Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine year 2 semester 1 > Case 14- Pregnancy 2 > Flashcards

Case 14- Pregnancy 2 Flashcards

1
Q

Partogram

A

Used to record and asess the progress of normal and abnormal labour. On the Y axis there is cervical dilatation, and on the X axis is time. It shows whether the labour is low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How often do you examine the baby in labour

A

For the first baby you examine the cervix every 4 hours after labour starts and expect the cervix to dilate 0.5cm every hour. For Multiparous women you would expect them to dilate 1cm an hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Primigravida and Multiparous

A
  • Primigravida- a women having her first baby

* Multiparous- a women who has already had one child and is having another

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Active stage of labour

A

During the second stage of labour the head flexes as the uterus contracts, the head descends and engages in the pelvis. The leading part approaches the ichial spine. The Occiput starts to rotate anteriorly. The Occiput reaches the pelvic floor (levator ani). Internal rotation continues in order to achieve an occipito-anterior position. Once the occiput goes below the symphysis pubis, the head extends to deliver. The head then sits on the maternal peritoneum. You then get restitution where the fetal head realigns itself with the fetal shoulders.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What stops the placenta from bleeding after birth

A

The uterus contracts. When the uterus contracts you get a plane of cleavage where the placenta separates from the Myometrium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Active management in the 3rd stage of labour

A

Oxytocin makes the uterus contract and the midwife applies traction on the umbilical cord to allow delivery of the placenta and the membrane. Pressure is also applied to the Suprapubic region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Active management in the 3rd stage of labour

A

Oxytocin makes the uterus contract and the midwife applies traction on the umbilical cord to allow delivery of the placenta and the membrane. Pressure is also applied to the Suprapubic region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Fetal check in labour

A
  • Auscultate or cardiotocograph (CTG)
  • Amniotic fluid- check if its clear or blood stained (bleeding in the uters). If Meconium is present it could be a marker of distress.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Maternal checks in labour

A
  • Observations: pulse, BP, temperature
  • Bleeding
  • Severe pain
  • Vaginal and rectal examination following delivery, check for trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

3 types of problems you may have in non-progressive labour

A
  • Powers- the uterine contractions may not be strong enough
  • Passengers- the fetus may be too big or not in the right position
  • Pelvis- the womens pelvis may not be big enough for delivery.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Amniotimy

A

Breaking the water with an amnihook, this allows the babies head to apply more pressure on the cervix to stimulate better contractions. Oxytocin can also be given- medical form in syntocinon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When is it Non progressive labour in the second stage

A

Non delivery after an hour of active pushing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Problems with the second stage of labour

A
  • Powers- give mum more encouragement, give an amniotomy or syntocion. If the women is unable to push you can use a suction cup (ventouse) or forceps.
  • Passenger- may be malpositioned (not occiput anterior) or malpresented (not cephalic). You can try and change the position of the baby, for example through rotation using the ventouse or forceps.
  • Pelvis- caesarean section
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How long should you give for delivery of the placenta and membranes

A

30mins- before giving oxytocin and CCT (cord traction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pre-term baby

A

Delivery before 37 weeks (22-36)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does pre-term outcome depend on

A

Gestational age and birth weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What can prematurity cause

A

Cerebral palsy, blindness, chronic lung disease and disability. Cerebral palsy is brain damage secondary to insult.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What can be given to improve lung function in the pre-term baby

A

Corticosteroids can be given to the mother to encourage surfactant production in the fetus’s alveolar cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Risk factors for pre-term birth

A

Smoking, low socio-economic class, extremes of maternal age, cervical surgery (LLETZ), infection (urinary, STI’s) and fetal abnormalities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Other drugs that can be given to pre-term babies

A

Tocolytic like atosiban (oxytocin inhibitor) can be given to try and stop labour so steroids can be given to the mother for fetal lung maturation. However, often they don’t work. Magnesium sulphate helps with the neural development of premature babies, especially between 24-28 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Risks of vaginal Delivery

A

1) Trauma- vaginal lacerations can damage the anal sphincter/rectum, incontinence
2) Haemorrhage- can be ani partum (before the baby is delivered or postpartum (more common). Happens when the uterus hasn’t contracted down fully after delivery and the blood vessels haven’t stopped bleeding.
3) Infection- if some placenta is left behind
4) Urinary retention/bladder damage- may need catheter use
5) Shoulder dystocia- the shoulder of the baby become stuck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Complications of C-section

