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Reproduction > Clinical- Week 3 > Flashcards

Clinical- Week 3 Flashcards

1
Q

what is offered to all rheusus negative mothers at 28 weeks gestation?

A

anti-D

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2
Q

at how many weeks is the booking scan performed?

A

8-12 weeks

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3
Q

what is the ‘lie’ of a foetus?

A

relation of foetal spine to maternal spine

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4
Q

if the foetal spine is parallel to the maternal spine, what is the lie?

A

longituindal lie

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5
Q

if the foetal spine is perpendicular to the maternal spine, what is the lie?

A

transverse lie

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6
Q

what down’s syndrome risk assessment is done in the first trimester?

A

combined US (for Nuchal thickness) and serum screening (HCG and PAPP-A)

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7
Q

at how many weeks gestation is the combined US and serum screening for down’s syndrome risk assessment performed?

A

11 - 13+6 weeks

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8
Q

what is nuchal thickness?

A

thickness behind fetal neck

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9
Q

what down’s syndrome risk assessment is done in the second trimester?

A

blood sample for assay of HCG and AFP

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10
Q

at how many weeks gestation is blood sample assay of HCG and AFP for down’s syndrome risk assessment performed?

A

15- 20 weeks

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11
Q

what ratio of AFP and HCG indicate a high down’s syndrome risk?

A

low AFP and high HCG

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12
Q

what specific diagnostic tests are done for down’s syndrome?

A

amniocentesis

chorionic villus sampling

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13
Q

at what gestation can amniocentesis be performed?

A

after 15 weeks

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14
Q

at what gestation can chorionic vilus sampling be performed?

A

after 12 weeks

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15
Q

which has a higher miscarriage rate- amniocentesis or chorionic villus sampling?

A

chorionic villus sampling (0.2% compared to 0.1%)

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16
Q

compare the functions of the inner and outer cell layers of a blastocyst?

A

inner- becomes embryo

outer- becomes placenta

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17
Q

by what day does the blastocyst become completely buried in the endometrial lining?

A

day 12

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18
Q

trophoblast cells (known as the chorion) differentiate into what multinucleated cells?

A

syncytiotrophoblasts

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19
Q

what is the function of syncytiotrophoblasts?

A

invade decidua and break down capillaries to form cavities filled with maternal blood

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20
Q

at what week is the placenta functional by?

A

5th week

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21
Q

at what week is the foetal heart functional by?

A

5th wek

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22
Q

before the placenta is in control of foetal nutrition, how does the fetus get nutrition?

A

trophoblastic nutrition

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23
Q

what stimulates the decidual cells to concentrate glycogen, proteins and lipids in the trophoblastic nutritional phase?

A

progesterone (from corpus luteum)

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24
Q

what blood vessel returns oxygen-saturated blood to the fetus from the placenta?

A

umbilical vein

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25
Q

what blood vessel returns oxygen-poor blood to the mother from the placenta?

A

uterine vein

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26
Q

what is the difference about fetal haemoglobin?

A

increased ability to carry oxygen

higher concentration of Hb in fetal blood

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27
Q

what is the Bohr effect?

A

fetal Hb can carry more oxygen in low CO2 pressures than in high pressures

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28
Q

what are the 3 main functions of human chorionic somatomammotropin?

A
  • growth-hormone like (protein tissue formation)
  • decreases insulin sensitiviy in mother (more glucose for fetus)
  • breast development
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29
Q

what is the main functions of human chorionic gonadotropin?

A

-prevents loss of corpus luteum

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30
Q

what are the 3 main functions of progesterone in a pregnant mother?

A
  • development of decidual cells
  • decreases uterus contractility
  • preparation for lactation
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31
Q

what are the 3 main functions of oestrogens in a pregnant mother?

A
  • enlargement of uterus
  • breast development
  • relaxation of ligaments
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32
Q

what are the 3 main oestrogens?

A

estradiol
estriol
estrone

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33
Q

what hormones cause hypertension in pregnancy?

A

placental CRH

leading to increased maternal ACTH and then aldosterone

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34
Q

what hormones cause oedema in pregnancy?

A

placental CRH

leading to increased maternal cortisol

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35
Q

what hormones cause hyperthyroidism in pregnancy?

A

placental HCG and HC thyrotropin

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36
Q

what cases hyperparathyroidism in pregnancy?

A

increased Ca demands of the placenta

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37
Q

what happens to the maternal cardiac output in pregnancy?

A

generally increases

decreases in last 8 weeks

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38
Q

why does the maternal cardiac output decrease in the last 8 weeks?

