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Human Development > Ob&Gyn > Flashcards

Ob&Gyn Flashcards

1
Q

Maternal adaptations to pregnancy- weight

A

Weight gain: 30Ib,
Due to fetus, placenta, amniotic fluid, uterus, blood volume
gain more weight if underweight and less if over weight
most weight gain during third trimester

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2
Q

Maternal adaptations to pregnancy: biochemical

A

Increase in fat soluble components- NEFA, FFA, TAGs, glycerol, cholesterol, Vitamin E

Decrease in water soluble components- aa, glucose, B12, folate, vit A, ions

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3
Q

Maternal adaptations to pregnancy: Cardiovascular

A

Increase HR, SV, CO

Decrease in TPR and BP

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4
Q

Maternal adaptations to pregnancy: Haematological

A

Increase in plasma volume due to activation of RASS
increase RBC synthesis but haematocrit from 40 to 32 falls due to hameodulation anaemia actually haematocrit<32
Increase BPG- offload O2
Increased coagulability- increase in plasma fibrinogen and clotting factors VII, VIII& X, decrease in fibrinolysis

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5
Q

Maternal adaptations to pregnancy: Respiratory

A

Increased Tidal Volume, RR,

ABG- compensated respiratory acidosis- PH 7.4-7.47,pCO2-3.6-4.3 PO2- 13.6-14

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6
Q

Maternal adaptations to pregnancy: Endocrine

Hormones: Oestrogen, Progesterone, HCG, , human Placental Lactogen, Leptin, Placental growth factor

A

Endocrine adaptations: placenta synthesises steroid hormones, neuropeptides, adrenaline NA

Oestrogen- stimulates fatty acid and cholesterol synthesis in liver, CVS adaptations, proliferation of uterus, Labour and parturition- increases gap junctions for coordinated contraction, stimulates cervical softening and ripening, stimulates RASS, weak anti insulin effects

Progesterone- secreted by CL for 8 weeks til taken over by placenta decreases immune system response against fetal Ag, substrate for fetal glucocorticoid and mineralocorticoid production, induces overbreathing increasing tidal volume and RR, labour- progesterone receptors internalise, maintains pregnancy- suppresses uterine contraction, growth of glandular tissue in breasts, secretory phase

HCG- maintains CL for 8 weeks levels peak at 8 weeks and subsequently decline, stimulates TSH receptor hyperthyroidism

Human placental lactogen-
Lipolysis- NEFA
Anti insulin effects- mobilises aa and glucose for placental transport
Angiogenesis- increase blood vessels

Leptin- secreted by placenta syncitio and cytotrophoblasts
placental transport of aa and FA

Placental growth factor- measure of placental function, placental growth angiogenesis increases blood vessels

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7
Q

Maternal adaptations to pregnancy: Renal

A

Increased CO to kidney Increased GFR- decreased plasma urea and creatinine

Increased frequency and urgency urination

Glycosuria- one off normal trace is normal, calciuria

Urinary Stasis and collecting duct dilation- increased UTI

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8
Q

Maternal adaptations to pregnancy: GI

A

Decreased smooth muscle tone, cardiac sphincter tone motility secretion
Biliary stasis
Constipation- increased water and nutrient absorption
Reflux
Hyperemesis gravidarum

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9
Q

Maternal adaptations to pregnancy: Skin

A

increased temperature hair and nail growth, reduced raynauds, nose bleeds, nasal stuffiness snoring

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10
Q

Labour stages

A

Stage 1:
Latent phase- irregular contractions cervical dilation 0-3cm-days
Active phase- regular contractions 3 in 10mins, cervical dilation from 3/4cm-10cm (0.5cm/hr) hrs
Transitional stage- head moves down into brith canal urge to push, change in mood

Stage 2: fully dilated to birth of baby lasts 1-2hrs, deliver head first then anterior shoulder then posterior shoulder then cord

Stage 3: from delivery of baby to delivery of placenta oxytocin important

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11
Q

Physiology of lactation

A

Milk production starts from 16 weeks but only can lactate post partum due to need for Oestrogen and progesterone levels to decrease

Prolactin is maintained til 3-4weeks without suckling

Suckling stimulates mechanoreceptors- stimulates VIP synthesis in PVN and decreases dopamine release- stimulates prolactin release- prolactin binds on to alveolar cells and stimulates lactogenesis

Suckling stimulates mechanoreceptors- synthesis and release of oxytocin from PVN and SON- causes myoepithelial cells surrounding alveolus to contract- forces milk into ductal system- increase in intramammary pressure- ejects from nipple

Lactation can be conditioned to baby’s cries

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12
Q

What is the puerperium?

