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A3 ME3034 REPRO > W01: Pregnancy Physiology; Antenatal Care & Screening; Contraception > Flashcards

W01: Pregnancy Physiology; Antenatal Care & Screening; Contraception Flashcards

1
Q

Outline how the cardiovascular system adapt to pregnancy

A

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
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2
Q

Outline how the respiratory system adapt to pregnancy

A

*⇧ O2 requirements

*⇧ Tidal Volume; ⇧Minute ventilation; RR (percieved as dyspnea)
- relative CO2 lower
- diaphragm pushed up

  • ⇧Progesterone = bronchodilates = ashtma improves in some
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3
Q

Outline how the renal system adapt to pregnancy

A
  • 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
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4
Q

Outline how the haematological system adapt to pregnancy

A

*⇧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
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5
Q

Outline how these changes may impact on disease and management in pregnancy

A

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
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6
Q

Outline how normal values for lab testing are different in pregnant compared to non- pregnant women

A

⇧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
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7
Q

Describe the role of pre-pregnancy counselling

A

a

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8
Q

Mechanical and Metabolic changes during pregnancy

A

*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
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9
Q

Significance of oedema

A

sign of pre eclampasia

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10
Q

Changes in Thyroid function in preg

A

⇧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

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11
Q

Role of Pain during Pregnancy

A

⇧circulating catecholamines = ⇧HR, BP, CO

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12
Q

Commonest haem. abnormalities in pregnancy

A
  1. Fe def anemia (⇧⇧ in twins)
  2. Folate def anemia
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13
Q

UTI mgmt in Pregnancy

A

> Nitrofurantoin
or
Amoxicillin
Cefalexin

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14
Q

Levels of ESR in pregnancy…

A

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.

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15
Q

Urate levels in pregnancy…

A

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

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16
Q

ALP levels in pregnancy…

A

Alkaline phosphatase is known to be produced by syncytiotrophoblasts in the placenta and its levels are normally increased in pregnancy.

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17
Q

Significance of haematuria in pregnancy

A

Common

Nil protein, infection, and renal uss normal = bleeds from dilated renal vasc

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18
Q

Outline the procedure and implications of the antenatal examination

A
  • 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

19
Q

Outline the basis of screening for fetal abnormality

A

Counselling prior to screening vital; allows detection of symptomless population

20
Q

Outline what screening tests are offered to pregnant women and understand their limitations

A

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

21
Q

Outline the ethical dilemmas associated with detection of fetal abnormalities

A
  • termination of life dt possible diagnosis
22
Q

Pre-pregnancy counselling

A

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
23
Q

First Trimester Screening

A

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

24
Q

CVillus Sampling Vs Amniocentesis

A

Both Invasive and risk of miscarriage

CVS = 10-14w
Amniocentesis = 15w

25
Q

Neural Tube Defect Screening

A

Not routinely offered
* only for increased risk
>5mg folic acid to reduce risk

  • First trimester USS detects anencephaly and sometimes spina bifida
  • Second trimester screening
  • good for structural abn but poor test for chromosmal abn.
26
Q

Describe the methods of male and female sterilisation along with their indications and

A

Laparocscopic Sterilisation: filshie clips across f tubes
* irreversible; nil effect on periods/hormones
* ⇩risl of ovarian ca.

Salpingectomy: removal of a Fallopian tube. This may be done to treat an ectopic pregnancy or cancer, to prevent cancer, or as a form of contraception.

Vasectomy: divided and ends cauterised w/ midline scrotal incision (most done in 1º care)
+ sperm samples required after
* irreversible; low risk of testicular pain; nil effect on hormones or sexual function
* nil effect on risk of ca.

27
Q

Outline the issues involved during counselling of a couple prior to sterilisation

A
  • irreversibility
  • risk of failure; thus require follow up
  • other low risk of complications such as pain
28
Q

Describe the Abortion Act

A

• first 24 weeks
• abortion treatment must be carried out in a hospital or a place approved by Scottish Government Minister
• prevent continuation of greater risk to maternal health and wellbeing and any existing children
• prevent significant great risk of poor quality of life for the potential chil; suffering from great physical or mental abnormality

  • consideration of infection risk and blood transfusion and contraception education
  • nil impacts: fertility, cancer risk but emotional impact yet much safer taht fullterm delivery
29
Q

LARC (Long Acting Reversible Contraception)

A

Less user input thus minimises user failure rates (dt incorrect usage) Vs MEthod Failure - pregnancy despite correct use of method

