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Normal pregnancy Flashcards

1
Q

Which hormone balance is suitable for implantation

A

High progesterone:oestrogen

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2
Q

What does fertilisation form

A

Zygote which undergoes mitosis for 3 days to form blastocyst

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3
Q

What does blastocyst consist of

A

Embryoblast- Foetal parts
Trophoblasts which form outer layer

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4
Q

What cells produce HcG

A

Trophoblasts

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5
Q

What is purpose of HcG

A

HCG from trophoblasts signal to corpus luteum to keep producing oestrogen and progesterone which suppress other follicles from maturing

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6
Q

How does producer of HCG change across pregnancy

A

In first trimester is trophoblasts
At end of first trimester switches to synctiotrophoblasts in placenta

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7
Q

What is main hormone producing cell of placenta

A

Synctiotrophoblsts

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8
Q

What do synctiotrophoblast cells produce

A

Oestrogen and progesterone
Low levels of HCG
Human plasma lactogen

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9
Q

What is role of human plasma lactogen

A

Blocks actions of insulin to increase amount of glucose available to fetus

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10
Q

What changes happen to CVS during pregnancy

A

Fluid volume increases by 30-50%
Is increase in RBC but does not match rise in fluid volume so anaemia
Increase in HR of 20 which can lead to transient hypertrophy
Drop in BP as progesterone dilates vessels
Uterus can block venous outflow from legs causing varicose veins

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11
Q

What is problem when lying down in pregnanct

A

Uterus can compress IVC which leads to hypotension
Solved by lying on side with pillow

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12
Q

What is significance of S3 in pregnancy

A

Normal physiology as get hypertrophy of ventricles secondary to HR

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13
Q

What changes happen to kidney during pregnancy

A

Increase in blood flow from large volume so increased GFR and urine output
Increase in size and get a pseudohydronephrosis and hydroutereters

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14
Q

Why are pregnant women more susceptible to UTIs

A

Progesterone reduces ureters motility

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15
Q

What changes happen to lungs in pregnancy

A

Harder to breathe as compression of diaphragm

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16
Q

What changes happen to nose in pregnancy

A

Increased nosebleeds
Increased congestion

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17
Q

What happens to gait in pregnancy

A

Can get a waddling gait as relaxation of ligmanets in the pelvic area

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18
Q

What changes happen to gut in pregnancy

A

Reduced peristalsis leading to constipation and bloating
Increased likelihood of GORD
Change in taste preferences
Pica

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19
Q

What is pica

A

Desire for non-food items like ice and mud etc

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20
Q

What are mental changes in pregnancy

A

Anxiety
Depression
Insomnia
Poor concentration

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21
Q

What changes happen to breasts in pregnancy

A

Readying for lactation
- fullness
- tenderness
- tingling

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22
Q

What skin changes happen in pregnancy

A

Increase in MSH production from APG
- darkening of areola
- linea nigra which is darkening of linea alba a fibrotic band down the umbilical line

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23
Q

What happens to thyroid function in pregnancy

A

Increased

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24
Q

Blood changes in pregnancy

A

Increased fibrinogen
Reduced antithrombin
Lower platelets
Increase in factor 7, 10,12
OVERALL A PROTHROMBOTIC STATE TO REDUCE PPH

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25
What PROM
Prelabour rupture of membranes
26
When can amniotic sac rupture
Before contractions or at end of stage 1
27
What is defined as labour
Regular and painful contractions that dilate and efface the cervix
28
What are parts to stage 1 of labour
Latent - cervical dilation up to 4cm - effacement up to 30% - contractions every 5-30 mins which last 30s Established - intense contractions every few minutes lasting 60s-90s - dilation up to 10 cm - full effacement
29
How to remember cardinal movements of baby
DFIER Descent into engaged position Flexion of neck as reach pelvic brom Internal rotation of shoulders Extension of neck out Restitution where head externally rotates
30
How does station scale work
-5 is superior 0 is at level of ischial spines 5 is below cervix
31
What heart sounds are normal in pregnancy
ESM Third heart sound Soft pansystolic murmur
32
After 24 weeks how much should SFH grow by
1cm/week
33
How to differentiate between gestational thrombocytopenia and ITP
ITP- occurs in first trimester Gestation thrombocytopenia- third trimester ITP- severe drop Gestational thrombocytopenia- typically only a drop of 10%
34
Management of ITP in pregnancy
Steroids If severe or unresponsive to steroids use IVIG
35
What causes pelvic girdle pain
Excessive movement of pubic symphysis
36
Presentation of pelvic girdle pain
Pain and tenderness over pubic symphysis which can spread to back and thighs Worse on walking up stairs Can hear clicking sound
37
Management of pelvic girdle pain
Analgesia and physio
38
Analgesia ladder in pregnancy
Paracetamol Low dose codeine 2nd line if really needed
39
What are dizygotic versus monozygotic twins
Dizygotic- 2 separate eggs fertilised as hyperovulation occurs Monozygotic- identical twins from zygote splitting in 2
40
Rfx for fraternal (dizygotic) twins
Related to high FSH - taller and heavier - less frequent menstrual cycles - older
41
What are the 2 parts to trophoblasts
Cytotrophoblast Syncytiotrophoblasts
42
What determines what chorionicity and amnionicity identical twins are
Day of zygote splitting as there are different stages to trophoblast development Before 4 days post fertilisation- dichorionic, diamniotic 4-8 post fertilisation- monochorionic, diamniotic 8-12- monochorionic, monoamniotic
43
What does lambda sign show
Dichorionic diamniotic twins
44
What does T sign show
Monochorionic diamniotic twins
45
How often are dichorionic diamnotic twins scanned
Every 4 weeks from 20 weeks
46
How often are monochorionic diamniotic twins scanned
Every 2 weeks from 16 weeks
47
How are monochorionic monoamniotic twins managed
At tertiary centre from consultant
48
Management of feto-foetal transfusion syndrome
Refer to feotal meicine for ablation of interconnecting vessels
49
When is feto-foetal transfusion syndrome diagnosed
1 amniotic sac has DVP (deepest vertical pocket) less than 2 cm and amniotic sac has depth of over 8 cm pre 20 weeks and over 8 cm post 20 weeks
50
Delivery complications of twins
PPH risk Malpresentation Cord prolapse
51
Antenatal complications of twins
Polyhydramnios Anaemia Gestation HTN Antepartum haemorrhage
52
Foetal complications of twins
IUGR Prematurity Malformation
53
When should uncomplicated dichorionc diamniotic twins be delivered and how
Either C-section or vaginal safe provided first baby is cephalic 37 weeks
54
When should uncomplicated monochorionic diamniotic twins be delivered and how
Either C-section or vaginal safe provided first baby is cephalic 36 weeks
55
When should monochorionc monoamniotic twins be delivered and how
C-section 32-33+6 weeks
56
What causes pansystolic murmur in pregnancy
Dilation of tricuspid valve
57
How does pruritic urticarial papules and plaques of pregnancy present
Itchy rash starting on stretch marks and spreading anywhere with umbilical sparing
58
When does pruritic urticarial papules and plaques of pregnancy start
Very end of pregnancy and will clear after delivery
59
How does pemphigoid gestationis present
Itchy rash which starts in the umbilicus that can develop into blisters
60
How does prurigo gestationis present
Rash of the trunk and arms with abdominal sparing
61
How does impetigo herpetiformis present
Blistering skin condition with cocontaminat febrile illness
62
What happens if with monozygotic twins, the zygote splits after day 13
Conjoined twins
63
Which conditions reduce in severity over pregnancy
MS and rheumatoid arthritis
64
What needs to be done to AEDs during pregnancy
Increase the dose
65
Which foods should be avoided in pregnancy
Liver Unpasteurised cheese

Obs (9 decks)

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