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Women's Health > 1 - Normal Antenatal Progress > Flashcards

1 - Normal Antenatal Progress Flashcards

1
Q

Why is pre-natal care so important?

A

To optimise health prior to pregnancy commencing

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2
Q

What two supplements are prospective pregnant mothers started on?

A

Folic acid

Vitamin D supplementation

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3
Q

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

A

Decreased sun exposure

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4
Q

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

A

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

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5
Q

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

A

Raised BMI
Hx/FHx of NTD
Antiepileptic medication
Diabetes

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6
Q

What are the 3 main roles of hormones throughout pregnancy?

A 
Maintain pregnancy (Prog)
Prepare for delivery (Oest)
Prepare for breast feeding
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7
Q

What hormone is indicative of pregnancy?

A

Beta-hCG

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8
Q

Where is beta-hCG produced?

A

Placenta

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9
Q

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

A

Prepares the body for delivery

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

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10
Q

What are the two main functions of progesterone throughout pregnancy?

A

1) Smooth muscle relaxant

2) Maintains uterine lining

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11
Q

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

A

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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12
Q

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

A

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

2) Decrease in BP

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13
Q

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

A

Systemic vascular resistance decreases

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14
Q

What condition arises in BP increases during pregnancy?

A

Pre-eclampsia

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15
Q

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

A

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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16
Q

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

A

Plasma volume massively outweighs RBC volume increase

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17
Q

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

A

DVT

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18
Q

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

A

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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19
Q

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

A

Oestrogen
Progesterone
beta-hCG
Human placental lactogen

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20
Q

What condition is associated with human placental lactogen?

A

Gestational diabetes

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21
Q

Which two glands can often under hyperplasia during pregnancy?

A 
Anterior pituitary
Thyroid gland (goitre)
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22
Q

What two dermatological changes arise as a result of pregnancy?

A

Increase skin pigmentation

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

23
Q

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

A 
Breast enlargement
Areolar pigmentation
Uterine hypertrophy + stretching
Cervical gland hypertrophy
Vaginal lactobacilli proliferation
24
Q

Which hormone is responsible for cervical gland hypertrophy ?

What is the resulting gynaecological effect?

A

Oestrogen

Stimulates glands to produce thick mucus plug

25
Q

Which hormone is responsible for vaginal lactobacilli proliferation?

How does it serve to facilitate success of a pregnancy?

A

Oestrogen

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

26
Q

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

A

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

27
Q

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

A

Estrogen

28
Q

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

A

Progesterone

29
Q

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

A

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

30
Q

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

A

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

31
Q

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

A

1) Reflux
2) Haemorrhoids
3) Constipation

32
Q

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

A

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

33
Q

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

A

May predispose post-partum depression / psychosis

34
Q

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

A

Hb level
Platelets
Infections
Blood group / Anti-b status

** + Haematological disorders if high risk from risk-assessment

35
Q

What two components make up the ‘combined’ antenatal test?

A

1) US scan (i.e. nuchal fold)

2) Blood test

36
Q

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

A

1) Pregnancy Associated Plasma Protein A (PAPP-A)

2) beta-hCG

37
Q

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

A

Offer diagnostic testing:

Either, chorionic villus sampling OR amniocentesis.

38
Q

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

A

Quad test

39
Q

What 4 components does the quad test assess?

A

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

40
Q

What are the main risk factors for gestational diabetes?

A 
BMI > 30
Ethnicity (e.g. Black african, indian)
FHx of 1st degree relative with DM
PCOS
Previous baby >4.5kg
Previous GDM
41
Q

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

A

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

42
Q

What is the purpose of an anti-D injection?

A

‘mop-up’ any fetal cells within maternal circulation.

43
Q

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

A

28 weeks

44
Q

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

A

Symphysis-fundal height (SFH) in cm

45
Q

List some of the most common causes of DIRECT maternal mortality

A 
Sepsis
Pre-eclampsia
Thrombosis
Amniotic fluid embolus
Early pregnancy
Haemorrhage
Anaethesia
46
Q

Define primary post-partum haemorrhage - what is it?

A

Loss of >500 within 24h

47
Q

What is the most common cause of primary PPH?

What are two other causes?

A

Uterine atony

Clotting factors
Trauma

48
Q

What are the risk factors for PPH?

A 
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)
49
Q

What is secondary post-partum haemorrhage?

What are the causes?

A

Loss of >500ml blood after 24h of delivery

Retained placental tissue / endometriosis

50
Q

What are the 3 features of obstetric cholestasis?

A

Pruritis
Jaundice
Raised bilirubin

51
Q

What two pharmacological agents can be used in obstetric cholestasis?

A

Vitamin K supplements

Ursodeoxycholic acid

52
Q

What are the 4 signs of labour?

A

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

53
Q

What is Puerperal pyrexia?

A

Raised temperature >38 within 14 days following birth

54
Q

What are the most common causes of puerperal pyrexia?

A

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

Women's Health (3 decks)

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