaxation). None beneficial to fetus, just give some time
No proved benefit to Abx or other channel modulators

8

Prevention

Progesterone admin, cervical clercage

9

Pre-eclampsia

Dx criteria are HT+proteinuria (or underlying renal dysfunction). Early onset is <34, late is >34 weeks. Eatrly onset is worse.
Other symptoms are oedema, epigastric pain, thrombocytopoenia, cerebral/visual disturvance, headache, sudden weight gain, muscle twitch, pulmonary oedema. May have raisedliver enzymes.

10

Pathophysiology of pre-eclampsia

In pergnancy, should be very little resistance to flow to placenta. Dysfunction thought to be due to trophoblast debris entering maternal circ. Poor trophoblast invasion, poor vasodilatory response, endothelial dysfunction (arteries don't dilate fully, endothelial damage). Ros and peroxides also implicated.

11

Pre-eclampsia risk factors

New partner, family Hx, maternal age (either extreme), CVD, renal disease, obesity

12

Pre-eclampsia treatment

low dose aspirin. Magnesium sulphate given for severe pre-eclampsia. Only real treatment is delivery of placenta (and baby).
Preeclamptic mothers and offspring have increased stroke risk

13

Intrauterine growth restriction

below 10th centile. Need serial growth measurements.Shares pre-eclampsia aetiology.

14

Asymmetrical IUGR

Typically late onset. Brain spared at expense of other organs. Examples are chronic hypoxia, malnutrition

15

Symmetrical IUGR

LEss common than asymmetrical. Typically early onset (<32 weeks). Normal ponderal index (HC/AC, both perameters reduced). Can be genetic disorders, drug use, or TORCH (toxoplasmosis, rubella, CMV)

16

Fetal undernutrition sequalae

Increases cortisol, pancreas/liver/kidneys/blood vessels underdeveloped, predisposes to insulin resistance, central obesity and HT/hyperlilidaemia. Increased risk of T2D

17

Dystocia

Responsible for 50% of C sections.
uncoordinated uterine contractions lead to abnormal fetal presentation (head hasn't turned), but can also be cephalopelvic disproportion (head:pelvis ratio). Oxytocin and Pgs may help

18

Shoulder dystocia

Different from dystocia. More common in larger babies, and with diabetes/maternal obesity

19

Gestational diabetes

new onset of glucose intolerance in pregnancy. Tends to produce macrosomia (large baby). Increased T2D risk

20

Zika

Viral, causes microcephaly. Transmission via mosquito/sexual/blood/semen, placenta.
Symptoms - rash, myalgia, arthalgia, fever. Dx by PCR Causes developmental delay in babies.

21

Gestational HT

new onset HT after 20weeks pregnancy without pre-eclampsia features

22

superimposed pre-eclampsia

pre-eclampsia in women with chronic HT/renal disease

23

Key feature of pre-eclampsia

proteinuria. Heavily associated with IUGR

24

Role of Angiotensin 2 in pre-eclampsia

In pregnancy, sensitivity to AG2 is lost (angiotensin 2 counters local vasodilator PGs). Pre-ecmaptic women retain AG2 sensitivity

25

HELLP syndrome

Haemolysis, elevated liver enzymes, low platelet count. Sx are headache, blurred vision, band pain (liver), nausea/vomiting and parasthesia. DDx of gall bladder, pyelonephritis, peptic ulcer, gastroenteritis, fatty liver of prenancy, hepatitis. Resulting thrombocytopoaenia can cause liver/brain haemorrhage.

26

HT control in pregnancy

Methyldopa (alpha 2 antagonist), hydralazine , labetalol(mixed alpha/beta adrenoceptor antagonist - CI asthma), prazosin, nifedipine (CCB)

ACEi, ARB, diuretics and atenolol are CI

27

What can be given to avoid resp distress syndrome

betamethasone

28

placenta praevia

placenta is too close to cervix, can be partial or total. C section required

29

Placenta accreta/percreta

placenta grows too deep and attaches to myometrium. Risk of heavy bleeding at birth. Accreta is partial thickness, percreta is full thickness and may need hysterectomy

30

placental abruption

3rd trimester. lining separates from uterus - placental insufficiency