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Medicine year 2 semester 1 > Case 14- pregnancy complications > Flashcards

Case 14- pregnancy complications Flashcards

1
Q

Neonate

A

Infant younger then 28 days

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2
Q

IUGR

A

Intrauterine growth restriction, where growth slows or ceases in-utero. Different to SGA as it applies to neonates with malnutrition and is irrespective of birth weight percentile. IUGR is when growth slows or stops

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3
Q

Extreme pre-term

A

<26 weeks of pregnancy

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4
Q

Pre-term

A

<37 weeks of pregnancy

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5
Q

Term (baby)

A

37-42 weeks of pregnancy

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6
Q

Post term

A

> 42 weeks of pregnancy

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7
Q

Small for gestational age (SGA)

A

Birthweight <10th centile for gestational age

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8
Q

Large for gestational age (LGA)

A

Birthweight >90th centile for gestational age

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9
Q

Low birthweight

A

<2500g

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10
Q

Very low birthweight

A

<1500g

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11
Q

Extreme low birthweight

A

<1000g

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12
Q

Placental causes of IUGR

A

Placental insufficiencies, Pre-eclampsia, Placental Abruption.

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13
Q

Foetal causes of IUGR

A

Multiple pregnancies, Chromosomal abnormalities (trisomy 13, 18 or 21), Major congenital abnormalities (congenital heart disease, neural tube defect, abdominal wall defects) and Rare genetic syndromes.

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14
Q

Maternal causes of IUGR

A

Age, Low socio-economic status, Parity, Inter-pregnancy interval, Previous delivery of SGA / IUGR baby, Substance abuse, Medication, Pre-pregnancy BMI, Assisted reproductive technologies, Medical conditions, Infections (viral).

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15
Q

Pre-term risk factors= Previous preterm birth / late miscarriage

A

Most likely risk factor for preterm baby. Future pregnancies need specialist treatment
Complication= preterm baby, stillborn or neonatal death

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16
Q

Difference between preterm and miscarriage

A

Late miscarriage= 12-24 weeks

Preterm= from >24 to <37 weeks

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17
Q

Pre-term risk factors= Cervical surgery

A

Overview- weakness of cervix, fetus not suspended as well, the pressure can induce early labour. Can happen at any time. Due to procedure on cervix or infection.
Complication- preterm baby / neonatal death

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18
Q

Pre-term risk factors= Pre-eclampsia

A

BP >160 or >110 diastolic with proteinuria. Can cause eclamptic fit and death. Asymptomatic, cured by delivery of the placenta. Usually around 30-34 weeks.
Complications= Preterm baby, eclampsia, maternal and neonatal death, renal failure, IUGR and fetal compromise

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19
Q

Pre-term risk factors multiple pregnancies

A

All multiple pregnancies are high risk and need consultant led care.
Complications- miscarriage and preterm delivery, IUGR, congenital abnormalities, cerebral palsy and disability

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20
Q

Pre-term risk factors- IUGR

A

Failure to thrive in utero. Can occur throughout the pregnancy.
Complications= increased perinatal mortality rates, Cerebral palsy rates, emergency C section, Meconium aspiration, Stillbirth, Hypoglycaemia and Hypocalcaemia

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21
Q

Biological consequences of foetal growth restriction

A

Poor growth
Cerebral palsy, gross motor and minor neurological dysfunction.
↑ chance of developing diabetes, hypertension, obesity, metabolic syndrome, coronary heart disease before adulthood.

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22
Q

Psychological consequences of foetal growth restriction

A

Lower levels of intelligence.
Lower scores on cognitive testing.
Behavioural problems: hyperactive behaviour, attention deficit hyperactivity disorder.
Poor perceptual performance, poor visuo-motor perception.

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23
Q

Social consequences of foetal growth restriction

A

Poor academic performance
Difficulties in school or requiring special education
Low social competence

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24
Q

Rooting reflex

A

Stroking an infants cheek or corner of their mouth will cause the infant to turn their head and open their mouth.

