Basics Of Pregnancy ➡️Infections In Pregnancy Flashcards
Duration of pregnancy is?
9month 7days from 1st day of LMP
40 wks, 280days
Preterm and postterm delivery?
Preterm pregnancy less than 37 wks
Post term - pregnancy more than or equal to 42 wks
Term delivery is pregnancy of?
37 wks to 41 wks +6 days
EDD is calculated by
Naegele’s formula
1st day of LMP +9 MONTHS +7 DAYS
In case of IVF EDD is calculated by
D3 transfer - Subtract 16 to get LMP
D5 transfer- Subtract 18 to get LMP
Period of viability acc to WHO AND INDIA
Who - 24 wks
India -28 wks
What is gravida and parity
Gravida is total number of time female conceive, irrespective of outcome
Present preg is included
Parity is number of past pregnancy that have gone beyond pd of viability
Present preg not included
Method of writing gravida and parity
GTPAL GRAVIDA TERM PRETERM 20-36 WKS +6 DAYS ABORTION <20 WKS NUMBER OF LIVING CHILDREN
Minimal ANC Visit acc to WHO AND INDIA
IDEAL ANC VISITS?
MINIMUM
INDIA -4
WHO-8
IDEAL 12-15
Investigation to be done during antenatal visits
Blood grp Urinalysis-dipstick Hiv Hbsag vdrl Pap smear Cbc Blood sugar -DIPSI trisomy Grp Bstreptococcal screening Usg
What to do to test for group B streptococcal screening
Why is this screening performed
What if screening is positive
Rectovaginal swab at 35-37 wks
Culture and sensitivity
To prevent neonatal sepsis
Screening positive- IV penicillin at active labour
If allergic cephazolin
Dating scan in pregnancy is done at?
6-8 wks of pregnancy
Imaging finding of ectopic pregnancy
Empty uterine cavity, gestational sac in tube
Doppler- ring of fire pattern
Snow storm appearance in usg is seen in
Molar pregnancy
Abortion is said on imaging when
Mean sac diameter- more than 25 mm( blighted ovum)
Crown rump length more than equal to 7 mm
No cardiac activity
Scan for downs syndrome and when it is done
Nuchal translucency scan
11-13 wks +6 days
Level 2 scan or booking scan is done for and at?
At 18-20 wks
For targeted imaging for fetal anomalies
Parameter for growth scan and when is it performed
Abdominal circumference
30-32 wks
Signs of pregnancy early signs- upto 8 wks of preg
Goodell -softening of cervix
Hegar- softening of lower part of uterus
Osiander- pulsation in lateral fornix of vagina
Piskacek - assymetrical growth of uterus in early pregnancy
Chadwick/Jacquemier- Bluish discoloration of vagina and cervix
Palmer’s- regular, rhythmic contraction of uterus
Absolute signs of pregnancy
Fetal movement
Fetal heart sound
Usg
Xray
What is quickening
Perception of first fetal movement by mother
In primi - 18 wks
In multi -16 wks
FHS is heard at
18-20 wks by steth
10 wks by doppler
All _____ vaccines are contraindicated in pregnancy
All ________ vaccine can be given in pregnancy
Live
Killed
Essential vaccine during pregnancy
Td -Tetanus+Diphtheria
2 doses, 1month apart
1st dose -1st AN visit
Contraindicated vaccine during pregnancy
Mumps Measels Rubella BCG Small pox Chicken pox HPV
Pregnancy upto 1 month after vaccination is contraindicated in which vaccine
Mumps Measels Rubella BCG Small pox Chicken pox HPV
Vaccine given only if pregnant female is travelling to an endemic area
Yellow fever
Polio
Cholera
Typhoid
Vaccine which are safe during pregnancy
Hep A& B Meningooccal Pneumococcal Rabies Flu
Weight gain in pregnancy
11-12.5 kg
Factors affecting weight gain
Pre pregnant weight
Socioeconomic status
Parity
Ethnicity
Factor which doesn’t affect maternal weight gain
Smoking
Pre pregnancy BMI of woman was less than 19
Recommended wt gain should be
Thin
12.5 -18 kg
Pre pregnancy BMI of woman was more than 30
Recommended wt gain should be
Obese
Recommended wt gain less than 7kg
Total calories needed in entire pregnancy
80,000kcal
Extra calories required per day by a pregnant woman
And lactating woman
350 kcal /day
600 kcal/day
Calories required in 1st trimester
No additional calories required in 1 st trimester
Only 2&3
Amt of water Na K retained in pregnancy
Water -6. 5L
Na 1000mEq
K 300 mEq
Cause of water retention in pregnancy
Its manifestation
Increased estrogen
Physiological pitting edema
Pregnancy is a anabolic/catabolic state??
BMR INCREASES /DECREASE by 10-20 %?
