GUM 235 Pregnancy 2 Flashcards
What increase in CO output is required in pregnancy and why?
30-50%
Due to the increased preload
What happens to HR in pregnancy?
Increases due to increase SV / preload
Why is the CO post-partum increased by nearly 80%?
Due to sudden increase in vascular resistance to prevent haemorrhage yet still increased blood volume
Why is there dyspnoea in pregnancy?
Rising fundus
Progesterone effect
What do you see on ECG in pregnancy?
sinus tachy and left axis deviation
What liver function test is raised normally in pregnancy?
ALP x1.5-2
What happens to protein levels in pregnancy
decreased: total protein, albumin and gamma globulin
What happens in a FBC in pregnancy?
neutrophillia,
decreased PLT,
increased RBC mass due to increase volume th. decreased hct / hb
Why is the female in a pro-thrombotic state during pregnancy?
To protect against post-partum haemorrhage
Why is there a compensatory respiratory alkalosis in pregnancy?
due to increased alveolar ventilation which facilitates fetomaternal oxygen transfer
What happens to kidney size and blood flow in pregnancy?
increased
therefore increased GFR - decreased urea and creatinine
What may altered tubular function in pregnancy result in?
glycosuria, proteinuria, calcium and bicarb in ?urine
th, UTI and pyelonephritis
Why can there be a transient hyperthyroidism in pregnancy?
B-HCG binds to the TSH receptor = increased T3 and T4
Why is there reflux in pregnancy?
prog decreases LOS tone
What are the RF’s for multiple pregnancy?
increased maternal age, fhx, race and assisted conception
monozygotic twins
identical - one zygote splits into two
dizygotic twins
non-identical - 2 different zygotes
dichorionic diamniotic (DCDA)
each twin has own chorion, placenta and amnion (always dizygotic)
Can be fused or separate
monochorionic diamniotic (MCDA)
one placenta and chorion but two amnions
monochorionic monoamniotic MCMA
one of everything between two!
What are the risks of multiple pregnancy?
miscarriage, congenital abnormalilties,pre-term, IUGR
What is the ABC before instrumental delivery?
A= adequate analgesia B = empty bladder C = dilated cervix
Where do you place the ventouse suction cap?
2-3cm anterior to posterior fontanelle
What are the main causes of bleeding in early pregnancy?
ectopic or miscarriage
What do you see in a threatened miscarriage ?
baby alive, os closed
What do you see in inevitable miscarriage?
os is open
How do you manage incomplete miscarriage?
Conservative
Medical : misoprostol and anti-D
Surgical
What are some causes of bleeding in late pregnancy/ labour?
placental abruption - separation of placenta
placenta praevia - placenta covers LOS
ruptured uterus
What are some causes of post-partum haemmorhage?
ruptured uterus,
uterine artery bleeding
trauma
retained placenta
What is primary PPH?
bleeding occurs
What is secondary PPH?
bleeding occurs >24-6 weeks post partum
What are some risk factors for post-partum haemmorhage?
previous history, smoking, increased age, previous TOP, IVF, defective endometrium
How would you managed PPH?
empty bladder, bimanual contraction, give oxytocis, repair surgically,
before delivery: group and save blood, IV access
What are the three features of pre-eclampsia?
proteinuria, HTN and oedema
What other features can you get with pre-eclampsia?
headache, vision distubrances, RUQ pain, N&V
placental ischaemia = decreased GFR and increased creat/urea
What is HELLP syndrome in pre-eclampsia?
haemolysis, elevated liver enzymes, low platelets
= emergency - must deliver!
What is the pathophysiology behind pre-eclampsia?
diffuse vascular endothelial dysfunction with circulatory disturbances involving multiple systems
affected by genetics
placental ischaemia in 1st half of pregnancy
abnormal placentation and trophoblast invasion
lack of vascular adaptation to pregnancy