30
Q

Combined Hormonal Contraception

A

Pill, patch, vaginal ring

  • ETHINYL ESTRADIOL (EE) and SYNTHETIC PROGESTOGEN
    = stops ovulation, affects cervical mucus and endometrium
  • 21d, one week off
  • Pill taken daily
  • Patch changed weekly
  • Ring changed every 3 weeks

+ reduced bleeding: benefits heavy/painful periods
+ improve premenstrual syndrome
+ reduced functional ovarian cysts
+ reduction in ovarian and endometrial ca.
+ improve acne/ hirsutism
+ ⇩ benign breast disease, Rheum Arth., colon ca., osteoporosis

31
Q

Combined Hormonal Methods Sfx & Considerations

A

Breast tenderness
Nausea
Headache
IRregular bleeding first 3mos

Wt gain - not causal

• increased risk of DVT: BMI >34, hx of VTE
• risk of thrombosis: smokers, hx of., migraines, 50yo+
• gall bladder disease, liver tum. hx

• cervical ca. risk increased
• breast ca risk increased

32
Q

Progesterone-only Pill (POP) mini-pill

A

No pill-free interval, not ideal if frequent GI upset

  • Desogestrel pill - 12 hour window
  • nearly all cycles anovulant, affect mucus
  • LNG NET pills - 3hr window
  • Oestrogen free thus few contraindications
    ! personal hx breast ca / liver tum
33
Q

Progesterone sfx

A

variable; troublesome sfx
* appetite
* hair loss/gain
* mood change
* bloating / fluid retention
* headache
* acne

nil thrombotic risks
! avoid if current breast ca or liver tum hx/present

34
Q

Injectable Progestogen

A

solution of medroxyprogesterone acetate dose every 13 weeks

1ml deep intramusc injection upper outer quadrant of buttock / or 0.6ml of thigh

  • prevents ovulation
  • alters cervical mucus = hostile to sperm
  • makes endometrium unsuitable for implantation
  • 12-14week intervals
  • estrogen-free
35
Q

Injectable Progestogen Sfx

A
  • delay in return to fertility: 9mos
  • reversible reduction in bone density: osteoporosis risk
  • problematic bleeding first 2 doses
  • weight gain: casual effect on wt gain
36
Q

Subdermal progestogen implant

A

Inhibits ovulation and effect on vervical mucus
3 years or be removed: no user input, or effect on weight

37
Q

Injectable Progestogen Sfx

A
  • Population of users experience prolonged bleeding
  • more frequent mood changes
38
Q

Intrauterine contraception: coil

A

Long acting reversible contraception: 5-10yr use

  • sfx immediately reversible upon removal
  • offer STI testing dt infection risk in first 3 weeks

Unsuitable if untreated pelvic infection or distored endometrial cavity

+ Cu Coil = toxic to sperm; prevents implantation of egg
• hormone free; potentially heavier periods; can be fitted after 40th bday can work until menopause

39
Q

Injectable Progestogen Sfx

A
  • infection risk
  • perforation risk on fitting
  • expulsion risk
  • ectopic risk if conception occurs
40
Q

Levonorgestrel IUS

A

Coil which releases hormones

  • slow rleease of progestogen = low circulating hormones vs other forms
  • reduces bleeding
  • MIRENA: 5yr option: bleed free 12mos; licenses to treat heavy bleeding
  • KYLEENA: contraception only, less progestogen thus less sfx but also less likely to be bleed free
41
Q

Emergency Contraception

A
  1. Copper IUD most effective
  2. Levonorgestrel pill: take within 72hrs
  3. Ulipristal pill: take within 120 hrs
    ! ci: breast feeding, enzyme inducing drugs
42
Q

Drug interactions of common forms of female contraception

A

ENZYME INDUCING DRUGS:
* Carbamezapine
* topiramate
* rifampicin
* St johns wort
= ⇧metabolism of progestogen and oestrogen = ⇩effectiveness

Injections and copper IUD or levonorgestrel IUS unaffected

43
Q

Describe the common medical and surgical methods of termination of pregnancy

A
  1. SURGICAL 5-12W
    cervical priming = MISOPROSTOL 3hr preop = dilation reduces risk of perforation and haemorrhage
  • GA or LA cervical block
  • Transcervical: 6-10mm suction catheter
    <10 mins

! perforation; cervical injury; GA risk

  1. MEDICAL 5-23 +5 weeks
    MIFEPRISTONE: antiprogestogen tablet
    * uterine contraction opens cervix and expels pregnancy

!failure risk => sx.

  1. EARLY MED. ABORTION AT HOME
    MISOPROSTOL prescription to take home for self-administration
    *under 10w gestation; healthy; have support; analgesia supplied

A3 ME3034 REPRO (21 decks)

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