Arch Pregnancy exam answers Flashcards
What do you measure in a pregnancy test and what secretes it
B-HCG – initially secreted by syncytiotrophoblasts and then after 10 weeks it is the placenta
What causes localised sharp groin pain in pregnancy
Stretching of the round ligament 🡪 Round ligament stretch pain → genital branch of genitofemoral nerve
Difference between subfertility and infertility
What are 3 causes of Infertility in females
Turner’s syndrome, STI’s, fallopian tube damage, early-menopause, Anorexia,
Table with 3 parameters you would test for in pregnancy and the reason behind testing for it
BP 🡪 to monitor for pre-eclampsia
BGL 🡪 gestational diabetes
Urine analyses 🡪 proteinuria 🡪 pre-eclampsia
Hb + platelets + elevated LFTs 🡪 HELLP Syndrome
In Down’s Syndrome, identify two common recurrent problems and their clinical
features
chromosomal abnormality or Robertsonian translocation 🡪 trisomy 21 🡪 Congenital heart defects (AV canal, VSD, PDA) + congenital GI tract malformation (Hirschsprung’s, duodenal stenosis/atresia, imperforate anus)
Upward slanting eye lids (palpebral fissures) Unusually shaped or small ears. Poor muscle tone. Broad, short hands with a single crease in the palm.
Most children with Down syndrome have mild to moderate cognitive impairment. Language is delayed, and both short and long-term memory is affected.
List two other trisomy conditions tested for in maternal screening (2)
Patau’s Trisomy 13 and Edwards Trisomy 18
Explain how trisomy occurs. What is the most common way in which it occurs. Use a diagram if necessary (5)
Most common way is non-disjunction 🡪 homologous chromosome or sister chromatids fail to separate properly during cell division (can be during meiosis 1 of oogenesis or meiosis II or spermatogenesis) 🡪 additional copy of chromosome in the child’s cells.
Less common is Robertsonian translocation 🡪 rearrangement between non-homologous acrocentric chromosome -> balanced translocation in asymptomatic parent 🡪 unbalanced in gamete 🡪 fixed copy of additional chromosome 🡪 trisomy
What is the single most common risk factor for trisomies
Advanced maternal age
How do autoimmune disorders such as SLE increase risk of miscarriages (2 marks)
Women with lupus are at higher risk for miscarriage and other complications during pregnancy. This is partly because lupus can cause health problems, such as kidney disease, high blood pressure and antiphospholipid antibodies (like lupus anticoagulants) that may increase the risk of a pregnancy loss.
What are two pre-natal screening tests and what they are looking for (4 marks)
- Blood type- Determines whether Rh positive or negative. Rh factor is a protein marker in the red blood cells. If mother is Rh negative and baby is Rh positive, maternal antibodies against Rh factor. This can cause problems with subsequent pregnancies.
- NON-INVASIVE PRENATAL TESTING (NIPT)- common genetic abnormalities (Trisomy 21, 13, and 18)
Why does pregnant lady with SLE need pre-natal screening?
To test for congenital issues + neonatal lupus so treatment can start before or at birth
She has groin pain, what is the likely cause? (2 marks)
Round ligament stretch pain → genital branch of genitofemoral nerve
What are 4 physiological changes that occur in women during pregnancy
- What are 3 mechanisms of the combined oral contraceptive
ethinyl estradiol suppresses FSH (inhibits ovulation and follicular development) and stabilises endometrium
levonorgestrel supresses LH, cause endometrial atrophy and thicken cervical mucus
3 major physiological events that precede menarche
growth spurt, breast budding (thelarche) then the arrival of pubic hair growth (pubarche) and then lastly the onset of menses
4 Combined pill risks that you would discuss with patient before starting contraception
Contraindications for COC
- Family History of breast cancer
- haemophilia/clotting disorders
- history of VTE
- smoker
COC use has been associated with increased risks of hypertension, myocardial infarction, and stroke in certain populations. Increased risk of breast cancer
What are 4 risk factors for ectopic pregnancy, how do they exert their effects
- smoking – diminishes ciliary activity
- tubal pathology or tubal surgery
- pelvic inflammatory disease
- previous ectopic pregnancy
implantation of the blastocyst outside the uterus can result in miscarriage if there is not adequate blood supply or the embryo can begin to grow into the new location often causing bleeding/haemorrhage and pain
What are two symptoms you would prescribe the combined OCP for and what is the mechanism of action behind this prescription?
can improve acne and dysmenorrhea, predictable bleeds,
2 effects of ethanol on growing fetus
Alcohol use when pregnant can cause a range of lifelong physical, mental and behavioural disabilities, known as Fetal Alcohol Spectrum Disorders (FASD). Alcohol exposure can also cause miscarriage, stillbirth, premature birth, and low birth weight
- BDNF and its effects Female Reproductive:
Brain-derived neurotrophic factor (BDNF) is expressed extensively in the mammalian female reproductive system and has been implicated in the development of follicles and oocytes.
Lower BDNF in late pregnancy leading to higher depressive symptoms.
What are two common precursors to progesterone & oestrogen?
Cholesterol and pregnelone
Sister had pain since menarche, what would this be classified as?
Period pain from your first period or shortly after, and without a specific cause, is known as primary dysmenorrhoea. Period pain caused by certain reproductive disorders, such as endometriosis, adenomyosis or fibroids, is known as secondary dysmenorrhoea.
How is endometriosis classified in pelvic pain?
persistent pelvic pain = at least 3 months of pain from pelvic organs/structures which is often associated with negative behavioural, sexual and emotional consequences
often causes depression and anxiety due to sensitive nature of pelvic structures
causes may include endometriosis, IBS, fibromyalgia, interstitial cystitis
neurobiological mechanisms involved may cause pain to spread between structures and for pain pathways to be activated inappropriately
Why is there more pain in endometriosis during menstruation?
Endometriosis 🡪 endometrial tissue found outside the uterus 🡪 oestrogen and progesterone release from ovary causes monthly build up of endometrial tissue 🡪 monthly progesterone withdrawal cause subsequent sloughing but in extra-uterine endometrial tissue cannot evacuate implantation site 🡪 local inflammation (release of pro-inflammatory chemicals) 🡪 activation of nociceptors at area of ectopic endometrium 🡪 cyclical menstrual pain.
How do PG cause pain & other menstrual symptoms?
During your period, prostaglandins trigger muscles in your uterus to contract. These contractions help expel the uterus lining. Higher levels of prostaglandins can cause more severe menstrual cramps, and severe contractions may constrict the blood vessels around the uterus.
2 symptoms of pelvic pain