Anabolic state
Bmr increases by 10-20%
O2 consumption in pregnancy and labour
Pregnancy increases by 20 %
Labor by 40-%60
Calcium requirement of mother at term
Calcitonin, Vit D, PTH levels are?
30g of Ca
Increased
Pth hormone increases late in pregnancy and decrease early in pregnancy
Vit D requirement in pregnancy
Calcium requirement
10mcg(400IU/day)
1200mg/day
Insulin resistance in pregnancy is due to
Human placental lactogen mainly
Others estrogen, progesterone, cortisol
Glucose is transported across placenta through?
Facilitated diffusion using GLUT3&1
PREGNANCY IS A DIABETOGENIC STATE
Glycosuria in pregnancy is physiological?
Proteinuria in pregnancy is physiological?
When is lactosuria physiological
Yes
No proteinuria is always pathological
Lactosuria is physiological during breast feeding
Skin changes in pregnancydue to estrogen
Linea nigra Striae gravidarum Chloasma gravidarum Striae albicans Spider nevi Palmar erythema
Skin changes in pregnancy due to progesterone
Basal body temperature in pregnancy in increased due to progesterone
Size and weight of breast during pregnancy is increased due to
Increased fat due to insulin
Increased alveoli due to progesterone
Increased ducts due to estrogen
Other changes in breast during pregnancy
Hyperpigmentation
Appearance of secondary areola
Montgomery tubercle appear
Diff bw colostrum and breast milk
K potassium
F fat
C carbs
Are less in colostrum as compared to breast milk
Vitamin lacking in breast milk
Vit K
Hormone responsible for milk ejection/ galactokinesis
Oxytocin - causes contraction of myoepithelial cells of alveoli
Two factor for milk production
Prolactin
Suckling by neonate
Prolactin levels in non pregnant female
15ng/m
Prolactin levels in pregnant female
Maximum level is when
150 ng/ml
At labor
Effect of estrogen on prolactin levels during pregnancy
Increased levels of prolactin by positive effect on lactotrope
Decrease activity of prolactin by negative effect
Effect of estrogen on prolactin levels after delivery
Decreased estrogen leads to decrease levelof prolactin but increased activity of prolactin leading to milk production
Changes in respiratory system in pregnancy
2cm-transverse diameter of chest increases by 2
4cm-diaphragm is pushed by gravid uterus by 4
6cm-circumference of chest increases by 6
Subcostalangle of non pregnant vs pregnant
68 degree
103 degree
Parameters increasing in pregnancy
Parameters remaining unchanged in pregnancy
Increasing
Inspiratory capacity
Tidal volume
Minute ventilation
Remain unchanged
Inspiratory reserve volume
Respiratory rate
Vital capacity
Mechanism of compensatory metabolic acidosis in pregnancy
Functional residual capacity decrease Air trapped in lungs increases Blood CO2 level decrease Respiratory alkalosis Compensatory excretion of bicarbonate by kidney
Bohr effect seen in pregnancy
O2 binding capacity of blood increases due to decrease bicarbonate
O2 carrying capacity of blood increases
O2 consumption increases
Action of progesterone leads to which changes in pregnancy
It is smooth muscle relaxant
LES relaxed, GI reflux increases
GB motility decrease
GI motility normal in anc, decrease in labor
Treatment of vomiting in pregnancy
Cause of vomiting
HcG is cause of vomiting Tt Doxylamine + pyridoxine 2 tab bedtime Or Hyoscine
How to diagnose Hyperemesis gravidarum
Non physiological vomiting
Wt loss more than 5% if pre pregnancy wt
Ketosis
Vital unstable
Cause of Hyperemesis gravidarum
Clinical features
Due to excessive hcg, estrogen, progesterone
Excessive hcg in twins, downs, molar preg, rh negative preg
Clinical features
Metabolic alkalosis
Hypokalemia
Ketosis
Complications of Hyperemesis gravidarum
Lft abnormal
Wernicke encephalopathy due to thiamine deficiency
Vit K deficiency
Scoring system in Hyperemesis gravidarum
Treatment
Mother Puqe scoring Rhodes index Tt Nil per oral Iv fluid Antihistamines - promethazine Dopamine antagonist metoclopramide
Anatomical changes in renal system-
Size of kidney increases by 1cm
Urinary stasis due to progesterone
Hydroureter ,more on rt side due to dextrorotation of uterus,
baldder mucosa congested
Anatomical changes in renal system-
Size of kidney increases by 1cm
Urinary stasis due to progesterone
Hydroureter ,more on rt side due to dextrorotation of uterus,
baldder mucosa congested
Physiological changes in renal system
RBF⬆️
GFR⬆️
Increased excretion of urea uric acid creatinine
Decrease serum urea, uric acid creatinine
Mc organ involved in PIH
Gfr in PIh increases or decrease?
