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Block I: Reproduction & Sexuality > Clinical: Normal Pregnancy and Ante-Natal Care > Flashcards

Clinical: Normal Pregnancy and Ante-Natal Care Flashcards

1
Q

3 sources of hormone secretion during pregnancy

A
  • Placenta
  • Maternal pituitary
    • Maternal adrenal
    • Maternal thyroid
  • Fetal Adrenal
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2
Q

4 hormones secreted by the placenta

A
  • hCG
  • hPL
  • Estrogens
  • Progesterone
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3
Q

2 main components of the placenta

A
  • Cytotrophoblast
  • Syncytiotrophoblast
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4
Q

Function of Hc GnRH in cytotrophoblast

A

Increase placental steroidogenesis and release of prostaglandins and hCG (similar in structure and action to GnRH)

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5
Q

When and where is hCG produced

A

Produced by syncytiotrophoblase immediately after implantation (~8 day after ovulation)

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6
Q

Structure of hCG

A

Similar to LH: consists of (common) alphha and (specific) beta subunit

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7
Q

Where is hCG secreted to?

A

Maternal and fetal circulation

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8
Q

Describe the hCG levels throughout gestation

A

Rapid rise in first trimester of pregnancy; maximum at 8-10 weeks of gestation

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9
Q

Important of hCG test (2 reasons)

A
  • Pregnancy test
    • Normal rate of rise = indication for fetal well-being
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10
Q

2 conditions that higher than normal [hCG] may indicate

A

indication for trophoblastic disease (choriocarcinoma or hydatidiform mole) or ectopic pregnancy

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11
Q

Maternal role of hCG

A

Maintenance of corpus luteum to ensure continued progesterone secretion before placenta takes over

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12
Q

Fetal function of hCG

A

Increase testosterone production by Leydig cells in fetal testes (as does LH in the adult). Also has TSH activity on fetal thyroid

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13
Q

Alternative name for hPL (human placental lactogen)

A

Chorionic somatotomammotropin

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14
Q

Where is hPL produced?

A

syncytiotrophoblast

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15
Q

Describe hPL levels throughout gestation

A

Rises throughout pregnancy proportional to placental mass (very high synthesis rates: 1-3 g/day)

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16
Q

Where is hPL secreted?

A

Mainly into maternal circulation

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17
Q

3 maternal effects of hPL

A
  • Increase glucose levels
  • Increase lipolysis (to increase free fatty acids) = fuel for fetus
  • Decrease insulin action (diabetogenic effect)
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18
Q

4 effects of estrogens

A
  • Increase uterine blood flow and growth
  • Increase prostaglandin synthesis
  • Increase prolactin secretion
    • other effects important for the maternal adaptation to pregnancy
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19
Q

Describe the uterus in pregnancy

A

50g pre-pregnancy –> 950 g term

Initially hypertrophy, then distension

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20
Q

Describe the changes in the cervix during pregnancy

A

Softer (ripening)

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21
Q

Describe the changes in the vagina during pregnancy

A

Mucosa thickens, stretches more easily

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22
Q

5 effects of progesterone that enable implantation of blastocyst

A
  • Induces decidualization
  • Decreased uterine contractions
  • Decreased prostaglandin formation
  • Decreased T-lymphocyte response
  • Decrease graft rejection and immune reaction
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23
Q

2 effects of progesterone that protect from hypertension

A
  • Decreased angiotensin II responsiveness
  • Smooth muscle relaxation
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24
Q

Causes of varicosities in pregnancy

A
  • Distended veins
  • Higher pressure of uterine venous return
  • Uterine mechanical pressure
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25
Q

3 locations of varicosities during pregnancy

A
  • Legs
  • Hemorrhoids
  • Vulvar varicosities
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26
Q

3 effects of pregnancy on the respiratory system

A
  • Deeper breathing –> increased tidal volume
  • Increased oxygen conumption (20%)
  • Increased ventilation rate (40%)

(Subjective “air-hunger” or overbreathing)

27
Q

2 reasons why deeper breathing occurs in pregnancy

A
  • Reduced diaphragmatic movement
  • Flared ribs
28
Q

4 effects of pregnancy on the gastro-intestinal system

A
  • Hypertrophic gums
  • Nausea and hyper-emesis in early pregnancy
  • Acid reflux
  • Constipation
29
Q

2 cause of nausea and hyper-emesis in early pregnancy

A
  • hCG
  • E2 mediated
30
Q

Reason for acid reflux in pregnancy

A

Relaxed cardiac sphincter

31
Q

4 effects of pregnancy on the renal system

A
  • Ureteric dilatation
  • Increased water excretion
  • Increased renal blood flow
  • Increased glomerular filtration rate (60%)
32
Q