A

in some body positions uterus can compress vena cava

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39
Q

what happens to the maternal heart rate in pregnancy?

A

increases up to 90/min

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40
Q

what happens to the maternal BP in pregnancy?

A

decreases during 2nd trimester

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41
Q

what happens to maternal plasma volume in pregnancy?

A

increases

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42
Q

what happens to maternal Hb concentration in pregnancy?

A

decreases (due to dilution- plasma volume is increased)

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43
Q

what happens to the maternal iron requirements in pregnancy?

A

increases

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44
Q

why does maternal lung function change in pregnancy?

A

due to progesterone and enlarging uterus

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45
Q

what does progesterone do to CO2 levels in pregnancy?

A

lowers them

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46
Q

how does progesterone lower CO2 levels in pregnancy?

A

increases respiratory rate and tidal volume

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47
Q

what happens to GFR and renal plasma flow in pregnancy?

A

increases

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48
Q

what is pre-eclampsia?

A

pregnancy induced hypertension with proteinuria

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49
Q

at what week can pre-eclampsia occur?

A

from week 20

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50
Q

where does oedema tend to occur in pre-eclampsia?

A

hands and face

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51
Q

what happens to the renal blood flow and glomerular filtration rate in pre-eclampsia?

A

decreases

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52
Q

what is the most significant risk factor for pre-eclampsia?

A

previous pre-eclampsia

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53
Q

what is the treatment of eclampsia?

A

vasodilators

cesarean section

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54
Q

what is the average maternal weight gain in pregnancy?

A

24 pounds

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55
Q

how heavy is the average fetus?

A

7 pounds

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56
Q

how many extra calories should a pregnant lady take per day?

A

250-300extra kcal/day

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57
Q

what are the 2 metabolic phases of pregnancy?

A
  1. up to week 20 (mothers anabolic phase, low metabolic demands of fetus)
  2. 21-40 week (carabolic phase, high metabolic demands of fetus)
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58
Q

in what phase- anabolic or catabolic- of pregnancy does a maternal insulin resistance occur?

A

catabolic phase

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59
Q

what 3 hormones cause insulin resistance in pregnancy?

A

human chorionic sommatomammotropin
placental CRH
growth hormone

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60
Q

why is vitamin K often given before labour?

A

to prevent intracranial bleeding during labour

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61
Q

why does the uterus become more excitable towards the end of pregnancy?

A

change in oestrogen:progesterone ratio (oestrogen increases contractility, progesterone inhibits)

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62
Q

what are braxton-hicks contractions?

A

false labour contractions- similar but not labour, increase towards end of pregnancy

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63
Q

what does stretching the cervix by fetal head do to the contractility of the uterus?

A

increases it

positive feedback

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64
Q

what does stretching the cervix by fetal head do to oxytocin release from the maternal pituitary gland?

A

increases it

positive feedback

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65
Q

describe the 3 stages of labour?

A
  1. cervical dilation (8-24 hours)
  2. passage (up to 30 mins)
  3. expulsion of placenta
66
Q

what hormones drive cervical dilation?

A

oxytocin and oestrogen

67
Q

why is it important that oestrogen and progesterone levels drop at birth?

A

because they inhibit milk production

68
Q

how does oestrogen prepare for lactation?

A

causes growth of ductile system in mammary tissue

69
Q

how does progesterone prepare for lactation?

A

causes development of lobule-alveolar system in mammary tissue

70
Q

what liquid is produced by the breast before milk production occurs?

A

colostrum

71
Q

describe colostrum in comparison to milk?

A

low volume, no fat

72
Q

what hormone stimulate milk production?

A

prolactin (1-7 days after birth)

73
Q

what hormone causes milk to be ejected?

A

oxytocin

74
Q

what stimulus cause milk to be ejected?

A

baby suckling on mechanoreceptors on nipple

75
Q

what stimulus causes higher brain centres to increase lactation and milk secretion?

A

sound of baby crying

76
Q

what is the definition of a pre-term birth?

A

delivery between 24 and 36+6 weeks

77
Q

what are the 6 main types of causes of pre-term birth?

A
  • infection
  • over-distention
  • vascular
  • intercurrent illness
  • cervical insufficiency
  • idiopathic
78
Q

what is placental abruption

A

when placenta complete/partially separates from the uterus causing bleeding (fetus can be derived of oxygen)

79
Q

what is the commonest compliation of multiple pregnancy?

A

pre-term labour

80
Q

why is pre-term labour a consequence of multiple pregnancy?

A

over-distension of the uterus

81
Q

what is cervical insufficiency?