A

Haemorrhage, infection, DVT (blood is designed to clot after delivery to prevent haemorrhaging), damage to other organs (bladder, ureter, bowel). If you have multiple C-sections you can get a scarred uterus, which is where the placenta might embed in future pregnancies. This causes placenta excreta where you get a lot of bleeding when you get a c-section.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Complications of C-section

A

Haemorrhage, infection, DVT (blood is designed to clot after delivery to prevent haemorrhaging), damage to other organs (bladder, ureter, bowel). If you have multiple C-sections you can get a scarred uterus, which is where the placenta might embed in future pregnancies. This causes placenta excreta where you get a lot of bleeding when you get a c-section.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Fetal hypoxia

A

Poor gas exchange between fetus and mother leads to Hypercapnoea (high CO2). This lowers the pH causing the baby to become acidaemic. Low fetal oxygen causes Hypoxaemia, this decreases oxygen in the tissues causing Hypoxia. Respiration goes from aerobic to anaerobic causing lactate to increase. This lowers the pH causing acidosis.
Tissue ischaemia -> Acidosis -> Tissue death (necrosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What causes fetal hypoxia

A

You get hypoxia in labour when the uterus is contracting. If labour is prolonged or contractions are excessive. You can get acute hypoxia where there is a lack of oxygen delivered to the baby. Babies heart rate dips after the contractions. If there is difficulty in heart tracing, you can use an amnioscope to take a blood sample from the fetus and use it to test for acidosis.
Chronic hypoxia- placenta is not developed properly, causes intrauterine growth restriction. Can test for it by using doppler to measure the blood flow through the chord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Types of assisted delivery

A

Forceps- you slide the cephalic curve around the babies head and then apply traction to deliver the baby.
Ventouse- suction is created by a handpump. The cup is applied to the babies head causing the head to flex and delivering the baby.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Morbidity

A

Suffering from a disease or medical condition

26
Q

Antenatal complications

A

Hyperemesis (severe nausea and vomiting- can be put on a drip for dehydration), Anaemia, Pyelonephritis, Gestational diabetes (increased risk of stillbirth), Obstetric cholestasis, Preterm labour (7% of pregnancies), Antepartum haemorrhage. Pre-eclampsia/Eclampsia can cause seizures and strokes, renal/liver failure and Disseminated intravascular coagulation. Can be life threatening.

27
Q

Intrapartum complications

A

Haemorrhage, Amniotic fluid embolism (amniotic fluid goes into the women’s lungs), Operative delivery and Anaesthetic risks. Needing a ventouse or C-section puts you at risk of other complications.

28
Q

Postnatal complications

A

Anaemia, VTE, Puerperal sepsis (infection within the womb), mastitis (infection of the breast tissue), perineal breakdown/haematoma (swelling of clotted blood within the tissue), Haemorrhage/retained products, postnatal depression/psychosis

29
Q

Maternal complications aggravated by pregnancy

A
  • Cardiac disease
  • Renal disease
  • Endocrine- diabetic keto-acidosis
  • Neurological- Epilepsy, CVA, Subarachnoid haemorrhage
  • Sepsis- Flu/pneumonia/pyelonephritis
  • Psychiatric issues- drugs/alcohol
30
Q

How are the majority of births performed

A

1) Vaginal birth (70%)- 20% are done with forceps or ventous

2) Caesarean section (30%)

31
Q

Complications of Caesarean section

A
  • Wound infection
  • Haemorrhage
  • Bladder/bowel/ureteric injury
  • Baby: respiratory distress/cuts
  • Complications increase with number of Caesarians, especially if you have more then 3. There is a risk of adhesions which can cause bowel or bladder injury. Risk of placenta not separating from the wall of the womb (Placenta accrete), this is treated with a planned Hysterectomy.
32
Q

Complications of birth

A

VTE, sepsis, pulmonary embolism, anaesthetic risk and sepsis.
Complications of vaginal birth- retained placenta, postpartum haemorrhage, 3rd/4th degree tear/haematoma/infection. Fetal distress- hypoxic encelopathy (brain damage)

33
Q

Most common of sepsis in childbirth

A

Group A streptococcus

34
Q

Maternal mortality rate

A

Its 1 in 11,00 live births, in Sierra leonne its 1 in 90
Direct MDR- 4/100,000
Indirect MDR- 5/100,000

35
Q

Maternal death

A

Death while pregnant or within 42 days of delivery from any cause related to pregnancy

36
Q

Direct death

A

Deaths from obstetric complications of pregnancy, intervention, omissions or incorrect treatment