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25
Q

Babkin reflex

A

A neonate whose palms are firmly stroked will open its mouth, close its eyes, and tilt its head forward

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26
Q

Plantar gasping reflex

A

Stroking the ball of the foot causes the infant to curl their toes and attempt to grab the finger

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27
Q

Placing reflex

A

Hold the infant upright under the arms, close to a table.
Let the dorsal “top” of foot touch the underside of the table.
Note flexing of hip and knee, followed by extension at the hip, to place foot on table
Reflex appears at 4 days after birth

28
Q

Moro reflex

A

In a sitting position, allow the head to momentarily fall backwards, the infant will symmetrically extend and abduct their arms and open their hands

29
Q

Galant reflex

A

Suspending the infant ventrally, supporting the anterior chest wall, applying pressure along the thoracic spine causes the infant to flex the trunk and swing their pelvis towards the stimulus

30
Q

List of Problems for Preterm new-borns

A

1) Temperature control- Hypothermia, skin
2) Respiratory control
3) Circulation- Hypotension, Patent ductus arteriosus, anaemia
4) Gastrointestinal and nutrition- Necrotising enterocolitis, Nasogastric tube feeding and feeding intolerances
5) Brain, Metabolic, Infection, Eyes and Ears

31
Q

Preterm babies- Hypothermia

A

Causes increases energy consumption which results in hypoxia, hypoglycaemia and failure to gain weight. Increases morbidity and mortality

32
Q

Preterm babies- Skin

A

Infants have large surface area, skin is thin and permeable, little subcutaneous fat and can’t generate heat by shivering (they use fat thermogenesis to regulate temperature)

33
Q

Preterm babies- Respiratory

A

1) Respiratory distress syndrome (RDS)- lungs are not fully developed
2) Pneumothorax- overinflation and bursting of alveoli from ventilator when air leaks into the pleural cavity
3) Apnoea, bradycardia and desaturation

34
Q

Preterm baby- Respiratory Distress syndrome (RDS)

A

Surfactant deficiency which lowers surface tension leading to alveolar collapse and inadequate gas exchange

35
Q

Preterm baby- Patent ductus arteriosus

A

The ductus arteriosus remains patent in many preterm infants causing oxygenated and deoxygenated blood to mix. Common in RDS. May be asymptomatic or cause apnoea, bradycardia and increased O2 requirements

36
Q

Preterm baby- GI

A

1) Necrotising enterocolitis- caused by low blood flow/oxygen to the gut. The intestine becomes inflamed, can rupture and be necrotic. ‘Bubble like bowel.’
2) Feeding intolerance- struggles to meet TPN (total Parenteral nutrition) due to lactose intolerance and problems latching

37
Q

Preterm babies- Brain

A

1) Haemorrhage
2) Post Haemorrhagic hydrocephalus
3) Ventricular dilation
4) Paraventricular leukomalacia

38
Q

Preterm babies- Periventricular Leukomalacia

A

The white matter around the brain has decreased blood and oxygen causing it to soften. The white matter transmits messages from the nerve cells. Causes problems with movement and body function. Can generate new pathways to reduce the disability

39
Q

Preterm babies- Ventricular dilation

A

An increased volume of cerebrospinal fluid (CSF) in the cerebral ventricles. Head measurements and USS detect it. Can resolve spontaneously or progress to hydrocephalus and require a ventriculoperitoneal shunt.

40
Q

Preterm babies- Post haemorrhagic Hydrocephalus

A

Progressive ventriculomegaly caused by disturbances in CSF flow or absorption following intraventricular haemorrhage.

41
Q

Metabolic problems for pre-term babies

A

1) Hypoglycaemia
2) Electrolyte disturbance- Hypocalcaemia
3) Osteopenia of prematurity- caused by calcium and phosphate deficiency. Causes low density in bones, poor bone growth and fractures

42
Q

Preterm babies- eyes and ears

A

1) Retinopathy of prematurity- vascular proliferation can lead to retinal detachment, fibrosis and blindness
2) Hearing- less developed

43
Q

Preterm babies- infection

A

Contributes to bronchopulmonary dysplasia, brain injury and disability

44
Q

Uterine corpus

A

The top of the uterus. Primarily a muscular (smooth) structure with a small amount of connective tissue. Consists of longitudinal, circular and spiral fibres. Contraction of smooth muscle reduces size of lumen, allowing for delivery. The uterus is densely innervated, muscular contractions are mediated by gestational hormones not nerve fibres. Oxytocin produced in the posterior putuitary gland helps in contraction

45
Q

Cervix

A

Primarily a fibrous structure with small amounts of smooth muscle, primarily a sphincter. May have an active role in labour. The amount of muscle fibres reduce as you go down the cervix

46
Q

Uterine Quiescence

A
  • HCG and CRH increase in concentration.
  • This increases levels of Cyclic AMP
  • Inhibits uterine contractility by preventing calcium mobilisation and MLCK activity.
  • Decreased Myosin-actin cross bridge cycling, cells are relaxed
47
Q

Effect of Connexin on labour

A

Prostaglandins promote uterine excitation by facilitating Connexin 43 (Cx43). This produces gap junction proteins which facilitates electrical connections between cells. Allows communication between cells. Towards labour more Cx43 is released. Signalling for contraction is passed from the top of the uterus down which allows coordination in contraction and increasing pressure, allowing delivery of the baby.

