changes in pregnancy + STIs Flashcards
treating bacterial vaginosis during pregnancy
metronidazole 400mg twice daily for 7 days
avoid alcohol during course
option of vaginal gel
treating chlamydia during pregnancy
erythromycin, amoxicillin
test of cure 3 weeks later
include partner tracing
hypermesis gravidarum (HG)
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
hypermesis gravidarum presentation
dehydration, ketosis
electrolyte + nutritional disbalnce
weight loss
altered liver function - up to 50%
signs of malnutrition
emotional instability, anxiety - severe cases can cause depression
management of hypermesis gravidarum
determind by severity
inpatient admission
- IV infusion, NG tube
- parenteral antiemetics
- electrolyte balance
- VTE prophylaxis, TEDs, fragmin, mobility
last resort = termination of preg
adenomyosis investigation
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)
management of adenomyosis
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)
first 8 days after fertilisation
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
cords of trophoblast role
advancing cords of trophoblastic cells tunnel deeper into endometrium, carvinf hold for trophoblast
- boundaries between cells in advancing trophoblastic tissue disintegrate
by what week is the placenta functional
5th week of pregnancy
(derived from both trophoblast + decidual tissue)
placental villi
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
early nutrition of embryo
HCG signals corpus luteum to continue secreting progesterone
- progesterone stimulated decidual cells concentrate glycogen, proteins + lipids
3 factors that facilitate o2 transport to fetus
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
cardiac changes in pregnancy
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
physiological ECG changes in pregnancy
- 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
haematological changes in pregnancy
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
WHO definition of anaemia in pregnancy
1st trimester = <110g/L
2nd + 3rd = <105 g/L
postnatal Hb <100g/L
respiratory changes in pregnancy
progesterone signals brain to lower CO2 levels
- RR increases
- tidal + minute volume increases
- pCO2 decreaes slightly
- vital capacity + pO2 dont change
urinary system changes in pregnancy
GFR + renal plasma flow increases (increased blood volume + cardiac output)
increased reabsorption of ions + water
average maternal weight gain
11kg, can be up to 30kg
anabolic vs catabolic phase of pregnancy
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
what does cervical stretch increase the release of
oxytocin from posterior pituitary
stretch of cervix by fetal head increases contractility
stages of labour
1st stage = cervical dilation - 8-24hrs
2nd stage = passage of fetus through birth canal - 3-12mins
3rd stage = expulsion of placenta
hormones involved in the production + release of milk
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
management of preganant women with previous VTE history
LMWH started immediately until 6weeks postnatally
(Warfarin is teratogenic)
treat infection with Chlamydia trachomatis in pregnancy
amoxicillin
-> erythromycin in penicillin allergy