37
Q

Indirect deaths

A

Deaths that result from pre-existing disease or from disease that developed during pregnancy which was aggravated by pregnancy but not directly due to pregnancy

38
Q

What is the most common cause of maternal death

A

Cardiac death
Most common direct cause is thrombo-embolism
Mental health illness is the most common cause of late maternal death
71% of mothers who die in childbirth receive substandard care

39
Q

Perinatal mortality

A

The number of stillbirths and early neonatal deaths (first week of birth) per 1000 births

5 in 1000

40
Q

The most common cause of still birth

A

Placental dysfunction

41
Q

What is the major cause of neonatal deaths

A

Neonatal complications and congenital abnormalities

42
Q

Direct causes of maternal death

A

1) Thromboembolism (36%)
2) Haemorrhage (15%)
3) Psychiatric (15%)
4) Sepsis
5) Amniotic fluid embolism
6) Pre-eclampsia

43
Q

Causes of indirect maternal death

A

Cardiac disease, Neurological, Malignancy (breast cancer- lumps aren’t noticed), Sepsis (flu/pneumonia etc), Psychiatric (drugs/alcohol etc).

44
Q

Why is cardiac disease a big cause of maternal death

A

Cardiac deaths have increased due to higher BMI, older mothers and people with congenital heart disease living to an older age.

45
Q

Risk factors for maternal death

A
  • Age
  • Being unemployed and living in deprivation
  • Being born outside the UK, migrants and refugees. Interpretation services are an issue.
  • Mental health, substance abuse, domestic abuse. Can make them poor attenders at antenatal clinics
  • Late booking / no antenatal care / concealed pregnancy
  • Child protection issues
  • BAME
  • Pre-existing health conditions- diabetes, cardiac, mental health
  • Smoking
  • Obesity- significant risk of thromo-embolism, pre-eclampsia, gestational diabetes, CS (operations are more difficult), and ITU admission.
  • Caesarian section
  • Multiple pregnancies
46
Q

Why are BAME women at increased risk of maternal death

A

Black women are 5x more likely to die. This is because they are more likely to have health issues and be affected by social and economic problems. Also due to systemic racism and racial bias, they are not listened to and less likely to disclose worries. They also receive less empathy from HP’s. Black women are more likely to have fibroid uterus’s.

47
Q

Stillbirth

A

A baby born with no signs of life after 24 completed weeks of pregnancy
Stillbirth rate- 3.94 per 1000
Babies of BAME parents are at a higher risk of stillbirth. There is a higher risk of stillbirth earlier on in gestation and with multiple pregnancies (3x higher risk for twins).

48
Q

Neonatal death

A

A live born baby (born at 20 weeks or later or >400g if accurate gestation not available) who died before 28 days after birth

49
Q

Early neonatal death

A

A live born baby that dies in the first week of life

50
Q

Late neonatal death

A

A live baby that dies after the 7th day and before the 28th day

51
Q

Causes of stillbirth

A

1) Unknown (40%)
2) Placenta (29%)- can separate from the baby
3) Congenital abnormalities (9%)
4) Umbilical cord- may be cord prolapse or knots in the tube
5) Maternal- diabetes etc

52
Q

Causes of neonatal death

A

1) Neonatal- extreme prematurity, neurological, cardio-respiratory, GI
2) Congenital (31%)
3) Infection (8%)
Bigger risk for teenagers and mothers over 40. The highest risk is mothers living in pregnancy. Increased risk if its earlier on in gestation and with multiple pregnancies (twins)

53
Q

Puerperium

A

The period up to 6 weeks after childbirth during which the mothers reproductive organs return to their original non-pregnant state.

54
Q

Puerperium- structural changes to the uterus

A
  • Contraction after delivery occludes blood vessels in the placental bed, reducing excessive blood loss.
  • Autolysis- excess protein in the uterine muscle and other cells are broken down and excreted in the urine, there is a negative nitrogen balance. The Uterus weighs about 1kg post delivery but autolysis shrinks the uterus to less then 60-80g in a few weeks.
  • After delivery the uterus is just below the umbilicus, after 10-14 days it goes back into the pelvic organ, below the pubis.
55
Q

Puerperium- Lochia

A
  • Dark period like loss in the first week, similar to the amount in a period. Lighter in colour and amount by second week
  • Made up mainly of necrotic superficial decidua and blood.
  • Rubra - red after delivery till day 5-7
  • Serosa – red brown till day 10-14
  • Alba – yellow till 14-21
  • Varies between women, the amount decreases over time.
  • New endometrium regenerates from basal layer within 7-10 days
  • Placental site endometrium take 6 weeks to regenerate.
56
Q

