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REPRO > Fetal circulation + pregnancy > Flashcards

Fetal circulation + pregnancy Flashcards

1
Q

Ductus Venous

A

highly oxygenated blood comes from placenta to fetus via umbilical vein –> directed to IVC via this shunt (bypass liver)
Travels directly to heart to move to brain

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2
Q

Foramen ovale

A

cardiac ventricles work on parallel

Allow highly oxygenated blood to move from right atrium to left atrium –> supply brain/heart

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3
Q

Ductus arteriosus

A

lungs not needed for oxygenation
90% blood from RV bypassed via this shunt from pulmonary artery to descending aorta
RV pumps deoxygenated blood to lower body and back to placenta

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4
Q

Umbilical vein

A

from umbilicus to DV

becomes ligamentum teres hepatis

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5
Q

Ductus venosus

A

from umbilical vein to inferior vena cava

becomes ligamentum venosum

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6
Q

Foramen ovale

A

from RA to LA

becomes closed atrial wall

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7
Q

Ductus arteriosus

A

from pulmonary artery to descending aorta

becomes ligamentum arteriosum

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8
Q

Umbilical artery

A

from common iliac artery to umbilicus

becomes superior vesical arteries; lateral vesicoumbilical ligaments

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9
Q

Positive dx of pregnancy

A

fetal heart
fetal movement
visualization of fetus

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10
Q

probable Dx of pregnancy

A 
enlarged uterus
uterine/cervical changes
palpation of fetus
Braxton hicks contractions
pregnancy test
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11
Q

Presumptive Dx of pregnancy

A 
amenorrhea
breast changes
congestion of vagina
skin changes
common symptoms (nausea, fatigue, bladder irritability)
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12
Q

Naegle rule

A

LMP + 7 days - 3months + 1 year

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13
Q

Ultrasound dating

A

measurement of fetal size compared to normal curves
earlier scan more accurate ( LMP if within 1 week difference
if over >2 weeks difference: take note if fetal growth restricted

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14
Q

First prenatal visit

A 
confirm pregnancy
do not have to repeat pregnancy test if patient has already done one
medical history
risk assessment
full physical + pap and swabs
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15
Q

Prenatal care

A 
pregnancy recommendations
smoking cessation
alcohol/illicit drugs
physical activity
sexuality - semen may have prostaglandins; if prematurity risk high, advise against sexual intercourse
supplements (folate, iron)
work environment
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16
Q

Routine investigations during pregnancy

A 
weight, BP
urine dip for protein
SFH
Fetal HR
fetal growth - SFH +/- ultrasound
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17
Q

1st visit labs for pregnancy

A 
Blood type/screen (repeat at 26-28 wks esp important in Rh- women)
CBC - Hb electrophoresis if indicated
Rubella (can't vaccinate since live attenuated)
syphilis - can treat
HBsAg - can vaccinate if needed
HIV - counsel
\+/- HC
Swabs GC/CT
Pap if needed
\+/- TSH (common)
Ultrasound - dating
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18
Q

Ultrasound schedule during pregnancy (N)

A

Dating

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19
Q

Genetic screening

A

all pregnant women should be offered
blood test available in first/second trimester, combination produces a risk estimate
CVS 10-13 weeks
amnio >15 weeks

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20
Q

Gestational diabetes screen

A

24-26 weeks

75g OGT - do earlier if at risk (twins - hPL, ethnicity, previous DM)

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21
Q

GBS screening

A

35-37 weeks

for risk of sepsis and meningitis

22
Q

Anemia in pregnancy

A

Hb 100 = anemia
Physiologic anemia of pregnancy
check for Fe deficiency with ferritin

23
Q

Physiologic anemia of pregnancy

A

due to 50% increase in plasma volume compared to only 20-30% increase in erythrocyte mass
generally normocytic, >105

24
Q

Risks of GDM

A

maternal: operative delivery, 50% risk T2DM
Fetal: macrosomia (sugar crosses but insulin doesn’t; fetus produces insulin and insulin-like growth factor), stillbirth
Neonatal:hyperglycemia

25
Q

Group B Strep - pregnancy

A

10-30%
universal screening at 35-37 weeks
don’t screen too early - part of normal flora

26
Q

GBS who to treat

A

treat GBS+ when membranes rupture
GBS bacteriuria in this pregnancy - treat, don’t need to swab
Prior GBS affected child: treat, don’t need to screen
GBS unknown and ROM > 18 hours: treat
GBS+, intrapartum: treat

Don’t need to treat:

  • elective C-section (if membranes don’t rupture beforehand)
  • GBS+ 1st pregnancy and infected baby –> treat child, don’t need to screen
27
Q

GBS treatment

A

can’t eradicate!
IV penicillin
if allergic: anaphylaxis: clindamycin/erythromycin
at least 2 intrapartum doses to mom

28
Q

Small SFH, lack of interval growth

A

ask about fetal movement
broad differential
maternal: HTN, chronic medical conditions, malnutrition, weight loss, medications, substance use, rupture membranes
Fetal: chromosomal, growth restriction, infection
Placental: poor implantation, chronic abruptio, oligohydramnios

US if SFH >3cm behind GA

Non-stress test: 20-45 min fetal heart rate tracing

29
Q

Fetal Heart visualization

A

normal maternal BMI:
5-6 wk on transvaginal ultrasound
8 wk on transabdominal ultrasound

30
Q

Fetal HR audio

A

10-12 wk with Doptone

31
Q

Hypertension in pregnancy

A

single elevated BP: 30-70% of women with single elevated BP will be normal on repeat testing