A

a serious complication of pregnancy where the cervix opens prematurely

82
Q

how do you estimate the height of a fetus?

A

fundal height- measured from pubic symphysis to fundus of uterus

83
Q

what should you do if fundal height seems small for gestational age?

A

US scan to determine size of fetus

84
Q

placental dysfunction (leading to intra-uterine growth restriction) is often secondary to what?

A

maternal hypertension

85
Q

describe symmetrical growth restriction?

A

both head and abdomen small

86
Q

describe asymmetrical growth restriction?

A

head normal size (head-sparing) and small abdomen

87
Q

when does growth restriction have to take place for symmetrical pattern?

A

in early pregnancy

88
Q

when does growth restriction have to take place for asymmetrical pattern?

A

in late pregnancy

89
Q

why is there a risk of hypoxia in a growth restricted fetus during delivery?

A

when uterus contracts, blood supply is cut off to the baby, if baby is growth restricted they do not cope with this well

90
Q

why is pre-eclampsia assocaited with growth restriction?

A

vasospasm in placental blood vessels

91
Q

why is there reduced liquor with placental insufficiency?

A

kidneys are underperfused so don’t produce as much fluid

92
Q

what are the 2 main causes for reduced liquor?

A

placental insufficiency

burst membranes

93
Q

why is reduced fetal movements a sign of placental insufficiency?

A

baby tries to conserve energy to deal with reduced oxygen supply

94
Q

what is carditocography?

A

a way of measuring the fetus’s heart

95
Q

on CTG, what indicates a good reflex reactivity of the fetal circulation?

A

acceleration at the start of the uterine contraction, returning to baseline

96
Q

what does loss of baseline variability on CTG indicate?

A

possible asphyxia

97
Q

what does deceleartion with lag time on CTG indicate?

A

possible asphyxia

98
Q

what does umbilical arterial doppler measure?

A

placental resistance to flow

99
Q

why might steroids initially improve absent end diastolic flow on doppler US of umbilical artery?

A

vasodilation effect

100
Q

what must be done urgently if there is reversed end-diastolic flow on doppler US of umbilical artery

A

deliver baby

101
Q

if delivering a baby below 30 weeks, why is magnesium sulphate given?

A

neuroprotection- reduces risk of intracranial haemorrhage

102
Q

what is middle cerebral artery doppler used for?

A

to look for redirection of blood flow

103
Q

what is polyhydramnios?

A

excess amniotic fluid

104
Q

what are the 5 main causes of polyhydramnios?

A
  • monochorionic twin pregnancy
  • fetal anomaly
  • maternal diabetes
  • hydrops fetalis
  • idiopathic
105
Q

why can polyhydramnios lead to pre-term labour?

A

stretch on uterus

106
Q

what does zygosity refer to?

A

number of eggs fertilised to produce twins

107
Q

what does chorionicity refer to?

A

the membrane pattern of the twins

108
Q

describe dichorionic diamniotic twins twins?

A

independent systems (both have their own chorion, amnion and placenta)

109
Q

what membrane patterns can dizygotic twins lead to?

A

only dichorionic diamniotic

110
Q

what membrane patterns can monozygotic twins lead to?

A

dichorionic diamniotic
monochorionic diamniotic
monochorionic monoamniotic

111
Q

describe monochorionic diamniotic twins?

A

shared chorion and placenta

separate amnions

112
Q

describe monochorionic and monoamniotic twins?

A

shared chorion
shared placenta
shared amnion

113
Q

if a fertilised egg splits to form monozygotic twins within 4 days of fertilisation, what pattern of membranes occurs?

A

dichorionic diamniotic

114
Q

if a fertilised egg splits to form monozygotic twins from 4-8 days of fertilisation, what pattern of membranes occurs?

A

monochorionic diamniotic

115
Q

if a fertilised egg splits to form monozygotic twins from 8-12 dyas of fertilisation, what pattern of membranes occurs?

A

monochorionic, monoamniotic

116
Q

what is the major risk with monochorionic twins?

A

twin-twin transfusion syndrome

117
Q

what is the major risk with monoamniotic twins?

A

cord entanglement

118
Q

what sign is seen on ultrasound that indicates dichorionic twins?

A

lambda sign

119
Q

at what gestational age do you use US to see if there are multiple pregnancies and the pattern of membranes with twins?

A

12-14 week scan

120
Q

describe AFP levels with multiple pregnancies?

A

high

121
Q

at what gestational age do you offer to deliver in dichorionic twins?

A

37 weeks

122
Q

how often do you scan dichorionic twins and monochorionic twins?

A

dichorionic twins- every 4 weeks

monochorionic twins- every 2 weeks

123
Q

how do you treat twin-twin transfusion syndrome?

A

fetoscopy and ablation of connecting vessels

124
Q

why do you put mothers on routine iron supplementation if she has a multiple pregnancy?

A

anaemia very common

125
Q

how do you deliver triplets?

A

C section

126
Q

how do you deliver twins?

A

vaginally if first baby is head first aligned (may have to progress to C section for second baby)

127
Q

post-natally, if a mother had gestational diabetes, when should you do a oral-glucose tolerance test to ensure diabetes was only transient?

A

6-8 weeks post-natally

128
Q

what is gestational diabetes?

A

carbohydrate intolerance resulting in hyperglycaemia with onset/first recognition during pregnancy

129
Q

why can gestational diabetes lead to shoulder dystocia of the baby?

A

macrosomia with weight especially around shoulders

130
Q

when is gestational diabetes screened for?

A

at booking bloods

131
Q

when is gestational diabetes diagnosed?

A

GTT at 28 weeks

132
Q

at what gestational age do you offer delivery for a pregnant lady with diabetes?

A

38 weeks gestation

133
Q

why does the rate of cervical cancer incidence increase steeply until around 35 and then decrease?

A

due to HPV risk

134
Q

at what stages in life does the transformational zone of the cervix chane?

A

menarche
pregnancy
menopause

135
Q

what type of cells line the ectocervix?

A

squamous epithelium

136
Q

what type of cells line the endocervix?

A

columnar epithelium

137
Q

why can the ecocervix undero physological squamous metaplasia?

A

exposure to acid of the vagina- cervical erosion

138
Q

what follicles form due to cervical erosion of the endocervix?

A

nabothian follicles

139
Q

what is follicular cervicitis?

A

sub-epithelial reactive lymphoid follicles present in cervix

140
Q

what is a cervical polyp?

A

localised inflammatory outgrowth (not premalignant)

141
Q

what cells in the cervix does HPV infect?

A

epithelial cells

142
Q

what 2 types of HPV cause 70% of all cervical cancers?

A

16 and 18

143
Q

what are the 4 main risk factors for cervical intraepithelial neoplasia/cervical cancer?

A
  • persistence of high risk HPV
  • vulnerability of squamous-columnar junction in early reproductive life
  • smoking
  • immnosuppression
144
Q

what three factors contribute to the increasing vulnerability of the squamous-columnar junction in early productive life?

A
  • age at first intercourse
  • long term use of oral contraceptives
  • non-use of barrier contraception
145
Q

what types of HPV cause genital warts?

A

6 and 11

146
Q

describe the histological changes of HPV genital warts?

A

condyloma acuminatum:

papillomatous squamous epithelium with cytoplasmic vacuolation (‘koilocytosis’)

147
Q

describe the histological changes of cervical intraepithelial neoplasia due to HPV infection?

A

epithelium remains flat but may show koilocystosis

148
Q

what is koilocystosis?

A

squamous epithelium which has undergone structural changes due to HPV infection

149
Q

what is the histology of most common type of malignant cervical tumours?

A

invasive squamous carcinoma

150
Q

what is the average time from HPV infection to high graDe CIN?

A

6 months to 3 years

151
Q

what is the average time from high grade CIN to invasive cancer?

A

5-20 years

152
Q

if cervical intraepithelial neoplasia is asymptomatiic and not visible by naked eye- how is it detected?

A

cervical screening

153
Q

describe the differences between CIN I, II and III?

A

I -basal 1/3 of epithelium occupied by abnormal cells
II -abnormal cells in middle 1/3 too
III -abnormal cells occupy full thickness

154
Q

in invasive squamous carcinoma, which happens first- lymphatic or haematogenous spread?

A

lymphatic spread to pelvic and para-aortic nodes

155
Q

what is the preinvasive phase of endocervical adenocarcinoma?

A

cervical glandular intraepithelial neoplasia (CGIN)

156
Q

why is screening less effective for CGIN than for CIN?

A

more difficult to diagnose CGIN on cervical smears

157
Q

which has a better prognosis- cervical squamous carcinoma or endocervical andenocarcinoma?

A

squamous carcinoma

158
Q

which HPV type is most associated with endocervical adenocarcinomas?

A

HPV 18

159
Q

what is the most important prognostic factor in vulvar invasive squamous carcinoma?

A

spread to inguinal lymph nodes

160
Q

what does vulvar pagets disease arise from?

A

sweat glands

Reproduction (9 decks)

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