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Obs (Owen) > Normal pregnancy > Flashcards

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
Q

What PROM

A

Prelabour rupture of membranes

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26
Q

When can amniotic sac rupture

A

Before contractions or at end of stage 1

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27
Q

What is defined as labour

A

Regular and painful contractions that dilate and efface the cervix

28
Q

What are parts to stage 1 of labour

A

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
Q

How to remember cardinal movements of baby

A

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
Q

How does station scale work

A

-5 is superior
0 is at level of ischial spines
5 is below cervix

31
Q

What heart sounds are normal in pregnancy

A

ESM
Third heart sound
Soft pansystolic murmur

32
Q

After 24 weeks how much should SFH grow by

A

1cm/week

33
Q

How to differentiate between gestational thrombocytopenia and ITP

A

ITP- occurs in first trimester
Gestation thrombocytopenia- third trimester

ITP- severe drop
Gestational thrombocytopenia- typically only a drop of 10%

34
Q

Management of ITP in pregnancy

A

Steroids
If severe or unresponsive to steroids use IVIG

35
Q

What causes pelvic girdle pain

A

Excessive movement of pubic symphysis

36
Q

Presentation of pelvic girdle pain

A

Pain and tenderness over pubic symphysis which can spread to back and thighs
Worse on walking up stairs
Can hear clicking sound

37
Q

Management of pelvic girdle pain

A

Analgesia and physio

38
Q

Analgesia ladder in pregnancy

A

Paracetamol
Low dose codeine 2nd line if really needed

39
Q

What are dizygotic versus monozygotic twins

A

Dizygotic- 2 separate eggs fertilised as hyperovulation occurs
Monozygotic- identical twins from zygote splitting in 2

40
Q

Rfx for fraternal (dizygotic) twins

A

Related to high FSH
- taller and heavier
- less frequent menstrual cycles
- older

41
Q

What are the 2 parts to trophoblasts

A

Cytotrophoblast
Syncytiotrophoblasts

42
Q

What determines what chorionicity and amnionicity identical twins are

A

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
Q

What does lambda sign show

A

Dichorionic diamniotic twins

44
Q

What does T sign show

A

Monochorionic diamniotic twins

45
Q

How often are dichorionic diamnotic twins scanned

A

Every 4 weeks from 20 weeks

46
Q

How often are monochorionic diamniotic twins scanned

A

Every 2 weeks from 16 weeks

47
Q

How are monochorionic monoamniotic twins managed

A

At tertiary centre from consultant

48
Q

Management of feto-foetal transfusion syndrome

A

Refer to feotal meicine for ablation of interconnecting vessels

49
Q

When is feto-foetal transfusion syndrome diagnosed

A

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
Q

Delivery complications of twins

A

PPH risk
Malpresentation
Cord prolapse

51
Q

Antenatal complications of twins

A

Polyhydramnios
Anaemia
Gestation HTN
Antepartum haemorrhage

52
Q

Foetal complications of twins

A

IUGR
Prematurity
Malformation

53
Q

When should uncomplicated dichorionc diamniotic twins be delivered and how

A

Either C-section or vaginal safe provided first baby is cephalic
37 weeks

54
Q

When should uncomplicated monochorionic diamniotic twins be delivered and how

A

Either C-section or vaginal safe provided first baby is cephalic
36 weeks

55
Q

When should monochorionc monoamniotic twins be delivered and how

A

C-section
32-33+6 weeks

56
Q

What causes pansystolic murmur in pregnancy

A

Dilation of tricuspid valve

57
Q

How does pruritic urticarial papules and plaques of pregnancy present

A

Itchy rash starting on stretch marks and spreading anywhere with umbilical sparing

58
Q

When does pruritic urticarial papules and plaques of pregnancy start

A

Very end of pregnancy and will clear after delivery

59
Q

How does pemphigoid gestationis present

A

Itchy rash which starts in the umbilicus that can develop into blisters

60
Q

How does prurigo gestationis present

A

Rash of the trunk and arms with abdominal sparing

61
Q

How does impetigo herpetiformis present

A

Blistering skin condition with cocontaminat febrile illness

62
Q

What happens if with monozygotic twins, the zygote splits after day 13

A

Conjoined twins

63
Q

Which conditions reduce in severity over pregnancy

A

MS and rheumatoid arthritis

64
Q

What needs to be done to AEDs during pregnancy

A

Increase the dose

65
Q

Which foods should be avoided in pregnancy

A

Liver
Unpasteurised cheese

Obs (Owen) (9 decks)

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