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C21 Phase 1 > Case 8 - Pregnancy > Flashcards

Case 8 - Pregnancy Flashcards

1
Q

What is the arterial supply to the breast

A

Internal thoracic branching into mammary artery

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2
Q

Where does most lymphatic fluid drain from the breast

A

Axillary lymphatic node

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3
Q

How is the breast supported to the pectoralis major

A

By Coopers Ligaments

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4
Q

What tissues are breasts comprised of

A

adipose and glandular

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5
Q

Why can mammograms only really be used on older women

A

Glandular tissue declines making the breast less dense and allowing the mammogram image to be much easier to interpret

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6
Q

How does the breast develop

A

Prepuberty - rudimentary lactiferous ducts

During puberty - oestrogen stimulates rapid ductal elongation and bifurcation. Progesterone stimulates the formation of spherical masses of epithelial cells at the end of each duct.

Breast size increases due to deposition of adipose tissue

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7
Q

Describe the duct system of the breast

A

Each breast divided into 15-20 lobes by fibrous septas

Lobes drain into 10 major lactiferous ducts

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8
Q

Where is breast milk stored

A

Alveoli

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9
Q

Which cells produce breast milk

A

Acini cells

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10
Q

Changes to the breast in pregnancy

A

Hypertrophy of alveoli by progesterone

Hypertrophy and proliferation of the ducts

Terminal alveolar cells differentiate into secretory cells

Vascularity increases

Areola darkens

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11
Q

What is lactogenesis

A

rising oestrogen initiates prolactin synthesis

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12
Q

Why might dopamine agonists be prescribed for late stage abortion/miscarriage

A

To prevent lactation which may still occur due to drop in progesterone

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13
Q

What is the effect of a baby suckling on the brain and endocrine system

A

Receptors in the nipple detect sucking. Hypothalamus responds by releasing oxytocin and prolactin which cause milk ejection and secretion respectively

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14
Q

What can impair lactation

A

High cortisol
Long labour
Birth by vacuum extraction
Cleft palate

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15
Q

Why is breastmilk production halted when the breast is full

A

Prolactin is blocked from binding

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16
Q

How does breastfeeding work as a form of contraception

A

Suppresses ovulation
Disrupts GnRH and stops LH
Partly mechanism unknown

Must be exclusively breastfeeding

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17
Q

Composition of colostrum

A

Relatively low in fats and lactose

High in immunoglobulins, proteins and minerals

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18
Q

Major breastmilk sugar

A

Lactose

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19
Q

Major breastmilk proteins

A

casein

Alpha-lactalbumin

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20
Q

Immunological benefits of breastmilk

A

Infant:

  • reduced infant morbidity/mortality
  • protects GI tract
21
Q

Risks of formula feeding

A 
to baby:
obesity
leukaemia
diabetes
lower resp tract infections
middle ear infections

to mother:
type 2 diabetes
ovarian cancer
breast cancer

22
Q

Causes of pain in the 1st stage of labour

A

repetitive uterine contractions
distension of lower uterine segment
cervical dilation

23
Q

Nerves involved in 1st stage of labour pain

A

T10-L1
unmyelinated c fibres
uterus -> parasympathetic ganglion -> lumbar parasympathetic chain

24
Q

Causes of pain in 2nd stage of labour

A

uterine contractions

distension of vagina, pelvic floor muscles and peroneal structures

25
Q

Nerves involved in 2nd stage labour pain

A

T10-L1, S2-S4
Fast myelinated A delta fibres

Pudendal, ilio-inguinal, and genitofemoral nerves via lumbo-sacral plexus

26
Q

Systemic impact of labour pain on mother

A

Increased cardiac output
Increased vasoconstriction
Increased BP
Decreased CO2

27
Q

What does decreased CO2 in maternal labour in blood cause

A

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

28
Q

Factors affecting pain in labour

A 
Parity (previous experience)
anatomy
physiology
psychology
position of foetus
size
augmentation (inducement)
analgesia
29
Q

Types of analgesia

A

Non-pharmaceutical
Pharmacological
Neuraxial
Nerve blocks

30
Q

Non-pharmaceutical pain management in labour

A 
Temperature
Birth partner/doula
hypnosis
breathing techniques
TENS machine
31
Q

Pharmacological pain ladder in labour

A

Opiates
Entonox
(DO NOT USE NSAIDS)
Paracetamol

32
Q

Pharmacological methods of pain management in labour

A

Entonox
Opiates
Pethidine
Opiates

33
Q

How does neuraxial analgesia

A

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

34
Q

Epidural pathway

A 
Skin
Subcut tissue
Supraspinous ligament
Interspinous ligament
ligamentum flavum
epidural space
35
Q

Spinal pain relief pathway

A 
Skin
Subcut tissue
Supraspinous ligament
Interspinous ligament
ligamentum flavum
epidural space
dura
CSF
36
Q

Impact and symptoms of iron deficiency anaemia on pregnancy

A

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.

37
Q

Impact and symptoms of folate deficiency anaemia on pregnancy

A

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.

38
Q

Impact and symptoms of B12 deficiency anaemia on pregnancy

A

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
39
Q

What is ABO incompatibility

A

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

40
Q

What are the complications of ABO incompatibility and how is it treated

A

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.

41
Q

What is rhesus disease

A

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.

42
Q

What are the complications of rhesus disease and how is it treated

A

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

43
Q

Risks of smoking in pregnancy

A

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

44
Q

Risks of obesity in pregnancy

A 
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.
45
Q

Causes of shorter than average symphysis-fundal height

A 
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
46
Q

Causes of larger than average symphysis-fundal height

A 
Twins/multiple birth
Error in estimated day of conception
Healthy but large foetus
Gestational diabetes
Too much amniotic fluid (Polyhydramnios)
Molar pregnancy
Breech birth
47
Q

Potential complications of vaginal delivery

A

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

48
Q

Stages of turning the baby during birth

A

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

C21 Phase 1 (45 decks)

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