2 potential consequences of pregnancy-induced ureteric dilatation

A

Stasis and urinary infection

33
Q

2 potential consquences of increase GFR in pregnancy

A

Occ. proteinuria and glycosuria

34
Q

4 effects of E2

A
  • Increases uterine size and blood flow
  • SOftens connective tissue
  • Breast development (PRL)
  • Water retention
35
Q

Describe the regulation of placental ACTH

A

No negative feedback; inhibition by glucocorticoids

36
Q

4 effects of increased corticosteroids in pregnancy

A
  • Abdominal striae
  • Glycosuria
  • Hypertension
  • Heavier features
37
Q

4 effects of pregnancy on the pituitary

A
  • ACTH, TRH, PRL all increase
  • Melanocytic activity?
  • PRL rises progressively up to wk30
  • FSH, LH secretion minimal (PRL effect and E2,P negative feedback)
38
Q

5 effects of pregnancy on the cardiovascular system

A
  • Increase in blood volume (4L to 5.5L)
  • Decrease in iron stores (BM, liver, spleen)
  • Increase in CO (SV 20% and HR 15%)
  • Decreased peripheral resistance
  • Redistribution of blood flow (kidneys, uterus)
39
Q

2 effects of pregnancy on the hematological system

A
  • Development of hypercoagulable state (estrogen mediated)
  • Increased leucocyte count
40
Q

RIsk of hypercoagulable state in pregnancy

A

Increased risk of DVT and PE

41
Q

3 risks of increased leucocyte count in pregnancy

A
  • Increased risk of infection
  • Increased severity of infection
  • Decreased immunity
42
Q

Mean weight gain in pregnancy

A

12 - 15 kg (9kg in final 20 weeks of pregnancy)

43
Q

3 sources of weight gain from pregnancy itself

A
  • Fetus (3000 to 3500 g)
  • Placenta (600 g)
  • Liqour (800 g)
44
Q

5 sources of weight gainfrom mother in pregnancy

A
  • Uterus (1000 g)
  • Breasts (500 g)
  • Blood (1500 g)
  • Fat (3500 g)
  • Fluid (2600 g)
45
Q

Define low-risk pregnancy

A

Normal women undergoing a normal physiological event

46
Q

3 criteria for high risk pregnancy

A
  • Pre-existingdisease
  • Previous pregnancy complications
  • Current pregnancy complications
47
Q

How often should physician visits be done when pregnant?

A

Every 3-4 weeks with increasing frequency towards date of delivery

48
Q

When are initial tests and screening performed?

A

10 - 12 weeks

49
Q

When is a detailed anomaly scan performed?

A

20 weeks

50
Q

When is screening for gestational diabetes performed?

A

26 weeks

51
Q

When should induction of labor be considered?

A

41 weeks

52
Q

7 elements of standard antenatal check

A
  • Obstetric assessment
  • Smoking history
  • BP check
  • Measurement in fundal height in cm
  • Fetal auscultation from 12 weeks
  • Fetal presentation from 30 weeks
  • Inspection of legs for edema
53
Q

4 things to look for in fetal ultrasound

A
  • First trimester screening
  • Nuchal translucency/nasal bone
  • Anencephaly
  • Other major defects
54
Q

2 fetal anomalies with no chance of being detcted by USG

A

Cerebral palsy

Autism

55
Q

4 fetal anomalies with a very high chance of being detected by USG (>90%)

A
  • Spina bifida
  • Anencephaly
  • Exomphalos/gastroschisis
  • Major limb abnormalities
56
Q

What does the symphyseal fundal height measurement in cm correspond to?

A

Weeks of gestation

57
Q

9 initial recommended tests for a pregnant woman

A
  • CBC
  • MCHC/MCV (Thal screen. Ferritin and Hb electrophoresis if low)
  • Blood group/antibody screen
  • HIV
  • Hep B (and C)
  • Syphilis (ideally prior 16 weeks)
  • Rubella antibodies
  • Urine microscopy
  • Pap (if due)
58
Q

3 recommended tests at 26 weeks

A
  • Gestational diabetes screening
  • Antibody screen on all women
  • Rhogam (Anti-Rh D antibodies) if Rh Neg
59
Q

Recommended test at 36 weeks

A

Group B Streptococcus screen

60
Q

When should screening be done for GDM

A

Between 24-28 weeks

61
Q

Wen should RVH screening be done?

A

26 weeks (all women)

62
Q

WHen should swabs be taken for prevention of early onset GBS

A

between 35 - 37 weeks

63
Q

4 reasons intrapartum antibiotics may be recommended to prevent early onset GBS

A
  • <37 weeks
  • Ruptures membranes >18 before delivery
  • Maternal temperture _>_38 C
  • Previous GBS colonisation, bacteruria or infant with GBS
64
Q

When should prophylactic Anti-D be administered?

A

28 and 34 weeks gestation (no level I evidence however)

Block I: Reproduction & Sexuality (23 decks)

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