Maternal and Foetal Health & Wellbeing Flashcards
What is a strucutral abnormality?
Problem with the body part eg: cleft palate, NTD
(Production of congenital malformation)
What is a functional abnormality?
Problem with how a body part or system works ie: developmental disability
(direct toxic effect on cells of embryo either lethal or reduction in growth
When is the embryo most susceptible to teratogens?
When you don’t know you’re pregnant
3-14/40
What can alcohol cause?
Foetal Alcohol Syndrome (most severe)
Foetal Alcohol Spectrum Disorder = LBW, Small head, Cerebral Palsy, ADHD
Heart defects
What can folic acid defiency lead to?
NTD eg: meningocele
What can rubella lead to?
Cataract, heart defects, mental retardation
What foods should be avoided?
What is the bacteria associated?
What are the symptoms
Soft cheese, blue cheese
Listeria bacterium
Associated w/ miscarriage, stillbirth & sick neonate
What does toxoplasmosis cause?
How can you avoid this?
Toxoplasmosis is a common infection that can be caught from the faeces of infected cats or from contaminated meat. Normally it rarely causes problems but if caught during pregnacy or few weeks prior to conception it can cause:
Miscarriage, still birth or rarely congential defects.
Avoidance: Don’t change the cat litter
What are the common symptoms in the first trimester?
What week does this ususally occur?
Why?
Morning sickness (often 8/40) due to rising hCG levels
- Hypermesis Gravidarium –> excessive nausea and vomiting, weight loss and dehydration, requires hospital treatment as more severe than morning sickness.
Frequency of mictuition (due to bladder frequency)
- Lasts until 16/40 until uterus rises out pelvis
What are some of the symptoms later on in pregnancy?
- Heartburn
- Peridontal
- Constipation (progesterone reduces gastric motility)
- Haemorrhoids
- Leucorrhoea (white vaginal discharge- non irritant or ofensive)
- Hyperpigmentation- areola, nipple, vulva, perianal region
- Backache
- Sympysis Pubis Dysfunction
- Carpal Tunnel syndrome
Give some example of how to improve maternal and foetal wellbeing
(think very general)
- Nutrition
- Decrease smoking
- Reduce alcohol
- Increase exercise
What is Gravidity?
The total number of pregnancies regardless of an outcome
Mutiple gestation counts as a single event
What is parity?
The total number of pregnancies carrierd over viability threshold (24 weeks)
Mutiple births count as a single parous event
The patient is currently pregnant they have had one child & a miscariage what is the notation?
G3 P1 +1
(+1 symbolises the miscarriage- not carried to 24 weeks)
The patient is not pregnant, they have had one live birth and one stilbirth- what is the notation?
G2 P2
The stillbirth was carried over 24 weeks thus it is P2
The patient is not pregnant- but had twins. What is the notation
G1 P1
How many births are premature
Up to 10%
What are stillbirths generally linked to?
What should you do in order to try and prevent this?
intrauterine Growth Restriction
2) Monitor growth to identify interuterine growth restriction
Identify anomolies
Prevent, Intervene, Deliver, Be prepared
What is a small, normal and large baby weight in kg
Small <2.5kg
Normal: About 3.5kg
Larger: 4.5kg
Define prematurity
What are the catagories?
Born before 37 weeks
Extremley preterm: <28weeks
Very preterm: 28-32 weeks
Moderate to Late preterm: 32-37 weeks
What can you do if there is a prematuirty risk?
- MgSO4
- Neuroprotectant to reduce cerberal palsy risk
- Steroids (Betamethasone)
- Stimulates surfactant synthesis- lubricates lungs so air sacs can glide without sticking
- Prevents brain bleedings
- Lower risk necrotizing entercolitis
24-32 weeks -double dose 24hrs apart
34-37 weeks- single dose
How can you establish EDD
LMP: (Naegele’sRule) Assume 28 day cycle & use First Day LMP
- Add 12 mnths
- Minus 3 mnths(or simply add 9)
- Add 7 days to first day of LMP
- (+/- days resulting EDD for differing cycle length)
2) Early Sonogram: CRL
- UK standard = Crown Rump Length @ early scan
- If > 84mm, gestation age should be estimated using head circumference
3) Symphysio-Fundal Height:
- From 24/40
- Separate Growth Chart
- Measure: TOP DOWN
What is a biometric test?
Predict foetal size @ point in gestation
Indicates growth but not foetal wellbeing
What is a biophysical test?
Predict foetal wellbeing but not growth
Foetal biometric tests:
How do you measure the baby size via Early sonogram?
What weeks?
CRL (top of head to bottom of torso)
6-13 weeks - used as there is little biological variabilty
Foetal biometric tests:
What measure ments are used in scans?
- Biparietal Diameter (measurement across parietal bones of baby’s head)
- Head circumference
- Abdominal Circumference
- Femur length
With intrauterine Growth Restrictions
a) What is it?
b) What are the risks?
Small for gestational age
Risks:
- Stillbirth
- LWB
- Decrease resistance to infection
- Hypoglycaemia
- Hypothermia
- Decrease O2 levels
- Difficulty handling vaginal delivery
How do you diagnose IUGR?
What are the types? What are the causes?
Use Centile charts e.g. symphysiofundal height = below 10% for gestational age
Type I: ALL Biometric less than expected
Usually presents earlier
Cause: Infection, Chromosome abnormality
foeType II: Disproportionate between diameters
AC (Abdominal circumference) classically affected
Foetal head sparing due to increased brain-liver ratio, preferential redistribution of blood towards the brain due to placental insufficiency.
Cause: Placental insufficiency, Pre-eclampsia
(Note: Foetal tachycardia may be present in 50%)
What is biophysical profiling?
What are Biophysical Profiling main area and additional areas of assessment?
