Maternal And Foetal Wellbeing Flashcards
What weeks is an embryo at most risk from teratogens?
3-14/40 (when they don’t know they’re pregnant)
What’s structural and functional abnormality?
Due to teratogens
Structural abnormality = problem with body part development eg cleft lip or neural tube defect
Functional abnormality = problem with how a body part/system works eg developmental disabilities
During which trimester is the embryo most susceptible to teratogens?
First trimester (first 12 weeks/3 months)
What’s toxoplasmosis?
Can cause miscarriage
Teratogens
Cat poo found in soil/cat litter
What food can be a teratogen?
Mould ripened cheese eg blue cheese
Listeria bacterium -> miscarriage/stillbirt
What are common symptoms in the first trimester of pregnancy?
Morning sickness due to rising hCG levels
Hyperemesis gravidarum (hospitalised morning sickness)
Increased frequency of micturition
Why is there increased frequency of micturition during pregnancy?
Due to increased vascularity of the bladder (lasts until 16/40 when the uterus rises out of the pelvic girdle)
What are 3 ways to date a pregnancy?
From the last menstrual period (first day)
Crown rump length at early sonogram
Fundus-symphysis height from week 24
What are symptoms during the later stages of pregnancy?
Periodontal disease Heartburn Constipation (rising progesterone = reduced gastric motility) Haemorrhoids Vaginal discharge (leucorrhoea = normal) Hyperpigmentation of skin Backache Symphysis pubis dysfunction Leg cramp Carpal tunnel syndrome + oedema in the carpal tunnel
What are some basic recommendations to improve health of childbearing women and their infants?
Improve maternal nutrition Reduce levels of smoking Reduce alcohol consumption Increase exercise Reduce incidence of premature births Increase incidence of healthier neonates
What’s Gravidity and Parity?
Gravidity = total number of pregnancies including the current one
Parity = number of live/still births after 24 weeks gestation (anything else counted as +1)
What’s the obstetric history of a woman with a GPA of G3 P3
Has been pregnant 3 times
Given birth 3 times
How is GPA expressed to a woman with one child and twins, who has never been pregnant another time
G2 P3
How many births will be premature? What’s stillbirth thought to be related to?
10%
Stillbirth thought to be linked to intrauterine growth restriction
What are 3 potentially modifiable factors for reducing stillbirths?
Obesity
Smoking
Foetal growth restriction
What are the 3 categories of birth weight?
Average 3.2 kg
Small under 2.5 kg
Large over 4.5 kg
Define prematurity - what are the 3 categories?
A baby that is born before 37 weeks
Extremely preterm less than 28 weeks
Very preterm 28-32 weeks
Moderate-late preterm 32-37 weeks
What are two drugs that can be used if there is a risk of prematurity?
Magnesium sulphate = neuroprotectant role in cerebral palsy
Steroids (Betamethasome) = prevents bleeding on the brain; lower risk of necrotising enterocolitis; stimulates synthesis of lung surfactant
When do you have a steroid injection during pregnancy?
24-34 weeks double dose
34-37 weeks
What’s the difference between biometric and biophysical tests?
Biometric tests predict size at a point in gestation
Biophysical tests predict foetal wellbeing (eg Doppler)
What are foetal biometric parameters during the first and second trimesters?
First trimester: crown rump length used in early pregnancy
Second trimester scans onwards: Biparietal diameter Head circumference Abdominal circumference Femur length
What are risks of intra-uterine growth restriction?
Low birth weight Decreased O2 levels Hypoglycaemia Hypothermia Less resistant to infection Difficulty handling vaginal delivery
What are types 1 and 2 IUGR and their causes?
Type 1 = all foetal biometrics less than expected
Caused by infection or chromosome abnormalities
Type 2 = disproportion between parameters, abdominal circumference classically affected
Caused by placental insufficiency, pre-eclampsia
What’s biophysical profiling?
Combines non-stress test with ultrasound to check health of foetus - measures foetal heart rate in response to foetal movements
What can biophysical profiling assess?
Foetal heart rate Foetal breathing Foetal movements Foetal tone Amniotic fluid volume
At what weeks does swallowing start in the foetal GI system? What does foetal swallowing regulate?
10-12
Amniotic fluid volume is regulated by swallowing
What’s meconium?
Baby’s first stool = dark green black gut debris as it accumulates in foetal gut
How is foetal waste excreted?
Via the placenta
How is the foetal urinary system monitored?
Foetal kidney number/size/structure
Amniotic fluid volume
Bladder activity
When does foetal urine add to the amniotic fluid?
After week 20 (in latter pregnancy majority of amniotic fluid volume is foetal urine)
How does the volume of amniotic fluid change throughout pregnancy?
10ml at 8 weeks
1L at 38 weeks
Falls to 300ml at 42 weeks
What’s polyhydramnios and oligohydramnios?
Too much and too little amniotic fluid
What are 3 additional structures in the foetal circulation?
Ductus arteriosus
Ductus venosus
Foramen ovale
Via which vessel does oxygenated blood get from the placenta to the foetus?
Umbilical vein
What’s the normal foetal heart rate?
110-160 bpm
How can you monitor foetal cardiovascular system?
Umbilical artery flow Doppler
What’s a cardiotocography?
Technique to record foetal heartbeat and uterine contractions during pregnancy
How does foetal circulatory system adapt after birth?
Onset of breathing as pulmonary vascular resistance decreases
Increased blood flow to the lungs increases volume of pulmonary venous blood returning to the left atrium so left atrial pressure exceeds right atrial pressure = foramen ovale closure
Ductus arteriosus constricts as flow through pulmonary circulation increases and O2 tensions rise
What causes the ductus arteriosus to close and when?
Within 1 day postnatal
Due to constriction of ductus arteriosus (as O2 tensions rise due to increased flow through pulmonary circulation)
(Ductus venosus closes within 2-3 months after birth)