48
Q

Initiation of labour

A
  • Progesterone is blocked locally
  • Decrease in gap junction protein and Prostaglandin inhibition
  • A decrease in the Progesterone/Oestrogen ratio (oestrogen high). This causes upregulation in gap junction activity, Prostaglandin synthesis, Oxytocin receptors and local oxytocin synthesis.
  • Decreased activity of cAMP pathway. This increases influx of calcium into the cells, there is increased release of intracellular calcium and increased MLCK activity
  • Accelerated cervical remodelling- permits passing of conceptus through cervix
  • Fetal adrenocortical activity signals to the mother
49
Q

What causes the cervix to dilate

A

Pressure from the babies head

50
Q

Cervical remodelling stages

A

There are 4 overlapping stages- Softening, Ripening/Dilation, Effacement and Postpartum repair

51
Q

Cervical changes at the end of the third trimester

A

Collagen solubility increases. Collagen organisation decreases. The cervix takes on water and releases inflammatory hormones (Prostaglandins). There is increased pressure from the babies head on the cervix which causes dilation. Effacement is where the cervix shortens, can monitor the progress of labour by recording cervix dilation

52
Q

Labour

A

Painful, regular contraction with the cervix dilated more then 3-4cm

53
Q

Station- pregnancy

A

The position of the baby in the maternal pelvis

54
Q

Bishop score

A

Assess’s changes to the cervix as it goes through labour. When the Bishop score is greater then 6 the womens water can get broken. If less then 6 prostaglandins are given to get the cervix ready for labour

55
Q

Initiation of labour

A

activity may also stimulate labour.

56
Q

Affect of Progesterone and Oestrogen in stimulating labour

A

Progesterone- decreases in gap junctions, decrease in Prostaglandin synthesis. Promotes quiescence.
Oestrogen- increases gap junctions, increases prostaglandin synthesis and oxytocin receptors. Increases local oxytocin production. Promotes excitation.

57
Q

The pacemaker cells in the uterus

A

Are located in the cornual area. Flow of depolarisation goes from top to bottom, the uterine muscle is made of myometrium

58
Q

First stage of labour

A

3cm to full dilation (10cm), latent phase and active phase. The latent phase is when women are contracting but not regularly, the latent phase can last for days. The active phase of labour is when women are contracting regularly and have dilated more then 3cm.

59
Q

Second stage of labour

A

Full dilation to delivery of baby, passive phase and active phase. In the passive phase the uterus is contracting, and the baby is moving through the pelvis. Takes an hour or two. In the active phase the women pushes and uses their abdominal muscles.

60
Q

Third stage of labour

A

Delivery of placenta and membranes, physiological and assisted. The release of oxytocin after delivery and from breast feeding helps delivery. It can also be assisted, which is where the women is given oxytocin and traction is applied to the cord in order to deliver the placenta

61
Q

Widest parts in the pelvis

A

Pelvic inlet- the transverse diameter

Pelvic outlet- anteroposterior diameter

62
Q

Position of the fetal head in the pelvis

A

The head enters the pelvic inlet in the Occipito-transverse position. The head rotates in the mid cavity and the head rotate 90 degrees to exit the pelvic outlet in the Occipito-anterior position.

63
Q

Landmark for fetal descent

A

You measure the babies descent by measuring how many cm it is above the Ischial spine.

64
Q

Moulding- pregnancy

A

When the fetal banes overlap

65
Q

Attitude of the fetal skull

A

The attitude of the fetal skull refers to how flexed it is, is the chin on their chest or is it raised up (deflexed position). In normal attitude you can feel the posterior fontanelle and the Sagital suture. If the baby is deflexed, you can feel the anterior fontanelle, if its very deflexed you can feel the babies forehead. Rarely, you have a face presentation.

Medicine year 2 semester 1 (53 decks)

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