Mcc of uti in pregnancy
Asymptomatic bacteuria can lead to __________
Kidney
GFR DECREASE IN PIH
E coli
Preterm labor and pyelonephritis
Antibiotics of uti
Doc
Nitrofurantoin 100mg BD for 3days
Sheehan syndrome
Pituitary size increases by 125% during pregnancy, after delivery if there is pph, ant pituitary necrosis occurs k a SHEEHAN SYNDROME
All enzyme are decrease in pregnancy except
Alkaline phosphatase
In pregnancy alkaline phosphatase is synthesized by
Liver and placenta (placenta producesheat stable alp)
Cholestasis of pregnancy is aka
Recurring jaundice of pregnancy/icterus gravidarum
Mcc of jaundice in pregnancy
Viral hepatitis
Mc symptoms of cholestasis of pregnancy
Pruritis in palms and sole
Best investigation, T/T of cholestasis
Increase bile acid
Alp increase
Ast alt increase
Doc ursodeoxycholic acid
Yellow necrosis of liver is other name for
Acute fatty liver of pregnancy
Mc cause of liver failure in pregnancy
Acute fatty liver of pregnancy
Pathogenesis and symptoms of acute fatty liver of pregnancy
Long chain hydroxyacyl dehydrogenase deficiency in male fetus
Leads to accumulation of long chain fatty acid in mother’s liver
Symptoms Hypoglycemia Encephalopathy due to ammonia Ascites Pulmonary edema Hemoconcentration Dic hepatorenal syndrome Upi
HelLP syndrome
Tennessee criteria Hemolysis LDH more than 600 IU/L Elevated liver enzymes Sgot sgpt 70 IU/L Low platelet Less than 1 lakh
Mgt of
HeLLP
AFLP
Cholestasis
HeLLP
MgSo4 and antihypertensive
Immediate termination of pregnancy
If more than 34 wks give steroid and terminate after 48 hrs
AFLP
Immediate termination of pregnancy even If more than 34 wks
Cholestasis
Termination after 37 wks
Mc hepatitis in pregnancy
Most fulminant hepatitis in pregnancy
Max maternal mortality is with ?
Hep B
HepE
HepE
Marker for infectivity and vertical transmission in viral hepatitis
Doc
HbeAg
Tenofovir
All parameters of iron metabolism decrease in pregnancy except
Serum transferrin
TIBC
Increase
Hepcidin level _____⬆️⬇️? In pregnancy
Decrease
As it aids in iron transfer into maternal circulation
Total iron needed in pregnancy
RDA of iron in pregnancy
1000 mg
40-60 mg /day
Only 10% is absorbed
AMB iron dosage and schedule
Elemental iron 60 mg
Folic acid 50mcg
Started from 4th month of pregnancy continue till 6 month after delivery
For pt planning pregnancy dose of IFA?
STOP IRON, ONLY FOLIC ACID GIVEN
What is physiological and pathological anemia
Physio- Hb never less than 11g
Pathological Hb less than 11
Severe and very severe anemia
Severe less than 7
Very severe less than 4
Mcc of anemia in pregnancy
Most sensitive rbc index
Most sensitive ans earliest marker of iron def
Iron deficiency anemia
Mchc less than 30%
S. Ferritin decrease
Treatment of iron deficiency anemia in pregnancy
Increase of Hb
First parameter to increase after giving iron
2IFA TABLET /DAY
AFTER 3 WKS AT 0.7g/dl/wk
Reticulocyte count
Treatment of iron deficiency anemia in pregnancy
Increase of Hb
First parameter to increase after giving iron
2IFA TABLET /DAY
AFTER 3 WKS AT 0.7g/dl/wk
Reticulocyte count
Rate of increase of Hb in parenteral iron therapy
Same as oral after 3 wk 0.7 gm/dl/wk
Mc iron parenteral
Best iron
Iron sucrose
Carboxymaltose
How to calculate dose of parenteral iron calculation
2.4* wt in kg*Hb deficit +500 mg (iron stores)
Mcc anemia after bariatric surgery
Vit b12 deficiency
Mc indirect cause of maternal mortality
What is dimorphic anemia
Anemia
Iron folic acid deficiency anemia
Indication for blood transfusion in anemia
Increase in Hb in blood transfusion
Hb less than 5 Severe anemia in late T3 Anemia causing heart failure Refractory anemia Acute hemorrhage causing hb less than 6
1 packed cell transfusion increase Hb by 1 gm%
Indication for blood transfusion in anemia
Increase in Hb in blood transfusion
Hb less than 5 Severe anemia in late T3 Anemia causing heart failure Refractory anemia Acute hemorrhage causing hb less than 6
1 packed cell transfusion increase Hb by 1 gm%
