1 - Normal Antenatal Progress Flashcards by Maxim Wallace

Why is pre-natal care so important?

To optimise health prior to pregnancy commencing

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What two supplements are prospective pregnant mothers started on?

Folic acid

Vitamin D supplementation

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Why might Asian women have an increase chance of vitamin D deficiency?

Decreased sun exposure

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What complications does appropriate folic acid supplementation reduce the chances of occurring?

Neural tube defects (NTDs) (e.g. spina bifida)

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In what situations would a higher dose of folic acid be recommended?

Raised BMI
Hx/FHx of NTD
Antiepileptic medication
Diabetes

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What are the 3 main roles of hormones throughout pregnancy?

Maintain pregnancy (Prog)
Prepare for delivery (Oest)
Prepare for breast feeding

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What hormone is indicative of pregnancy?

Beta-hCG

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Where is beta-hCG produced?

Placenta

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What is the role of oestrogen during pregnancy, and through what mechanism?

Prepares the body for delivery

–> increases the expression of oxytocin receptors within the uterus.

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What are the two main functions of progesterone throughout pregnancy?

1) Smooth muscle relaxant

2) Maintains uterine lining

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What 3 changes occur to maternal respiratory physiology as a result of pregnancy?

1) Diaphragmatic breathing (=> with the uterus enlarging, a greater pressure builds within the abdomen)
2) Relative hyperventilation (=> remove excess co2)
3) Increase tidal volume (=> increase o2 intake)

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What are the 2 main changes to maternal cardiovascular physiology as a result of pregnancy?

1) Increase cardiac output (=> both HR and SV increase)

2) Decrease in BP

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What features of the peripheral vessels is the reason for why SV increases and BP decreases?

Systemic vascular resistance decreases

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What condition arises in BP increases during pregnancy?

Pre-eclampsia

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What 3 main changes occur in haematological maternal physiology during pregnancy?

1) Increase in plasma volume (40%) (=> can lead to peripheral oedema)
2) Increase in RBC volume
3) Increase in clotting factors (=> hypercoagulable state)

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Why might some pregnant mothers become anaemic despite the increase in plasma and RBC volume?

Plasma volume massively outweighs RBC volume increase

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What risk is associated with having an increased number of clotting factors secondary to pregnancy?

DVT

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What are the main musculoskeletal changes that occur to maternal physiology as a result of pregnancy?

1) BMI increase
2) Stretch marks
3) Low back pain
4) Lordosis
5) Carpel tunnel syndrome
6) Sciatica
7) Calf cramp

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What 4 hormones are subject to the greatest changes in their production?

Oestrogen
Progesterone
beta-hCG
Human placental lactogen

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What condition is associated with human placental lactogen?

Gestational diabetes

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Which two glands can often under hyperplasia during pregnancy?

Anterior pituitary
Thyroid gland (goitre)

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What two dermatological changes arise as a result of pregnancy?

Increase skin pigmentation

Distension / proliferation of blood vessels (e.g. spider angiomata, facial flushing, stria gravidarum)

What are the main gynaecological changes that occur as a result of pregnancy?

Breast enlargement
Areolar pigmentation
Uterine hypertrophy + stretching
Cervical gland hypertrophy
Vaginal lactobacilli proliferation

Which hormone is responsible for cervical gland hypertrophy ?

What is the resulting gynaecological effect?

Oestrogen

Stimulates glands to produce thick mucus plug

Which hormone is responsible for vaginal lactobacilli proliferation? How does it serve to facilitate success of a pregnancy?

Oestrogen Increases lactic acid and thus, decreases pH - creating unfavourable conditions for other pathogens.

What are the 3 main breast changes that occur as a result of pregnancy?

1) Increase adipose tissue 2) Increase lactiferous duct system 3) Enlargement of breast lobule

Which hormone is responsible for increasing the adipose content / lactiferous duct system within the breast?

