Case 8 - Pregnancy Flashcards

Question

Nerves involved in 2nd stage labour pain

Answer 1

T10-L1, S2-S4 Fast myelinated A delta fibres Pudendal, ilio-inguinal, and genitofemoral nerves via lumbo-sacral plexus

Answer 2

Increased cardiac output Increased vasoconstriction Increased BP Decreased CO2

Answer 3

Maternal alkalosis -> uterine artery vasoconstriction -> decreased uteroplacental blood flow

Answer 4

``` Parity (previous experience) anatomy physiology psychology position of foetus size augmentation (inducement) analgesia ```

Answer 5

Non-pharmaceutical Pharmacological Neuraxial Nerve blocks

Answer 6

``` Temperature Birth partner/doula hypnosis breathing techniques TENS machine ```

Answer 7

Opiates Entonox (DO NOT USE NSAIDS) Paracetamol

Answer 8

Entonox Opiates Pethidine Opiates

Answer 9

Injection given below spinal conus into CSF. Local anaesthetic inhibits the depolarisation of nerves blocking transmission of pain signals

Answer 10

``` Skin Subcut tissue Supraspinous ligament Interspinous ligament ligamentum flavum epidural space ```

Answer 11

``` Skin Subcut tissue Supraspinous ligament Interspinous ligament ligamentum flavum epidural space dura CSF ```

Answer 12

this type of anaemia occurs when the body doesn't have enough iron to produce adequate amounts of haemoglobin. That's a protein in red blood cells. It carries oxygen from the lungs to the rest of the body. In iron-deficiency anaemia, the blood cannot carry enough oxygen to tissues throughout the body. Very common symptoms of anaemia include: Dyspnoea. Fatigue. Headache. Common symptoms of anaemia include: Cognitive dysfunction. Restless leg syndrome. Vertigo. Rare symptoms of anaemia include: Dysphagia (in association with oesophageal web which occurs in Patterson-Brown-Kelly or Plummer-Vinson syndromes). Haemodynamic instability. Syncope. In pregnant women anaemia is defined as a Hb below 110 g/L throughout pregnancy. An Hb level of 110 g/L or more appears adequate in the first trimester, and a level of 105 g/L appears adequate in the second and third trimesters. Postpartum an Hb level of below 100 g/L indicates anaemia.

Answer 13

folate is the vitamin found naturally in certain foods like green leafy vegetables A type of B vitamin, the body needs folate to produce new cells, including healthy red blood cells. During pregnancy, women need extra folate. But sometimes they don't get enough from their diet. When that happens, the body can't make enough normal red blood cells to transport oxygen to tissues throughout the body. Man-made supplements of folate are called folic acid. ``` Symptoms include: Cognitive changes. Dyspnoea. Headache. Indigestion. Loss of appetite. Palpitations. Tachypnoea. Visual disturbance. Weakness, lethargy ``` Serum folate of less than 7 nanomol/L (3 micrograms/L) is used as a guide to indicate folate deficiency.

Answer 14

the body needs vitamin B12 to form healthy red blood cells. When a pregnant woman doesn't get enough vitamin B12 from her diet, her body can't produce enough healthy red blood cells. Women who don't eat meat, poultry, dairy products, and eggs have a greater risk of developing vitamin B12 deficiency, which may contribute to birth defects, such as neural tube abnormalities, and could lead to preterm labour. ``` Symptoms include: Cognitive changes. Dyspnoea. Headache. Indigestion. Loss of appetite. Palpitations. Tachypnoea. Visual disturbance. Weakness, lethargy ```

Answer 15

Not all non-matching combinations of blood types are problematic. ABO incompatibility can occur only if a woman with type O blood has a baby whose blood is type A, type B, or type AB. If a baby is type O there won't be a problem with a negative immune response because type O blood cells don't have immune-response triggering antigens

Answer 16

The most common problem caused by ABO incompatibility is jaundice. Jaundice occurs when there's a buildup of an orangish-red substance in the blood called bilirubin that's produced when red blood cells break down naturally. Some infants with mild jaundice will get better on their own simply by being fed more often. For infants whose jaundice is more severe, phototherapy, or light therapy, is effective. In rare cases, a baby with an HDN will need to be treated with a type of blood transfusion called an exchange transfusion.

Answer 17

If a woman is Rh-negative and her baby is Rh-positive, then the woman’s body will approach the Rh-positive protein as a foreign object, if her immune system is exposed to it. This means that if blood cells from your baby cross your bloodstream, which can happen during pregnancy, labour, and delivery, your immune system will make antibodies against your baby’s red blood cells. If you have an Rh-negative blood type, you’re considered “sensitized” to positive blood types once your body has made these antibodies. This means that your body might send these antibodies across the placenta to attack your baby’s red blood cells.

Answer 18

When your antibodies attack your baby’s red blood cells, haemolytic disease can occur. This means your baby’s red blood cells are destroyed. Most treatment is preventative by administering anti-d-antibodies to the mother to prevent her body attacking the foetus’ red cells. Affected babies may need blood transfusions

Answer 19

Miscarriage and stillbirth – due to harmful chemicals in cigarettes Ectopic pregnancy – nicotine contracts fallopian tubes making it more likely a pregnancy will get stuck Placental abruption Placenta Previa Pre-term birth Low birth weight – nicotine reduces access of nutrients to foetus Birth defects

Answer 20

``` Increased risk of: Miscarriage (1/4 instead of 1/5) Gestational diabetes HBP/Pre-eclampsia Blood clots Shoulder dystocia Post-partum haemorrhage Large baby Spina bifida Stillbirth (1/100 instead of 1/200) Nuchal translucency is not easy to measure in overweight women. ```

Answer 21

``` Foetal descent into pelvis pre-birth Error in estimated day of conception Healthy but small foetus Deficiency of amniotic fluid (Oligohydramnios) Non-longitudinal lie Intrauterine growth restriction ```

Answer 22

``` Twins/multiple birth Error in estimated day of conception Healthy but large foetus Gestational diabetes Too much amniotic fluid (Polyhydramnios) Molar pregnancy Breech birth ```

Answer 23

Episiotomy, forceps, vacuum, c-section, shoulder dystocia, perineal tears, perinatal asphyxia, foetal distress.

Answer 24

Descent: Baby descends through pelvic inlet towards the pelvic floor, descent occurs due to uterine contractions, amniotic fluid pressure, voluntary conc abdominal muscle contraction by mother) Flexion: Head comes into contact with pelvic floor, cervical flexion occurs, fetal skull has smaller diameter which assists passages through pelvis Internal Rotation: Head rotates form L or ROT to an occipito-anterior position Crowning: Widest diameter of fetal head goes through narrowest part of maternal pelvis Extension: Occiput slips beneath the suprapubic arch as the head extends and the nape of the neck is pivoting against arch – extension of head causes stretching of perineum Restitution Internal Rotation (shoulder) Posterior shoulder Lateral flexion