When is it usually carried out?
Biophysical profiling combines a non stress test with ultrasound to check the health of the foetus.
Measures foetal heart rate in response to foetal movements
Usually in 3rd trimester
Also Measures: Foetal breathing, movements, tone and Amniotic fluid volume
Foetal GI system:
When does swallowing take place?
What are they swallowing?
Where does what they swallow go through? (think GI tract areas)
What does it permit?
What happens if no swallowing takes place?
Swallowing developed in 10-12wk
Swallowing Amniotic fluid
Goes through stomach & SI
Fluid movement in GI tract permits growth and development of GI tract
Polyhydramnios occurs if foetus does not swallow enough amniotic fluid
Foetal Urinary System:
How is most waste ecreted?
How often does the bladder empty into amniotic fluid?
At ____ weeks foetus produces ___ml urine p/d
At term it rises to?
Debris accumulates in foetal gut forming what?
Most waste excreted via placenta
urine enters the bladder and the bladder emoties into–> Amniotic fluid every 40-60mins
At 25 Weeks foetus produces 100ml urine p/d
Rising to 500mls at term
Foetus swallows amniotic fluid constantly and absorbs watera and electrolytes.
Debris accumulates in the foetal gut, together with gut debris forms meconium (first foetal stool).
What is the function of the amniotic fluid?
How much @ 8 weeks
How much at 38 weeks?
How much @ 42 weeks?
What does it contain in early pregnancy
What does it contain in second trimester?
After 20 weeks what else does it contain?
Mechanical protection and Moist environment
8 weeks = 10mls
38wks = 1L
42 weeks = 300mls
Early pregnancy: Ultra filtrate of maternal plasma
Second trimester: + ECF (which diffuses through foetal skin) - composition: foetal plasma
After 20w: Foetal urine
What does amniotic fluid contain?
Hydrocholoric acid, enzymes
Water, Electrolytes, Amnion, Proteins, Cells from foetus
by 20wk = foetal urine
How is the foetal urinary system monitered?
Foetal kidney number, size & strucutre
Amniotic fluid volume
Bladder acitivty
What is most of the AVF comprised of in late pregnancy?
What does this reflect?
What is too litle/ too much amniotic fluid called
Foetal urine
2) Renal function, Bladder, GI, and Foetal metabolism from the placental supply.
3) Polyhydramnios = too much amniotic fluid
Oligohydramnios = too little amniotic fluid
What is the role of the placenta?
Respiration, Nutrition, excretion
Gas exchange occurs in the placenta.
What are the 3 shunts in utero?
- Ductus Venosus -> shunts a portion of the left umbilical vein blood directly into the inferior vena cava, bypassing the liver. Forms the ligamentum venosus in the adult (remnant) and the umbilical vein forms the ligamentum teres.
- Foramen Ovale
- Ductus arteriosus
What are some of the modifications of the feto-placental circulation (aside from shunts)
Large & more RBC
Modified Hb to pick up max O2
Oxygenated blood arrives from placenta in umbilical vein- Where can the blood go?
Hepatic micro circulation (later joints IVC via hepatic veins)
Directly to IVC through ductus venosus
Blood to the IVC can come from?
Hepatic micro circulation
Abdo, pelvis & Lower limbs
Ductus venosus
50% of blood from ____ is shunted into ____ ____
due to flow patterns in R atrium
50% of blood from Placenta is shunted into Left atrium due to flow patterns in R atrium
How is the right to left flow maintained?
Larger quantity & greater speed of blood flow from IVC to right atrium compared to that entering blood left atrium from pulmonary veins
Goes through Foramen ovale
(Lungs are fluid filled, High pulmonary resitance, more blood entering R atrium compared to left atrium thus blood shunted through foramen ovale)
Is the blood from the lungs entering the L atrium in foetal life high or low oxygenated and why?
Lung tissue extracts O2 from low circulating blood volume entering from the right ventricle & returns poorly oxygenated blood to L atrium
What is the Ductus Ateriosus?
Muscular artery connecting pulmonary trunk to descending aorta
What does the DA allow?
Most blood leaving R ventricles to perfuse the lower body & placenta
(so the blood that hasn’t gone through foramen ovale, majority will pass through DA)
What do the DA and FO allow?
Blood to bypass lungs and be directed to placenta
During interuterine life the foetal- placenta circulation provides what?
What is it maintained by?
Operates as a single unit providing low resistance, high capacity reserviour in vascular bed of placenta.
Maintained by abscence of valves in umbilical veins
What is the normal foetal HR?
110-160bpm
What are the circulatory adaptations after birth?
Removal of low-resistance circulation of placenta
Onset of breathing: Pulmonary vascular resistance decreases (lungs drained of fluid)
Increased blood flow to lungs: Increases blood returing to left atrium so L atrium pressure > R atrium pressure
–> FO closure
As flow through pulmonary circulation increases & arterial O2 tension rise DA begins to constrict
When does the DA functionally constrict?
1 day postnatally
What is required for permanent closure of DA? How long does this take?
Thrombosis & Fibrosis
Takes several weeks
When does DV close? (ductus venosus)
Ductus venosus remains partially open but closes within 2/3 months after birth
What is the notation for a pregnant women who has had one set of twins born at 28 weeks and a singleton born at term
G3 P2
What is a structural abnormality?
When does this normally occur?
Production of congenital malformation by teratogen (most common between 3-8weeks) aka- problem w/ body parts
What is a functional abnormality?
When does this normally occur?
Direct toxic effect on cells of embryo either lethal or reduction in growth (aka: how body parts or systems work)
Most common after 8 weeks
What are common teratogens?
Alcohol
Dietary intake
Viruses
Medication during pregnancy
What can anti-epileptic drugs cause?
Cleft lip & Palate