Estrogen

Which hormone is responsible for the enlargement of a female's breast lobules?

Progesterone

What 3 main urological changes are seen as a result of pregnancy?

1) Increase renal blood flow (40%) 2) Kidney enlargement 3) Ureter dilatation (progesterone)

What are the 3 main gastriointestinal effects that occur as a result of pregnancy?

1) Oesophageal relaxation 2) Increase in intra-abdominal pressure 3) Reduced bowel motility

What symptoms may arise as a result of progesterone's muscle relaxation effects?

1) Reflux 2) Haemorrhoids 3) Constipation

what are the 3 ways in which ethnicity may affect / contribute to a different risk-assessment for pregnancy?

1) Risk of diabetes 2) Risk of haematological disorders (e.g. thalass, sickle cell) 3) Genital mutilation?

How might previous mental health issues alter a risk-assessment for a pregnant mother?

May predispose post-partum depression / psychosis

What is assessed in the screening / monitoring aspects of antenatal care for: Blood tests

Hb level Platelets Infections Blood group / Anti-b status ** + Haematological disorders if high risk from risk-assessment

What two components make up the 'combined' antenatal test?

1) US scan (i.e. nuchal fold) | 2) Blood test

Within the blood sample for the 'combined' test, what two components are assessed?

1) Pregnancy Associated Plasma Protein A (PAPP-A) | 2) beta-hCG

If mothers are deemed high-risk from the 'combined test', what tests are then offered?

Offer diagnostic testing: Either, chorionic villus sampling OR amniocentesis.

If an US scan cannot be offered / is unavailable, what test is subsequently offered?

Quad test

What 4 components does the quad test assess?

1) Alpha feto-protein 2) Inhibin A 3) Oestriol 4) beta-hCG

What are the main risk factors for gestational diabetes?

``` BMI > 30 Ethnicity (e.g. Black african, indian) FHx of 1st degree relative with DM PCOS Previous baby >4.5kg Previous GDM ```

In the context of Rhesus disease, define and list examples of 'sensitising events'

Events that may increase the passage of fetal blood into maternal circulation e.g. Miscarriage, termination of pregnancy, invasive procedures, trauma, placental abruption, blood transfusion

What is the purpose of an anti-D injection?

'mop-up' any fetal cells within maternal circulation.

After how many weeks is a prophylactic anti-D injection offered?

28 weeks

During low-risk pregnancy, how is fetal growth measured?

Symphysis-fundal height (SFH) in cm

List some of the most common causes of DIRECT maternal mortality

``` Sepsis Pre-eclampsia Thrombosis Amniotic fluid embolus Early pregnancy Haemorrhage Anaethesia ```

Define primary post-partum haemorrhage - what is it?

Loss of >500 within 24h

What is the most common cause of primary PPH? What are two other causes?

Uterine atony Clotting factors Trauma

What are the risk factors for PPH?

``` Previous PPH Prolonged labour Pre-eclampsia Increased maternal age Polyhydramnios Emergency Caesarean section Placenta praevia, placenta accreta Macrosomia Ritodrine (a beta-2 adrenergic receptor agonist used for tocolysis) ```

What is secondary post-partum haemorrhage? What are the causes?

Loss of >500ml blood after 24h of delivery Retained placental tissue / endometriosis

What are the 3 features of obstetric cholestasis?

Pruritis Jaundice Raised bilirubin

What two pharmacological agents can be used in obstetric cholestasis?

Vitamin K supplements | Ursodeoxycholic acid

What are the 4 signs of labour?

Regular, painful uterine contractions Shortening, widening of cervix A show (shedding of mucus plug) Rupture of membranes

What is Puerperal pyrexia?

Raised temperature >38 within 14 days following birth

What are the most common causes of puerperal pyrexia?

1) Endometritis (MOST common cause) 2) Urinary tract infection 3) Wound infections (perineal tears + caesarean section)