Puerperium- Cervix

A
  • Cervix is stretched to 10cm, its floppy and curtain like after delivery
  • Within 2-3 days it regains its tone and consistency.
  • The External os may retain open for a few weeks but the internal os will close after a few days. The appearance of the external os is permanently elliptical after childbirth.
57
Q

Puerperium- Vagina

A
  • The vagina become less vascular. After delivery it is smooth, soft and oedematous with the distension from labour remaining.
  • The vagina regains its tone and returns to normal by 3-6 weeks, with rugae reappearing
  • After multiple births the vagina is more capacious and the opening is permanently larger than a nulliparous woman.
58
Q

Puereperium- muscle tone

A

Pelvicalyceal dilation in pregnancy will revert back to normal dimensions. Return of muscular tone in the pelvic floor and abdominal wall. This muscle tone returns with pelvic floor exercises and doing sit ups. Fading of the striae gravidarium (stretch marks) and linea nigra.

59
Q

Hormonal changes in tthe Puereperium

A
  • Falling levels of sex steroids: progesterone and oestrogen with delivery of placenta.
  • Falling levels of prolactin, unless breastfeeding.
  • Falling thyroid hormones (T3 and T4) over 4-6 weeks.
  • Declining renin, aldosterone, cortisol.
  • Return of cyclical pituitary and ovarian function. First menstruation is usually anovulatory (without ovulation), at 7-9 weeks in non lactating woman. 70-80% will menstruate by 12 weeks postpartum. Need contraception if not breastfeeding exclusively.
60
Q

Hormonal changes in lactating women

A
  • Suckling stimulates nerve endings in the nipples
  • Which send signals to the hypothalamus to inhibit the release of PRL release inhibiting hormone, causing prolactin release from the anterior pituitary. It makes the milk in the breast move for the next feed.
  • Once oestrogen and Progesterone levels drop, Prolacatin is released and causes the production of milk
  • Prolactin causes development of mammary tissue in preparation for birth
  • Inhibits gonadotrophins secretions and causes anovulation
  • Oxytocin release from the posterior pituitary is responsible for stimulating the myoepithelial cells around the glands to the nipples, to promote milk ejection.
  • Drops in progesterone allow expression of alpha-lactalbumin which stimulates milk lactose production.
  • Milk let-down (milk ejection) reflex is dependent on oxytocin and prolactin production in a breastfeeding woman. Oxytocin is released when the mother is expecting a feed and the baby is suckling. Can be caused by thinking about the baby or hearing it cry.
61
Q

Puereperium- Cardiovascular adaptions

A
  • Fall in plasma volume- by day 10 its to non pregnant state. Due to increased urination.
  • Cardiac output- increases immediately after delivery then slowly declines. There is an increase in stroke volume due to increased venous return despite a fall in heart rate by 10bpm. Venous return increases due to organs like the uterus returning their volume to the vasculature
  • Hb immediately rises, followed by a 4 day fall before steadily rising as plasma volume is lost.
62
Q

Puereperium- Haematological changes

A
  • Leucocytes rise at delivery and then fall to non pregnant levels by day 6
  • Platelets decrease in the first 2 days of delivery then rapidly rise.
  • The Hypercoagulable state of pregnancy persist up to 6 weeks postpartum. The highest risk of VTE is in the postpartum period.
63
Q

Top to toe check for women

A
  • Psychological state- baby blues
  • Symptoms of anaemia- if she had blood loss
  • Chest symptoms
  • Breast symptoms- mastitis/abscess
  • Eating / drinking- not vomiting
  • Passing urine/ bowels- especially if she had trauma in the area. May have issues urinating if the mother had an epidural
  • Lochia- if its heavy it may be a haemorrhage
  • Wounds
  • Leg symptoms including mobility
64
Q

6 week check for mothers in primary care

A
  • Mental Health
  • Feeding method and any breast problems
  • Period or abnormal bleeding
  • Contraception- does it interfere with breast feeding
  • Smear- if due
  • Scar healing– caesarean, tears
  • Bowel and bladder function
65
Q

Baby blues

A

1) 80% of women
2) First week after birth of baby
3) Due to significant physical and horomonal changes
4) The mother can feel emotional and irrational, burst into tears randomly, feel irritable and depressed
5) Usually improves 10 days post partum

Medicine year 2 semester 1 (53 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions