Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Reproduction > Normal Pregancy and Labour > Flashcards

Normal Pregancy and Labour Flashcards

1
Q

At what stage of development does an embryo implant

A

Fertilised ovum with divide to the blastocyst stage then move from the ampulla to the uterus - day 3-5
Blastocyst implants at day 5-8
Becomes the trophoblast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What do the different parts of the blastocyst become

A

Inner cells develop into embryo

Outer cells burrow into uterine wall and become placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does the blastocyst implant

A

Cords of trophoblastic cells from the surface begin to penetrate the endometrium.
This creates the space for the blastocyst to develop
When implantation is finished the blastocyst is completely buried in the endometrium - by day 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the placenta derived from

A

Trophoblast and decidual tissue - outer cells of blastocyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What happens when the trophoblast cells start to differentiate

A

They become multinucleate cells (syncytiotrophoblasts) which invade decidua and break down capillaries to form cavities filled with maternal blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does the foetal blood supply contact the developing placenta

A

Developing embryo sends capillaries into the syncytiotrophoblast projections to form placental villi
Each villus contains fetal capillaries separated from maternal blood by a thin layer of tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Is there direct contact between maternal and foetal blood

A

No

There a thin layer of tissue between them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

At what point does the placenta become functional

A

5th week of pregnancy

Foetal heart also starts functioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does exchange occur through the placenta

A

2 way exchange of respiratory gases, nutrients, metabolites between mother and foetus, largely down diffusion gradient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does HCG maintain a pregnancy

A

signals the corpus luteum to continue secreting progesterone

Progesterone stimulates decidual cells to concentrate glycogen, proteins and lipids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does the developing foetus receive oxygen

A

The placenta plays the role of the foetal lungs
Done through exchange of maternal blood and the umbilical blood
Oxygen diffuses from the maternal into the foetal circulation
CO2 does the reverse
The umbilical veins carries the O2 rich blood to the foetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is the foetal circulation designed to get sufficient oxygen

A

Foetal haemoglobin has a higher affinity for oxygen than adult
There is also 50% more Hb to maximise oxygen transport
Bohr effect (Foetal Hb can carry more oxygen in low pCO2 than in high pCO2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do water and electrolytes reach the foetus

A

Water diffuses into placenta along its osmotic gradient
Exchange increases during pregnancy up to the 35th week
Electrolytes follow H20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a developing foetus’ main energy source

A

Glucose

Passes through the placenta via simple transport

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Can drugs cross the placenta

A

YES

Must be careful when prescribing as can lead to problems for the baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the role of human placental lactogen in pregnancy

A

Produced from ~ week 5 of pregnancy
Growth hormone-like effects - protein tissue formation.
Decreases insulin sensitivity in mother which means more glucose for the foetus
Involved in breast development - cause of tender breasts in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the function of progesterone in pregnancy

A

Development of decidual cells
Decreases uterus contractility - can therefore be given to those with recurrent miscarriage to try and prevent
Preparation for lactation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the role of oestrogen in pregnancy

A

Enlargement of uterus

Breast development - contributes to tender breasts with HPL

Relaxation of ligments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How quickly should HCG rise

A

Serum levels should double every 48 hours in a singleton early pregnancy
Start falling again from 12-14 weeks after it peaks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What may be happening if HCG levels aren’t rising quickly or at all

A

If HCG levels aren’t rising quickly enough then it suggests an ectopic pregnancy
If the levels are falling it suggests a failing pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What do very high HCG levels suggest

A

Multiple pregnancy

Molar pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the side effect of HCG production

A

N and V
It is the rising HCG that causes morning sickness
Worse in multiple/molar pregnancy due to higher HCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How can increase Ca demands in pregnancy affect the mother

A

Can lead to hyperparathyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What happens to cardiac output in pregnancy

A

Cardiac output increases by up to 50% in pregnancy to cope with the increased demand of supplying the foetal circulation
Plasma volume increases
Caused by increased stroke volume and reduced systemic vascular resistance, in combination with an increased heart rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What happens to CO in labour

A

Increases 30% more during labour.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How might pulse change during pregnancy

A

Lots of pregnant women will have an increased HR of around 90bpm
Usually rises by around 10-20 bpm
May have a collapsing or bounding pulse
May also get new functional murmurs and ECG changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What happens to BP in the second trimester

A

It drops
This is because uteroplacental circulation expands and peripheral resistance decreases
First dip at 10 weeks then rises again before a second dip at 21 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the haematological changes that occur in pregnancy

A

Plasma volume increases proportionally with CO
RBC production increases
MCV and Hb conc stay the same
Maternal Hb is decreased by dilution (haemocrit and red cell count also fall)
Iron requirements increases significantly - may need supplements

Get a modest leukocytosis - high white cells

Platelet count falls progressively throughout pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How does progesterone impact lung function

A

Progesterone signals the brain to lower CO2 levels

To do this RR increases, Tidal and minute volume increases, pCO2 decreases slightly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What effect does pregnancy have on the respiratory system

A

Progesterone signals the brain to lower CO2 levels
O2 consumption increases to meet metabolic need of fetus, placenta and mother
Enlarging uterus has an impact on lung expansion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How does pregnancy affect the renal system

A

GFR and renal plasma flow increases due to the increased plasma volume - early in pregnancy
There is increased re-absorption of ions and water
Slight increase in urine formation
Increased protein excretion and glucose loss in urine
Collecting system dilates - can cause physiological hydronephrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the average healthy weight gain for a pregnant woman

A

Around 11kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How many extra calories does a pregnant woman need per day

A

Around 200-300 extra calories per day

Most is used by the foetus and some is stored as fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Describe the 2 metabolic phases of pregnancy

A

1st - 20th week - mother´s anabolic phase
In anabolic metabolism and has small nutritional demand from foetus
lower plasmatic glucose level
lipogenesis, glycogen stores increases

21-40 weeks - foetus has high metabolic demands and there is ‘starvation’ of the mother
get insulin resistance and lipolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

At what stage of pregnancy is gestational diabetes more likely to develop

A

The later stage when there is high metabolic demand on mum
This is because there is increased insulin resistance
If a woman develops gestational diabetes early on she is more at risk of diabetes in later life as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What causes insulin resistance in pregnancy

A

HPL, cortisol and growth hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What supplements may be needed in pregnancy

A

Folic acid - prevent neural tube defects
Vit D
High protein diet
Iron - not given routinely, only when needed for anaemia
B-vitamins - help with erythropoiesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What hormone changes can trigger labour

A

Placenta produces increasing levels of peptide hormone CRH which increases oestrogen and prostaglandin synthesis and reduce progesterone levels
More oestrogen increases contractility
Mother releases oxytocin from pituitary which increases contractions and excitability (direct action at tissue and also increases prostagladins)
Foetal hormones: oxytocin, adrenal gland, prostaglandin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What increases contractility of the uterus

A

Oestrogen
Mechanical stretch of uterine muscles
Dilation of the cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How can you induce labour

A

Vaginal prostaglandins are given
Can do a membrane sweep – insert finger through the cervix to stretch it and stretch the membrane under the baby
Once the waters have been broken, IV oxytocin can be given

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

When do Braxton Hicks contraction occur

A

Increase toward the end of pregnancy

Thought to be the uterine muscles preparing for labour.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What causes abdominal contraction in labour

A

Strong uterine contraction and pain from the birth canal cause neurogenic reflexes from spinal cord that induce intense abdominal muscle contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Where is oxytocin released from

A

The mother’s and foetus’ posterior pituitary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are the stages of labour

A

1st = Cervical dilation (8-24 hours)
Latent phase is up to 4cm dilated and effaced
Active phase is 4-10cm
Will have contractions

2nd = passage through birth canal, delivery of baby
(few min to 120 mins)

3rd = time between delivery of baby and expulsion of the placenta and membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Where is prolactin released from

A

The anterior pituitary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What effect do progesterone and oestrogen have on breast development and milk production

A

Oestrogen: growth of ductile system
Progesterone: development of lobule-alveolar system

Both inhibit milk production
Sudden drop at birth triggers the milk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Which hormone stimulates milk production

A

Prolactin - it steadily rise from week 5-birth

Oxytocin also has a role

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is colostrum

A

First milk produced which is high in protein and contains lots of immunoglobulins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are the principles of a good screening test

A 
highly sensitive
highly specific 
have a high positive predictive value
easily used in a large population
safe and cheap 
quick and straightforward to perform
able to detect a disease with a known natural history and where early diagnosis has a proven benefit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What examinations are usually carried out at the booking visit

A

Height and weight
BP
CVS exam and abdo exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What investigations are usually done at the booking visit

A

Hb
Blood type and Rhesus (+ other antibodies
Screen for syphilis, HIV, Hep B and C and haemoglobinopathies

Urinalysis; MSSU C and S
US - confirm viability, number of babies, estimate gestational age, look for major structural abnormality
Can measure nuchal thickness to screen for Down’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What checks are usually done at each follow up antenatal appointment

A 
Physical and mental health
Foetal movements
BP and urinalysis
Symphysis- fundal height
Lie and presentation
Engagement of presenting part
Foetal heart auscultation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

How is foetal growth measured

A

Serial measurement of symphysis fundal height - plotted on a customised chart
Carried out at every appointment from 24 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Which supplements should be taken in pregnancy

A

400 micrograms Folic acid pre-conception & first trimester (up to 12 weeks)
10 micrograms Vitamin D through pregnancy and continuation if breast feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Which groups are most at risk of malnutrition in pregnancy

A

Exclusion diets - vegan etc
Underweight /Overweight
Adolescents- improper mobilization of fat storage
Multiple pregnancies- increased risk of depletion
Low income Family
Previous poor pregnancy outcome
Smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Which women need a higher dose of folic acid

A

Obese women (BMI >30)
Diabetics
History of baby with NTD or FH
On anti-epileptics

These women need 5mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is the role of folic acid

A

Folates play a crucial role in many metabolic reactions such as the biosynthesis of DNA and RNA, and amino acid metabolism
In pregnancy it reduces risk of neural tube defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Which women are at risk of developing anaemia in pregnancy

A

Young age at first pregnancy
Repeated pregnancies
Multiple pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the function of iron in pregnancy

A

Involved in numerous enzymatic processes

Plays essential roles in the transfer of oxygen to tissues.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

By how much should a women increase her calorie intake during pregnancy

A

70 kcal/day in the first trimester
260 and 500 kcal/day in the second and third, respectively
Should also increase by 500 for the first 6 months of exclusive breastfeeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are the maternal risks of vitamin D deficiency

A 
Osteomalacia
Pre-eclampsia
Gestational diabetes, 
Caesarean section, 
Bacteria vaginosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What are the foetal risks of vitamin D deficiency

A

SGA,
Neonatal Hypocalcaemia
Asthma/Respiratory Infection
Rickets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What food/drink should pregnant women avoid

A

Unpasteurised cheese, pate, liver, cured meat, raw fish - due to infection risk
Alcohol
Should also reduce caffeine intake,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

How does being underweight affect your fertility

A

It is reduced
2X more likely to take more tan 1 year to become pregnant
Causes hormonal imbalances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What are the risks of being underweight during pregnancy

A

Risk of nutritional depletion
Even higher if they suffer from hyperemesis
Risk of IUGR and low birthweight
Preterm labour more common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Which pathway are obese pregnant women put on

A

Red pathway - high risk pregnancy

Require more monitoring and review

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Which hormones influence the onset of labour

A

Oestrogen makes the uterus contract and promotes prostaglandin production
Oxytocin initiates and sustains contractions and also promotes prostaglandins
Increase in production of foetal cortisol stimulates an increase in maternal estriol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is the purpose of liquor

A

Nurtures and protects foetus and facilitates movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is the normal progress of cervical dilation

A

In the latent phase the duration varies = can take many hours
In active phase it is usually 1-2cm per hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is considered an prolonged second stage of labour

A

In nulliparous women considered prolonged if it exceeds 3 hours if there is regional analgesia, or 2 hours without
In Multiparous women it’s if it exceeds 2 hours with regional analgesia or 1 hour without

71
Q

How long do you leave the third stage of labour before intervening

A

After 1 hour preparation made for removal under GA

72
Q

How can you manage the 3rd stage of labour

A

Watch and wait - spontaneous delivery of placenta, mum may feel like pushing
Active management: use of uterotonic drugs and controlled cord traction is preferred for lowering risk of post partum haemorrhage

73
Q

How do contractions change throughout labour

A

Time between them gets shorter
The length of time they last gets longer
And they get more intense and painful over time

74
Q

What are the 3 factors that are part of labour

A 
Power = contractions 
Passage  = the maternal pelvis 
Passenger = foetus
75
Q

What are the paraments of cervical assessment in labour

A 
Effacement
Dilatation
Firmness 
Position
Level of presenting part or station
76
Q

How should the baby present in the birth canal

A

Head should present first
Should be lying occipito-anterior; head engages occipito-transverse
Head should be flexed

77
Q

How can you determine foetal position in the birth canal

A

Feel for the fontanelles

78
Q

What are the analgesia options for labour

A 
Paracetamol/ Co-codamol       
TENS
Entonox - gas and air 
Diamorphine
Epidural
Remifentanyl
Combined spinal/epidural
79
Q

Describe the cardinal movements of labour

A 
1= Engagement = widest part presents to a level below pelvic inlet 
2= Decent = presenting part passes down through pelvis 
3= Flexion = head flexes passively 
4= Internal Rotation
5= Crowning and extension - neck extends once head is at the vaginal opening 
6= Restitution and external rotation -head adopts optimal position for shoulder
7= Expulsion - anterior shoulder first, then rest if body delivered
80
Q

What is the purpose of delayed cord clamping

A

Allows a higher red blood cell flow to the vital organs

81
Q

What is an episiotomy

A

Incision made during labour to prevent trauma to anal sphincters

82
Q

Is there a benefit to immediate skin to skin contact

A

Yes
It helps calm the baby and aids its transition
Recommended to have 1hr STS after birth

83
Q

What is considered a normal blood loss during labour

A

Volume less than 500mls

84
Q

What is puerperium

A

Period of repair and recovery after labour

Takes about 6 weeks

85
Q

What type of discharge is expected after birth

A

Lochia: Vaginal discharge containing blood, mucus and endometrial castings
Rubra (fresh red) 3-4 days
Serosa (brownish-red, watery) 4-14 days
Alba (yellow) 10-20 days

86
Q

What triggers lactation

A

It is initiated by placental expulsion and a decrease in oestrogen and progesterone
This allows prolactin to exert it effect on the mammary glands (previously blocked by the other hormones)

87
Q

When are US scans carried out in pregnancy

A

Booking/Dating Scan - usually 10-12 weeks

Detailed Scan at 20 weeks to look for structural abnormalities

88
Q

When are abnormalities picked up on US

A

Cardiac (12-20 weeks)
Microcephaly (Usually after 22 weeks)
Short Limbs (Usually after 22 weeks)
Brain malformations

89
Q

How can you test foetal DNA in pregnancy

A

Chorionic Villus Biopsy from placenta between 11-13+6
Amniocentesis at 16+ weeks

Usually PCR based with results in 2-3 days

90
Q

Is there a non-invasive option for pre-natal testing

A

Harmony test
Can take a blood sample and look for baby DNA
Placenta sheds DNA into the mother’s blood so some DNA can be found in the mother’s serum
Not yet available on the NHS

91
Q

What does trisomy 18 cause

A

Edwards Syndrome

92
Q

What are the side effects of using diamorphine in labour

A

Risk of respiratory depression in both mum and baby
Coma, respiratory depression, hallucination and pinpoint pupils in overdose
Arrhythmias and palpitations
Constipation
Confusion and drowsiness

93
Q

What are the side effects of an epidural

A

Low BP
Light-headedness and nausea
Loss of bladder control
Headache (if there is a puncture)
Risk of developing an abscess at the site
High risk of haematoma in those with blood disorder

94
Q

How are contractions recorded on a partogram

A

Recorded as the number per 10 mins and how long they last

95
Q

What is moulding

A

Moulding is where the foetal skull bones overlap one another as the baby passes through – seen in an obstructive labour

96
Q

Which forms of pain relief can be delivered in the midwife unit

A

Up to 2 doses of diamorphine

All others apart from an epidural, spinal or pudendal

97
Q

Can midwives repair vaginal tears

A

A midwife can do it under local anaesthetic if 1st or 2nd

If 3rd or 4th then an obstetrician is needed

98
Q

What typically abnormal heart sounds can be considered normal in pregnancy

A

Ejection systolic murmur
A loud first heart sound
A third heart sound
Ectopic beats.

99
Q

Which ECG changes are considered non-pathological in pregnancy

A

Small Q waves and inverted T waves in lead III
ST depression and T wave inversion inferiorly and laterally
Left shift of the axis

100
Q

What happens to tidal volume in pregnancy

A

Increased by up to 45%

This occurs from the first trimester

101
Q

What happens to respiratory rate in pregnancy

A

It is unchanged

102
Q

Does peak flow (PEFR) change in pregnancy

A

No

So can be used as normal in the assessment of patients with asthma.

103
Q

What happens to functional residual capacity in pregnancy

A

Late in pregnancy this is reduced as a result of diaphragmatic elevation

104
Q

What happens to inspiratory reserve volume in pregnancy

A

Is reduced early in pregnancy as a result of increased tidal volume

Then increases in the third trimester as a result of reduced functional residual capacity

105
Q

How does pregnancy affect ABGs

A

Pregnancy causes relative hyperventilation
Leads to increased PaO2 and reduced PaCO2
Causes a mild, fully compensated respiratory alkalosis.

106
Q

How might LFTs change in pregnancy

A

Liver metabolism increases leading to:
Decreased albumin
Raised ALP = produced by placenta
ALT/AST in the upper limit of normal

107
Q

Gastric motility is reduced in pregnancy - true or false

A

True

Can cause reflux and constipation

108
Q

Urinary tract infection is more common in pregnancy - true or false

A

True

109
Q

List the red flags of a pregnant woman presenting with headache

A

Sudden onset headache/thunderclap or worst headache ever
Headache that takes longer than usual to resolve or persists for more than 48 hours
Has associated symptoms such as fever, seizures, focal neurology, photophobia, diplopia
Excessive use of opioids

110
Q

Which neurological conditions may present/worsen in pregnancy

A

Headaches are common - migraines can get worse
Compression neuropathies including carpal tunnel syndrome occur more frequently
Women with epilepsy may have more seizures due to fear of taking medication and/or drug levels falling due to haemodilution and increased renal clearance

111
Q

What changes to the skin can occur in pregnancy and postpartum period?

A

Hyperpigmentation
Melasma - light brown facial pigmentation
Spider naevi
Palmar erythema
Hair loss - commonly between 4 and 20 weeks postpartum
Pruritis

112
Q

What is Polymorphic eruption of pregnancy

A

A rash of pruritic, urticarial papules and plaques most commonly on abdomen (but sparing umbilicus) and thighs
Occurs in pregnancy usually around 34 weeks
Will rapidly resolve after delivery - doesnt affect baby

113
Q

What is Pemphigoid gestationis

A

Rare skin condition of pregnancy - usually third trimester
Often occurs on abdomen (involving umbilicus), spreading to limbs, palms and soles
Associated with low birthweight, preterm delivery and stillbirth
Neonate can be affected by same eruption, which is mild and transient

114
Q

What is atopic eruption of pregnancy

A

The commonest pregnancy specific dermatosis - mainly occurs in the second or third trimester,
It is associated with atopy. More commonly in multiparous women. I
Patches of intensely itchy papules which become excoriated.
Treatment includes emollients, antihistamines and topical steroids.

115
Q

What causes the hypercoagulable state in pregnancy

A

Increased factors VIII, IX and X and fibrinogen, reduced fibrinolytic activity and a decrease in antithrombin and protein S all contribute

116
Q

Pregnancy is an insulin resistant state - true or false

A

True

Due to increased production of hormones

117
Q

An increase in thyroid hormone production is required in pregnancy to maintain circulating levels - true or false

A

True
50% more thyroid hormone is required
This is due to the effect of oestrogen on TBG and thyroid hormone metabolism by the placenta
Women on levothyroxine may need an increased dose

118
Q

Why might thyroid tests on a pregnant woman show a false hyperthyroidism result

A

βHCG is structurally similar to TSH.
In early pregnancy, the high βHCG levels can result in increased T4 production and TSH suppression
The women will have no symptoms so just monitor them

119
Q

How can pregnancy affect RA

A

Many women find their symptoms improve

However, they will have to stop their DMARDs in pregnancy so flares are common, particualrly post-partum

120
Q

There is an increases risk of an SLE flare during pregnancy - true or false

A

True
It also increases risk of iscarriage, fetal death, pre-eclampsia and preterm delivery. if there is renal involvement or antiphospholipid antibodies

121
Q

Which women get uterine artery doppler scans

A

It is a screening test used for those at high risk of pre-eclampsia
Done around 20 weeks
Abnormal measurements are associated with the subsequent development of pre-eclampsia and/or fetal growth restriction

122
Q

Can pregnant women be given the COVID Vaccine

A

Yes

Should avoid the 1st trimester

123
Q

Which radiological tests are safe to use in pregnancy

A

Chest X-ray
V/Q scan
MRI
CT head

124
Q

What is meant by gravidity

A

Gravidity refers the number of times a women has been pregnant regardless of the outcome

125
Q

What is meant by parity

A

Parity is the number of deliveries after 24 weeks gestation (regardless of outcome).

126
Q

When should an elective section be performed

A

After 39 weeks gestation

This reduced the risks to baby

127
Q

What is considered term for a pregnancy

A

37-42 weeks

128
Q

What is involved in the first stage of labour

A

The first stage of labour is where there is regular contractions with dilation of the cervix to fully dilated

129
Q

What is involved in the second stage of labour

A

The second stage of labour is from fully dilated to delivery of the baby

130
Q

What is involved in the third stage of labour

A

The third stage of labour is from delivery of the baby to delivery of the placenta.

131
Q

At which point does the position/lie of the baby become clinically relevant

A

In labour or at risk of labour, i.e., usually after 36 weeks gestation
Before this it is normal for the fetus to be in varied positions

132
Q

What are the indications for examination of the pregnant abdomen

A

At each antenatal assessment from 24 weeks gestation (to assess growth)
Prior to auscultation of the fetal heart and use of CTG (to work out where to listen)
Prior to vaginal examination
During labour

133
Q

Why should you avoid lying a pregnant woman flat on her back

A

The weight of the baby can cause aortocaval compression
This decreases maternal CO, and may reduce uteroplacental perfusion which may result in fetal acidosis
Should always keep her semi-recumbent

134
Q

How should the symphisis-fundal height correlate to gestation

A

This distance in centimeters should correlate approximately with the
gestational age in weeks(+/- 2cm allowance)

12 weeks gestation –pubic symphysis
20 weeks gestation –umbilicus
36 weeks gestation –the xiphoid process of the sternum

135
Q

What are the 3 main types of foetal lie

A

Longitudinal
Oblique
Transverse

136
Q

How is foetal engagement assessed

A

The fetal head is divided into fifths when assessing engagement

If you are able to feel theentire headin the abdomen, it isfive fifthspalpable(not engaged)

If you arenot able to feel the headat all abdominally, it iszerofifthspalpable(fully engaged)

137
Q

Where should you auscultate the foetal heart beat

A

You should aim to place the doppler between the fetal shoulders on the fetal back

138
Q

Which other examination should always be performed prior to bimanual vaginal examination

A

Abdominal exam

139
Q

At what point in pregancy should a pattern of foetal movement be established

A

By 24 weeks

Before 24 weeks an anterior placenta can reduce the
sensation of fetal movements for women but after 24 weeks the
location of the placenta has no bearing on movements

Reduced movement after 24 weeks should be investigated

140
Q

What is included in the 36 week and above antenatal check

A

Abdominal examination, measure fundal height
plot on customised flow chart, presentation and fetal heart rate
in conjunction with maternal pulse rate, fetal movements, BP,
Urinalysis, symptoms check.

141
Q

What are some risks of early induction of labour

A

Cord prolapse due to artificial rupture of membranes if the fetal
head is not engaged.

Failed induction (i.e. can’t get cervix to dilate, labour to establish)

Potentially a longer labour with increased risk of medical intervention - instrumental

Uterine hyperstimulation, and associated fetal distress and uterine rupture

142
Q

What happens to the placental blood flow during contractions

A

It is reduced temporarily
Therefore O2 exchange is also reduced
The baby has enough reserves to cope with these short periods of hypoxia

143
Q

What is the normal range for foetal HR

A

When first heard (earliest 4 weeks) its around 100bpm
It progressively rises to 140-150 bpm by 8 weeks
It then falls slightly to baseline rate

144
Q

What causes acceleration in the foetal HR

A

Foetal activity and movement

Also responsible for the baseline variability

145
Q

What 3 parameters are used to asses foetal behaviour

A

Foetal heart rate
eye movements
body/limb movements

There are 3 behavioural states

146
Q

What are the potential adverse outcomes of intrapartum foetal hypoxia

A

Perinatal death (stillbirths and neonatal deaths)
Hypoxic ischemic encephalopathy (HIE) - damage to CNS
Cerebral palsy

147
Q

What monitoring is performed on all women in labour (i.e. the minimum)

A

Temperature 4-hourly
Palpate the maternal pulse hourly, or more often if there are any concerns, to differentiate between the maternal and fetal heartbeats
Blood pressure and respiratory rate at least 4-hourly
Frequency and duration of contractions at 30 min intervals
Frequency of bladder emptying and the results of urinalysis if performed
Abdominal palpation findings 4-hourly
Description of vaginal loss and vaginal examination findings 4-hourly

148
Q

How and when is intermittent auscultation performed in labour

A

Foetal heart is auscultated with stethoscope or doppler
Done for low risk pregnancy

In the first stage of labour, IA of the fetal heart should be undertaken after a uterine contraction for at least one minute, at least every fifteen minutes

During the second stage, IA should be performed after a contraction for at least one minute, at least every 5 minutes

149
Q

What type of stethoscope is used to listen to foetal HR

A

A Pinard stethoscope

150
Q

Why do you auscultate after a contraction in intermittent auscultation

A

This allows you to pick up on late decelerations

151
Q

What are the indications for continuous monitoring in labour

A

Abnormal foetal HR (<100 or >160)
Decelerations after contraction that dont improve on position change
Fresh bleeding in labour
Oxytocin for augmentation
Maternal pyrexia 38 °C once or 37.5 °C on two occasions 2 hours apart
Suspected chorioamnionitis or sepsis
Maternal tachycardia of >120
Significant meconium stained liquor and particulate
Confirmed delay in the first or second stage of labour
Contractions that last longer than 60 seconds (hypertonus), or more than 5 contractions in 10 minutes (tachysystole)

152
Q

Why does foetal HR increase in response to hypoxia

A

Hypoxia puts the baby under stress so it releases adrenaline = increased HR
Aims to improve oxygen circulation

153
Q

Should maternal pulse be monitored in labour

A

Yes

You have to be able to differentiate between maternal and foetal HR to ensure accurate monitoring and action

154
Q

What is considered preterm labour

A

It is defined as labour occurring before the commencement of the 37th week of gestation
The earlier they are born the more help babies will need

155
Q

The average time for labour is 10 hours - true or false

A

False

The average is 5.5 hours but there is no ‘normal’ duration of labour

156
Q

Prolonged labour is associated with which adverse outcomes

A 
Increased fetal and maternal morbidity and mortality
Foetal distress 
PPH 
Pelvic floor dysfunction 
Fistulae
157
Q

How quickly should the cervix dilate in labour

A

It is expected that the cervix will dilate: More than or equal to 2cm in 4 hours during labour.

158
Q

Describe the passive second stage of labour

A

Full dilatation of the cervix prior to or in the absence of persistent (occurring with every contraction) involuntary expulsive contractions

159
Q

Describe the active second stage of labour

A

This is when baby is visible
Will have full dilation
Either persistent involuntary expulsive contractions or maternal effort to push baby

160
Q

Describe physiological management of the 3rd stage of labour

A

Uterotonic drugs (oxytocin) are not used

The cord is not clamped until the pulsations have ceased

The placenta is delivered by maternal effort.

161
Q

Describe active management of the 3rd stage of labour

A

Involves use of uterotonic drugs (oxytocin or syntometrine) with the birth of the anterior shoulder or immediately after the birth of the baby and before the cord stops pulsating or is clamped and cut
Bladder catheterisation
Deferred clamping and cutting of the cord
Controlled cord traction after signs of separation of the placenta.

162
Q

What is the purpose of active management of the 3rd stage of labour

A

Shortens the stage

Reduced risk of PPH and need for transfusion

163
Q

List the 4 main signs of placenta and membrane separation

A

The uterus contracts, hardens and rises
Umbilical cord lengthens permanently
There’s a gush of blood variable in amount
Placenta and membranes appears at introitus.

164
Q

What are the indications for active management of the 3rd stage of labour

A

Excessive bleeding or haemorrhage occurs
Failure to deliver the placenta within one hour
The patient desires to shorten the third stage.

165
Q

List the clinical signs of the onset of labour

A

Regular, painful contractions which increase in frequency and duration and that produce progressive cervical dilatation

The passage of blood-stained mucus from the cervix (the ‘show’) is associated with but not on its own an indicator of onset of labour.

Rupture of membranes can be at the onset of labour but this is variable and can occur without uterine contractions.

166
Q

The integrity of the cervix is important to retain the products of conception - true or false

A

True

However, at term it has to soften to allow birth

167
Q

What happens to the cervix towards term

A

It softens and stretches
This is due to a decrease in collagen caused by the increase in enzyme activity.
Progressive uterine contractions cause effacement and dilatation of the cervix - caused by changes in myometrial fibres

168
Q

Generally, parous women have less operative delivery - true or false

A

True

169
Q

When is the booking visit carried out

A

10-12 weeks

This is the first appointment the women gets when she finds out she is pregnant

170
Q

When are pregnant women offered the whooping cough vaccine

A

offered between 28-32 weeks gestation if they are not yet vaccinated

171
Q

List the tests/exams that are carried out routinely in pregancy

A

Offered BP, urinalysis checks and abdominal palpation to check SFH measurement, position and lie of baby, fetal heart auscultation

172
Q

How does the uterus change in the puerperium period

A

The endometrial lining of the uterus rapidly regenerates by day 7
post-partum.
The fundus of the uterus, which usually sits around the umbilical level during
pregnancy, returns to its physiological location within the pelvis by around 2 weeks.
Uterine weight decreases to around 5% of what it was immediately after birth by
the end of puerperium

All termed uterine involution

173
Q

It is normal for pregnant women to have a lower Hb - true or false

A

True
Haemoglobin is decreased by dilution as plasma volume increases
Physiological process
Can lead to anaemia = defined as <110 g/l in the first
trimester

174
Q

What is implantation bleeding

A

Minimal bleeding in early pregnancy - light brown and limited
This occurs in around 20% of pregnancies
Occurs just before the
woman’s period would have been due (roughly 10 days post ovulation)
Should settle as pregnancy continues

Reproduction (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions