3. Pregnancy, Paedatric Milestones & Vaccination Programmes Flashcards
What is a predisposing factor to development of spina bifida ?
Folate deficiency during pregnancy.
What are factors causing fertility issues ?
Age.
Obesity.
BMI.
Exercise.
Drugs.
Folate.
Alcohol.
Between what weeks is first trimester ?
0-12 weeks - structures of embryo forming and tissue differentiation begins.
Between what weeks is second trimester ?
12-28 weeks - specialisation and final differentiation.
Between what weeks is third trimester ? What occurs during this time ?
29-40 weeks - growth and acquisition of changes necessary for facilitation of successful birth.
Why do mothers experience increased weight during pregnancy ?
Baby.
Increased fluid and blood volume to prevent hypovolemia due to blood loss during birth.
What are 4 maternal changes which occur in pregnancy ?
Increased oestrogen and progesterone.
Lower oesophageal sphincter relaxation.
Hormonal changes increasing - reduces insulin sensitivity.
Haematological.
Relaxation of vascular smooth muscle.
Vascular compression by uterus.
Hyper-coagulation - risk of DVT.
What is the consequences of increased oestrogen and progesterone during pregnancy ?
Act on kidney to -
- Increase renin secretion.
- Increase salt and water retention.
- Increased plasma volume by 45%.
- Hb falls from 15 to 12g/dL - so patients will appear to have low haemoglobin but measured against increased circulation volume, remains high.
What is the consequence of lower oesophageal sphincter relaxation in pregnancy ?
Increased GORD.
What are the significant haematological changes in pregnancy ?
High RC and WC (20% increase in RC mass).
Increased platelet consumption - platelet count normal to low.
Increased WC - diagnosis of infection difficult.
What is the consequences of relaxation of vascular smooth muscle during pregnancy ? What is the purpose of this change ?
< peripheral resistance.
< systolic and diastolic blood pressure.
Compensatory > in HR by 25%.
All to help body cope with increased vascular load.
What is the dental consequence of vascular compression by uterus ?
Difficulty with venous return when supine position due to positioning of vena cava and aorta behind uterus.
What coagulation changes are seen during pregnancy ?
Clotting factor production increases.
Fibrinolysis increased.
Increased system sensitivity.
Increased DVT risk.
When does embryonic circulation begin ?
Week 6 - start of embryonic growth and development.
When does a zygote become an embryo ?
Week 4.
When does development of neural tube, gut tube and brain begin ?
Before week 4.
When does embryo become a foetus ?
Week 10.
When do features and limbs become developed and active ?
Between weeks 10-14.
In what trimester is miscarriage most common ?
First trimester.
Define miscarriage.
Abnormality in development of foetus, natural termination of pregnancy where foetus would be unable to sustain life or difficulty obtaining nutrients from mother - due to maternal and foetal factors.
When will pre-eclampsia begin ?
Around 20 weeks.
What are 2 risk factors for pre-eclampsia ?
Insulin dependent diabetes.
Multiple pregnancies.
What is the consequences of pre-eclampsia ?
High BP.
Unlikely placenta will form fully.
What are signs of pre-eclampsia ?
Proteinuria.
Thrombocytopenia.
Increased liver enzymes.
What is the placenta ?
Large organ with capillary base joined by stalk to child.
Interlining mesh of BVs so that material and foetal circulation do not mix - vessels sit in close proximity to allow diffusion of nutrients between mother and child.
What foetal testing can suggest chromosomal abnormalities in foetus within first trimester ?
FAST - foetal abnormality screening programme - ultrasound and blood sample.
AFU carried out in second trimester - abnormality follow up.
What assessment is part of birth testing ?
APGAR.
Activity, pulse, grimace, appearance, respiration.
When should an APGAR score be taken ?
1 minute and 5 minutes after birth.
Define pregnancy gingivitis.
Gingivitis as a result of change in hormonal levels making vascularity of blood vessels in response to gingival plaque higher i.e. increased WBCs.
What 5 conditions are tested for in blood spot test shortly after birth ?
PKU.
Hypothyroidism.
Cystic fibrosis.
Sickle cell disease.
MCADD.
