changes in pregnancy + STIs

Question 1

treating bacterial vaginosis during pregnancy

Answer 1

metronidazole 400mg twice daily for 7 days
avoid alcohol during course

option of vaginal gel

Question 2

treating chlamydia during pregnancy

Answer 2

erythromycin, amoxicillin
test of cure 3 weeks later

include partner tracing

Question 3

hypermesis gravidarum (HG)

Answer 3

excessive N+V, altering quality of life

N+V common in first trimester, mostly mild
start as early as time of missed period, can last beyond 1st trimester

Question 4

hypermesis gravidarum presentation

Answer 4

dehydration, ketosis
electrolyte + nutritional disbalnce
weight loss
altered liver function - up to 50%
signs of malnutrition
emotional instability, anxiety - severe cases can cause depression

Question 5

management of hypermesis gravidarum

Answer 5

determind by severity
inpatient admission
- IV infusion, NG tube
- parenteral antiemetics
- electrolyte balance
- VTE prophylaxis, TEDs, fragmin, mobility

last resort = termination of preg

Question 6

adenomyosis investigation

Answer 6

transvaginal US = 1st line
2nd line = MRI + transabdominal US
- would see only really see on MRI as inside myometrium

gold standard = histological examination of uterus after hysterectomy
(not suitable way of establishing diagnosis for obvious reasons)

Question 7

management of adenomyosis

Answer 7

depends on symptoms, age, plans for pregnancy
same Mx as heavy menstrial bleeding
- mirena IUS or tranexamic acid

hysterectomy = definitive (histological examinaton after = definitive diagnosis)

Question 8

first 8 days after fertilisation

Answer 8

3-5days - transport of blastocyst into uterus
5-8days = blastocyst attaches to lining of uterus

blastocyst = inner cells develop into embryo
- outer cells burrow into uterine wall + become placenta

placenta = produces several hormones to maintain pregnancy

Question 9

cords of trophoblast role

Answer 9

advancing cords of trophoblastic cells tunnel deeper into endometrium, carvinf hold for trophoblast
- boundaries between cells in advancing trophoblastic tissue disintegrate

Question 10

by what week is the placenta functional

Answer 10

5th week of pregnancy
(derived from both trophoblast + decidual tissue)

Question 11

placental villi

Answer 11

developing embryo sends capillaries into syncytiotrophoblast projections to form placental villi
- each villus contains fetal capillaries separated from maternal blood by a thin layer of tissue (*no direct contact between fetal + maternal blood)

as placenta develop, it extends villi into uterine wall - increasing contact between uterus + placent - more wate products/nutrients can be exchanges

-> circulation within intervilli-ous space acts partly as an arteriovenous shunt

Question 12

early nutrition of embryo

Answer 12

HCG signals corpus luteum to continue secreting progesterone
- progesterone stimulated decidual cells concentrate glycogen, proteins + lipids

Question 13

3 factors that facilitate o2 transport to fetus

Answer 13

fetal Hb - increased ability to carry O2

higher Hb concentration - 50% more than adults

Bohr effect - fetal Hb can carry more O2 in low pCO2 than in high pCO2

Question 14

cardiac changes in pregnancy

Answer 14

increase CO - beginning 6wks + peaking 24wks
heart rate - increases up to 90 to increase CO

BP drops during 2nd trimester
ECG changes, functional murmurs/heart sounds

Question 15

physiological ECG changes in pregnancy

Answer 15

• Relative sinus tachycardia
• Slight left axis deviation
• Inverted or flattened T waves – leads III, V1-3
• Q wave – leads II, III, aVF
• Atrial + ventricular ectopic beats more common

Question 16

haematological changes in pregnancy

Answer 16

plasma volume increase (proportionally with cardiac output)

erythropoiesis increases -> Hb decreases by dilution, this decreases blood viscosity

iron requirement increases significantly - iron supplements needed

hypercoaguable state - increased VTE risk, reduced risk of haemorrhage during + after delivery

Question 17

WHO definition of anaemia in pregnancy

Answer 17

1st trimester = <110g/L
2nd + 3rd = <105 g/L

postnatal Hb <100g/L

Question 18

respiratory changes in pregnancy

Answer 18

progesterone signals brain to lower CO2 levels
- RR increases
- tidal + minute volume increases
- pCO2 decreaes slightly
- vital capacity + pO2 dont change

Question 19

urinary system changes in pregnancy

Answer 19

GFR + renal plasma flow increases (increased blood volume + cardiac output)
increased reabsorption of ions + water

Question 20

average maternal weight gain

Answer 20

11kg, can be up to 30kg

Question 21

anabolic vs catabolic phase of pregnancy

Answer 21

1-20wks = anabolic
- small nutritional demands
- normal/increased sensitivity to insulin
- lower plasmatic glucose level
- lipogenesis, glycogen stores increases
- growth of breast, uterus, weight gain

21-40wks = catabolic
- high metabolic demands
- accelerated starvation of mother
- reduced insulin sensitivity
- increased transpost of nutrients through placental membrane
- lipolysis

Question 22

what does cervical stretch increase the release of

Answer 22

oxytocin from posterior pituitary

stretch of cervix by fetal head increases contractility

Question 23

stages of labour

Answer 23

1st stage = cervical dilation - 8-24hrs

2nd stage = passage of fetus through birth canal - 3-12mins

3rd stage = expulsion of placenta

Question 24

hormones involved in the production + release of milk

Answer 24

oestrogen = growth of ductile system
progesterone = development of lobule-alveolar system
–> both of these inhibit milk production, sudden drop in both at birth

prolactin = stimulates milk production
- steady rise in levels wk5-birth
- stimulates colostrum

oxytocin = “milk let down” reflex

Question 25

management of preganant women with previous VTE history

Answer 25

LMWH started immediately until 6weeks postnatally

(Warfarin is teratogenic)

Question 26

treat infection with Chlamydia trachomatis in pregnancy

Answer 26

amoxicillin
-> erythromycin in penicillin allergy