Module 2 - Pregnancy and Neonatal Health - Part 1 Flashcards
Pregnancy
What is the difference between pre-eclampsia and eclampsia?
Seizures.
From week 13, what endocrine organ produces the hormones to support the embryo?
The placenta.
What happens in the third stage of labour?
- Separation and birth of the placenta and membranes.
- Some controlled bleeding.
What are some risk factors for pre-eclampsia and eclampsia?
1. First pregnancy
2. Multiple gestations
3. Mother is > 35 years
4. Hypertension
5. Diabetes
6. Obesity
7. Family history
What negative outcomes are associated with antepartum haemorrhage?
- Fetal hypoxia
- maternal shock
- preterm birth.
What happens to the dermis during pregnancy?
- The dermis (skin) expands as the uterus grows.
- Stretch marks (striae) may appear.
What hormone continues to rise during the pregnancy?
Estrogen
What is Postpartum Haemorrhage?
Bleeding of 500ml or more following labour and birth.
What happens to the circulatory system during pregnancy?
- Blood volume increases by 1-2 litres.
- The mothers BP and pulse rise.
How are gestational hypertension and pre-eclampsia different?
Gestational Hypertension - increased BP only (*WITHOUT any other symptoms)*.
Pre-Eclampsia - Increase in BP and presence of protein in urine (proteinuria), headaches, visual disturbances, RUQ pain.
What can happen to the stomach during pregnancy?
The uterus can put pressure on the stomach causing gastric reflux.
How many stages of labour are there?
3
What 3 hormones are important in pregnancy?
- Estrogen
- Progesterone
- Human Chorionic Gonadotropin (HCG)
How long does the average pregnancy last?
38.5 weeks
What are some signs and symptoms of pre-eclampsia?
- Edema (legs, face, hands)
- Increased BP ( > 140/90)
- Headaches
- Blurred vision
- RUQ pain
- Protein in urine
- Pulmonary edema (cough and SOB)
- Cerebral Edema (headaches, confusion and seizures)
What are the two phases of the first stage of labour?
Latent Phase and active phase.
What is the BP for hypertension in preeclampsia?
140/90
What happens to the bladder during pregnancy?
The uterus puts increased pressure on the bladder later in pregnancy which results in frequent need to urinate.
What are the two classifications of PPH?
Primary - within 24hrs of birth
Secondary - 24 hrs to 6 weeks postpartum
The anterior pituitary glad stimulates the _________. This increase the mother’s metabolic rate.
Thyroid Gland.
What are some complications associated with GDM for both the fetus / infant?
- stillbirth
- fetal hyperglycemia
- macrosomia (big baby)
- birth trauma
- congenital abnormalities
What are three things that can happen if blood flow is restricted to the placenta?
- intrauterine growth restriction
- fetal death
- release of proinflammatory proteins into the blood stream.
What is the leading cause of maternal mortality and morbidity globally?
Postpartum Haemorrhage (PPH)
What are the phases of pregnancy called?
Trimesters
What is Bimanual compression?
Bimanual uterine compression is an intervention performed by a skilled birth attendant, where one hand is placed in the vagina and pushed against the body of the uterus, while the other hand compresses the uterine fundus above through the abdominal wall.
If a PPH occurs after vaginal birth, and is due to uterine atony, bimanual uterine compression can act as a temporizing measure until definitive treatment is available.
What causes antepartum haemorrhage?
Placenta previa - placenta has implanted at the bottom of the uterus, over the cervix or close by, which means the baby can’t be born vaginally.
Placental abruption - the placenta separates early from the uterus.
What could be an outcome for someone with severe preeclampsia (160/110) ?
Name 2.
1. Hemorrhagic stroke (artery bleeds into the brain)
2. Placental abruption (placenta separates early from the uterus)
What parts of the body can pre-eclampsia effect?
- Kidneys
- Retina
- Liver
- Brain
What are some common complications of pregnancy? List 6.
1. Pre-eclampsia
2. Eclampsia
3. Gestational diabetes
4. Preterm labour
5. Antepartum haemorrhage
6. Postpartum haemorrhage
What is the BP for severe preeclampsia?
160/110
What is the treatment for pre-eclampsia?
- Delivery of fetus and placenta.
- Manage symptoms after delivery
- Additional measures such as supplemental oxygen and medication.
How does pre-eclampsia affect the placenta?
Restricts blood flow.
What happens in the second stage of labour?
This stage begins when the cervix is fully dilated and ends with the birth of the baby.
How is Postpartum Haemorrhage managed? Name at least 3 strategies.
- Mechanical : uterine massage
- Pharmacological : Oxytocin (Syntocinon), Ergometrine or Misoprostol
- Repair tears
- Removal of retained products
- Tranexamic acid
- Blood transfusion: RBC + platelets + clotting factors
- Bimanual compression
If a woman was diagnosed with high blood pressure before being pregnant or before 20 weeks, what is this called?
Chronic Hypertension.
When is the second trimester?
14 - 26 weeks
What are some maternal strategies used to manage GDM?
- Diet
- Exercise
- Oral hypoglycaemic and insulin
- Monitor BSL and fetal development.
What is classified as a severe PPH?
> 1000ml
During pregnancy what happens to the lungs?
- Increase in tidal volume
- Increase oxygen consumption
- elevated diaphragm
- nasal stuffiness
- epistaxis (nose bleed)
Mirella is 34 weeks pregnant she has peripheral oedema, epigastric pain and a blood pressure of 145/95. Which condition may she have?
Preeclampsia
What is GDM and when does it occur?
Gestation Diabetes Mellitus
Diabetes that occurs during pregnancy.Results in multiple complications for both fetus and mother.
What are some risk factors for GDM? Name at least three.
- Maternal age > 35
- Obesity
- Family history
- PCOS
- Previous GDM.
Until around week 12 the ovaries and _________ produce most of the estrogen and progesterone to support the embryo and placenta.
Corpus Luteum
Is a woman has high blood pressure without any other symptoms after 20 weeks gestation, what is it called?
Gestational hypertension.
What syndrome can develop in 10-20% of women with severe preeclampsia?
HELLP Syndrome. Hemolysis Elevated Liver enzymes Low Platelets.
What are some complications associated with GDM for the mother?
- hypertensive disorders
- increased risk of infection
- caesarean section
- developing diabetes in future
When can women get pre-eclampsia?
- After 20 weeks gestation
- 6 weeks post delivery
Why is estrogen important?
1. Suppresses the production of SH and LH
2. Import for the growth of the fetus’ organ system.
3. Stimulates maternal tissue growth (uterus and breasts)
What contributes to weight gain during pregnancy?
- growing fetus
- placenta and amniotic fluid
- breast tissue
- uterus
- blood volume
When is the third trimester?
27 - 38.5 weeks
NEWBORN PAEDIATRIC ASSESSMENT
What is the paediatrician looking at when assessing general appearance of a newborn?
- Skin colour, integrity, perfusion
- State of alertness
- Activity, range of spontaneous movement
- Posture, muscle tone
How is antepartum haemorrhage managed?
- bood test
- ultrasound
- CTG monitoring
- blood transfusion
- steroids
- birth
Describe what happen in the first stage of labour.
- True contractions
- Ends with the cervix is fully dilated (10cm)
Why does a woman’s metabolic rate increase during pregnancy?
To produce energy to support gestation.
When is the first trimester?
1 - 13 weeks
What is antepartum haemorrhage?
Bleeding from or in the genital tract, occurring from 24 weeks gestation to prior to the birth.
What are the 4Ts (causes) of PPH?
Trauma: uterine rupture/ cervical/vaginal, perineal tear
Tone: uterine atony, oxytocin withdrawal, increased parity, prolonged labour
Tissue: retained products; placenta/ membranes
Thrombin: clotting disorder.
What is the corpus luteum?
Structure formed by the matured follicle cells during ovulation. Secretes estrogen and pregesterone. Essential for pregnancy to occur.
