W01: Pregnancy Physiology; Antenatal Care & Screening; Contraception Flashcards
(43 cards)
Outline how the cardiovascular system adapt to pregnancy
Changes persist from 1st trimester all the way to post-natal normalisation to pre-preg conditions of all systems
*⇧ LV EDV, CO, HR
- complications w/ dilated cardiomyopathy or lesions; mitral stenosis or pulm. hypertension
- CO increases put pt with AO stenosis at risk
- fall in systemic vascular resistance dt ⇧circulating vasodilators and diversion into low pressure of uteroplacental unit
- ⇧O2 demand in myocardium
- risk of MI
• Warm red hands and feet
• ⇧Nose bleed risk
• Stuffiness or congestion
Outline how the respiratory system adapt to pregnancy
*⇧ O2 requirements
*⇧ Tidal Volume; ⇧Minute ventilation; RR (percieved as dyspnea)
- relative CO2 lower
- diaphragm pushed up
- ⇧Progesterone = bronchodilates = ashtma improves in some
Outline how the renal system adapt to pregnancy
- smc relaxation of ureter dt progesterone + mechanical compression of uterus = dilatation of urinary collecting system
- phys. hydronephrosis pronounced on right
- fall in systemic resistance = ⇧renal plasma flow; ⇧⇧Creatinine clearance
- ⇧Excretion of protein, vit d, renin, EPO but RETENTION OF WATER ⇧
- Microscopic haematuria commonly dt bleeds from dilated vessels
- Glycosuria common; UTI common
Outline how the haematological system adapt to pregnancy
*⇧BV, Red cell mass
* haemodilution = anemia
* Physiological Anemia = 105Gb at 28weeks = normal
- ⇧ Fe requirements dt foetal use = Fe def anemia common (likelihood ⇧ with twins)
- ⇩Serum Folate but normal liver folate
- ⇧ WCC and Neutrophils
- ⇧FACTORS PROMOTING CLOTTING
Outline how these changes may impact on disease and management in pregnancy
Immune modulation = sometimes AuImm conditions improve during preg. such as Crohns, RArth.
*Existing cardiac disease = complications and fatality as well as dx of undiagnosed disease
- cardiac disease leading indirect cause of maternal death
- ⇧ DVT RISK dt thrombotic state and venodilation = ⇧venous stasis = Pulmonary Embolus common cause of death
Outline how normal values for lab testing are different in pregnant compared to non- pregnant women
⇧TBG in pregnancy but raised T3 and T4 thus normal levels
⇧ Catecholamines
- Physiological Anemia = 105Gb at 28weeks = normal
WCC of 16x109/L = normal
HYPERCOAGUABLE STATE
- ⇩Lower urea and creatinine dt raised clearance
Describe the role of pre-pregnancy counselling
a
Mechanical and Metabolic changes during pregnancy
*RELAXIN, OESTROGEN, PROGESTERONE = ⇧pliability, extensibility
- lumbar lordosis
- pubic symphyseal gap increase
- ⇧Relative insulin insensitivity
- placental lactogen acts against maternal insulin
- hormones = relaxed oesoph sphincter = ⇧risk of reflux + pressure of uterus contributes + delayed gastric emptying
- ⇧Na and Water retention = oedema in 80% of preg people
+ ⇧BV and compression on IVC = ⇩venous return = peripheral oedema
Significance of oedema
sign of pre eclampasia
Changes in Thyroid function in preg
⇧TBG form liver; however T4 and T3 increasede thus levels remain same
I2 deficiency dt active transportation + excretion doubled thus ⇧GOITRE likelihood
BHCG hormone structurally similar to TSH thus similar consequence to hyperthyr.
> propanolol
Role of Pain during Pregnancy
⇧circulating catecholamines = ⇧HR, BP, CO
Commonest haem. abnormalities in pregnancy
- Fe def anemia (⇧⇧ in twins)
- Folate def anemia
UTI mgmt in Pregnancy
> Nitrofurantoin
or
Amoxicillin
Cefalexin
Levels of ESR in pregnancy…
ESR: erythrocyte sedimentation rate increases during pregnancy due to an increase in fibrinogen and globulin levels; there is however a fall in the amount of albumin.
Urate levels in pregnancy…
During early pregnancy serum uric acid levels fall, often to 3 mg/dl or below, related to the uricosuric effects from estrogen and from the increase in renal blood flow. Uric acid levels then increase during the third trimester, reaching levels of 4–5 mg/dl by term
ALP levels in pregnancy…
Alkaline phosphatase is known to be produced by syncytiotrophoblasts in the placenta and its levels are normally increased in pregnancy.
Significance of haematuria in pregnancy
Common
Nil protein, infection, and renal uss normal = bleeds from dilated renal vasc
Outline the procedure and implications of the antenatal examination
- maternal, foetal, and social aspects of health
- routine enquiry: general wellness and feeling of fetal movements
- BP, urinalysis
• SYMPHYSEAL FUNDAL HEIGHT
+ estimate size of baby
+ estimate liquor volume: amniotic fluid index
• Fetal presentation: palpation and auscultation
Outline the basis of screening for fetal abnormality
Counselling prior to screening vital; allows detection of symptomless population
Outline what screening tests are offered to pregnant women and understand their limitations
Infection screen = Hep B; Syphilis; HIV; MSSU
> Penicillin (syphilis)
Anemia screen: Fe def.
Isoimminisation screen: rhesus disease, anti-c, anti-kell
First Visit Scan: ensure viable preg.; abnormalities
+ Offer Down’s Syndorme screening
= offers risk of baby affected
+ follow up. test offered to definitively tell
Outline the ethical dilemmas associated with detection of fetal abnormalities
- termination of life dt possible diagnosis
Pre-pregnancy counselling
Ideally for all women; aim of improving general health measures; smoking cessation;
*1/3 of pregnancies are unplanned
*ID known medical problems: psychiatric; existing medications
- Risks and previous pregnancy issues recurring
- DVT; pre-eclampsia
- pre-term delivery; intrauterine growth restriction
First Trimester Screening
at 10-14w gestation
- B-hCG
- Preg. associated plasma protein A (PAPP-A)
- fetal nuchal translucency (NT measurement)
- increases with gestational age
High Risk Results
- CVS
- Amniocentesis
- Non-invasive prenatal testing: maternal blood detect fetal cell free DNA
CVillus Sampling Vs Amniocentesis
Both Invasive and risk of miscarriage
CVS = 10-14w
Amniocentesis = 15w