32
Q

Dx of gestational HTN

A

SOGC: diastolic > 90 based on average of >=2 measurements taken in same arm >15 min apart
diastolic is a better predictor of adverse pregnancy outcomes
Systolic > 160 diagnostic
BUT keep an eye on systolic > 140

33
Q

Preeclampsia

A

gestational HTN + proteinuria (>=2 2+ on dipstick, 0.3 g/day or 30 mg/mol on spot PCR)

34
Q

GERD in pregnancy

A

more common due to:

  • progesterone affecting smooth muscle
  • delayed gastric emptying
  • mass effect from uterus

Drugs in pregnancy:

  • some drugs cross placenta
  • ranitidine is okay
35
Q

Postpartum blues

A

80% women, lasting

36
Q

Postpartum depression

A

10-25% women = medical condition needing treatment

37
Q

Contraception post-partum

A

Lactation
Combined OCP can affect milk supply - progesterone less effect but also less effective as contraception
IUD: wait 6 weeks postpartum to allow uterine involution

38
Q

Lactation as contraception

A

Exclusive breastfeeding at 6 mo: 95% effective
non-exclusive: 50% ovulate by 6 weeks
non-BF: often resume by 45 d

39
Q

Breast changes during pregnancy

A

early: tenderness/paraesthesias
>2 mo: increase in size, delicate veins visible
- nipples enlarge, more deeply pigmented/erectile
Later: colostrum can be expressed from nipples by gentle massage
- areolae become broader, more deeply pigmented
some striations if breasts become large

40
Q

Cervical changes during pregnancy

A

softening/cyanosis as early as 1 mo after conception
- increased vascularity, edema, hypertrophy/hyperplasia of cervical glands

Proliferation of glands:
- produce mucus rich in Ig and cytokines, may act as immunological barrier
mucus plug expelled at onset of labour/earlier –> bloody show

Small amounts of smooth muscle, mostly CT
collagen-rich CT rearranged = ripening
- decreases collagen/Proteoglycan concentrations, increase water content
- regulated by local E and P

41
Q

Uterine changes during pregnancy

A 
500-1000x bigger
- most marked in fundus
increase in weight to 1.1 kg
cavity ~5L or >20 L
early:
- hypertrophy/stretching of muscle cells stimulated by E, maybe P
- production of new myocytes limited
- accumulation of fibrous tissue, esp in external muscle layer
- increase in elastic tissue content

Late:
- relatively thin-walled muscular organ

42
Q

Pulmonary changes during pregnancy

A 
diaphragm rises ~4 cm
thoracic circumference increases ~6 cm
diaphragmatic excursion increases
FRC decreases 20-30%
inspiratory capacity increases 5-10%
total lung capcity unchanged/decreases by
43
Q

Oxygen delivery during pregnancy (maternal blood)

A

amount of O2 delivered to lungs by increased tidal volume exceeds O2 requirements
total Hb mass increases
maternal A-V O2 difference increased
O2 consumption increases~20%

44
Q

Acid-base equilibrium (maternal) during pregnancy

A

increased awareness of a desire to breathe
- physiological dyspnea caused by increased tidal volume that lowers blood PCO2 slightly

Respiratory alkalosis

  • to compensate: HCO3- decreases
  • blood pH increases only minimally
  • shift O2 dissociation curve to left: Bohr effect –> decrease O2 releasing capacity of maternal blood
45
Q

Cardiovascular changes during pregnancy

A

Plasma volume increases by 45%
- P and E on kidney –> Renin –> RAS –> Na retention (protection from hemorrhage)
Increase renal EPO production: RBC mass increase 20%
- hemoglobin falls
White cell count rises, peaks after delivery
Fall in peripheral vascular resistance by 20%
- E & P –> vasodilation
- systolic/diastolic BP fall –> reflex increase in HR by 25%
- SV increased by 25%, CO increased by 50%

46
Q

Coagulation during pregnancy

A

plasma concentrations of fibrinogen/all clotting factors gradually increase
increase in platelet production (but relative thrombocytopenia because of increased activity and consumption)
increase in fibrinolysis

47
Q

Metabolic changes during pregnancy

A

insulin production rises
increased insulin resistance caused by placental hormones (hPL)
Any carbohydrate load will cause greater than normal increase in plasma glucose concentrations –> facilitates glucose transfer

48
Q

GU changes during pregnancy

A

renal plasma flow, GFR increase
urea/creatinine/urea clearance and excretion of HCO3- increased –> plasma concentration decrease
Activities of RAS, aldosterone, progesternoe increase –> water retention, decreased plasma osmolality
resorption of glucose falls
progesterone-mediated ureteric smooth muscle relaxation –> urinary stasis –> increased risk for UTI, urinary incontinence

49
Q

GI changes during pregnancy

A 
Heartburn common
- increased intraabdominal pressure
- progesterone-mediated reduction in LES tone
Pregnancy gingivitis
- gums hyperemic, softened
Hemorrhoids common
More likely to develop gallstones
50
Q

Immune tolerance during pregnancy

A

Semiallogeneic fetus allowed to growt within maternal uterus

51
Q

MSK changes during pregnancy

A

progressive lordosis

sacroiliac/sacrococcygeal/pubic joints increased mobility

52
Q

Skin/orofacial changes during pregnancy

A

abdominal wall: striae gravidarum
Hyperpigmentation:
- up to 90% of women
- usually more accentuated in those with darker complexion
- melanocyte-stimulating hormone level elevated
- E and P - melanocyte-stimulating effects???

Vascular changes:
- angiomas: esp on face, neck, upper chest, arms; palmar erythema (due to hyperestrogenemia??)
increased cutaneous blood flow; dissipate heat generated by increased metabolism

REPRO (18 decks)

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