3. Pregnancy, Paedatric Milestones & Vaccination Programmes

Question 1

What is a predisposing factor to development of spina bifida ?

Answer 1

Folate deficiency during pregnancy.

Question 2

What are factors causing fertility issues ?

Answer 2

Age.
Obesity.
BMI.
Exercise.
Drugs.
Folate.
Alcohol.

Question 3

Between what weeks is first trimester ?

Answer 3

0-12 weeks - structures of embryo forming and tissue differentiation begins.

Question 4

Between what weeks is second trimester ?

Answer 4

12-28 weeks - specialisation and final differentiation.

Question 5

Between what weeks is third trimester ? What occurs during this time ?

Answer 5

29-40 weeks - growth and acquisition of changes necessary for facilitation of successful birth.

Question 6

Why do mothers experience increased weight during pregnancy ?

Answer 6

Baby.
Increased fluid and blood volume to prevent hypovolemia due to blood loss during birth.

Question 7

What are 4 maternal changes which occur in pregnancy ?

Answer 7

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.

Question 8

What is the consequences of increased oestrogen and progesterone during pregnancy ?

Answer 8

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.

Question 9

What is the consequence of lower oesophageal sphincter relaxation in pregnancy ?

Answer 9

Increased GORD.

Question 10

What are the significant haematological changes in pregnancy ?

Answer 10

High RC and WC (20% increase in RC mass).
Increased platelet consumption - platelet count normal to low.
Increased WC - diagnosis of infection difficult.

Question 11

What is the consequences of relaxation of vascular smooth muscle during pregnancy ? What is the purpose of this change ?

Answer 11

< peripheral resistance.
< systolic and diastolic blood pressure.
Compensatory > in HR by 25%.
All to help body cope with increased vascular load.

Question 12

What is the dental consequence of vascular compression by uterus ?

Answer 12

Difficulty with venous return when supine position due to positioning of vena cava and aorta behind uterus.

Question 13

What coagulation changes are seen during pregnancy ?

Answer 13

Clotting factor production increases.
Fibrinolysis increased.
Increased system sensitivity.
Increased DVT risk.

Question 14

When does embryonic circulation begin ?

Answer 14

Week 6 - start of embryonic growth and development.

Question 15

When does a zygote become an embryo ?

Answer 15

Week 4.

Question 16

When does development of neural tube, gut tube and brain begin ?

Answer 16

Before week 4.

Question 17

When does embryo become a foetus ?

Answer 17

Week 10.

Question 18

When do features and limbs become developed and active ?

Answer 18

Between weeks 10-14.

Question 19

In what trimester is miscarriage most common ?

Answer 19

First trimester.

Question 20

Define miscarriage.

Answer 20

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.

Question 21

When will pre-eclampsia begin ?

Answer 21

Around 20 weeks.

Question 22

What are 2 risk factors for pre-eclampsia ?

Answer 22

Insulin dependent diabetes.
Multiple pregnancies.

Question 23

What is the consequences of pre-eclampsia ?

Answer 23

High BP.
Unlikely placenta will form fully.

Question 24

What are signs of pre-eclampsia ?

Answer 24

Proteinuria.
Thrombocytopenia.
Increased liver enzymes.

Question 25

What is the placenta ?

Answer 25

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.

Question 26

What foetal testing can suggest chromosomal abnormalities in foetus within first trimester ?

Answer 26

FAST - foetal abnormality screening programme - ultrasound and blood sample.
AFU carried out in second trimester - abnormality follow up.

Question 27

What assessment is part of birth testing ?

Answer 27

APGAR.
Activity, pulse, grimace, appearance, respiration.

Question 28

When should an APGAR score be taken ?

Answer 28

1 minute and 5 minutes after birth.

Question 29

Define pregnancy gingivitis.

Answer 29

Gingivitis as a result of change in hormonal levels making vascularity of blood vessels in response to gingival plaque higher i.e. increased WBCs.

Question 30

What 5 conditions are tested for in blood spot test shortly after birth ?

Answer 30

PKU.
Hypothyroidism.
Cystic fibrosis.
Sickle cell disease.
MCADD.