A

from 3rd stage til 6-8weeks after birth

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13
Q

What are the changes that occur to the uterus during puerperium and the potential pathologies?

A

Uterus- involution- shrinking back
Lochia- vaginal discharge red and bloody to white and yellow completely gone by 6 weeks

Pathologies- PPH- EBL>500mls features of hypovolemic shock- anxious restless irritable confusion coma , tachycardia, tachypnenia, sweaty clammy pale cyanoses skin, rapid weak pulse, low pulse pressure, low BP reduced urine output
primary after birth secondary>24hrs
Causes: 4 Ts- Tone- uterine atony most common cause, Tissue- RPOC- placenta most common secondary cause, Thrombin- coagulopathy, Trauma- tears
Investigations- Vitals, Bloods- FBC, U&E, INR, Group and save, crosmatch, CRP, ESR, lactate, blood cultures monitor urine output
Management- surgery to cauterise bleeding, blood transfusion, fresh frozen plasma or platelet transfusion, remove RPOC

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14
Q

What are the changes that occur to the perineum during puerperium and potential pathologies that can occur?

A

Healing of tears, reduced swelling of vulva, regaining muscle tone, stretch
Pathologies- infection, pain, dyspareunia, urinary incontinence

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15
Q

What are the changes that occur to the abdomen during puerperium and potential pathologies that can occur?

A

healing of C section scar, shrinking back stretch

Pathologies- constipation after birth encourage plenty fluids laxatives, abdominal pain, infection

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16
Q

What are the changes that occur to the breasts during puerperium and potential pathologies that can occur?

A

lactation- first milk is colostrum- full of fat with Ab, breastfeeding

Pathologies- pain, infection, mastitis

17
Q

What are the changes that occur to the mental health during puerperium and potential pathologies that can occur?

A

emotional time range of changes in emotion- adjustment anxious, teary baby blues normal

Pathologies:

Post partum depression- >6 weeks post partum experience any of following for >2 weeks: Anhedonia, Apathy, Low mood, tearfulness, disturbed sleep, tired, unable to bond with baby, thoughts of hurting self or baby, agitated restless withdrawn, lack concentration
Risk factors for PPD- Social- martial difficulties, lack of family support, domestic violence, negative life events, low SES, migration, Psycholgical- Past mental health issues, FHx, substance misuse
Biological- genetics, multiple births, increased parity,pregnancy/ birth complications,age, PMHx
Management- self help strategies- relaxation techniques mindfulness , talking therapies, CBT, medication- SSRIs

PTSD- any birth as birth is a traumatic experience for any woman, symptoms- months after flashbacks, night mares, sweating, negative thoughts palpitations, nausea vomiting headaches when think about it management- CBT, propranolol

Puerperal psychosis- comes in within 1month birth mental health emergency need to be admitted to mum and baby unit reviewed by psychiatry. Symptoms- delusions, hallucinations, thought disorder, thoughts of harming self/ baby more likely to occur again in subsequent pregnancy
Risk factors- previous puerperal psychosis, mum or sister, bipolar, schizophrenia

18
Q

What are the changes that occur to the haematology during puerperium and potential pathologies that can occur?

A

increased risk of infection due to low immunity, increased plasma volume, increased coagulation

Pathologies- thrombosis, anaemia- blood loss, infection

19
Q

Where is best to deliver baby?

A

Nulliparous women- midwife led unit or hospital

Multiparous women- home birth (carries no extra risk) or midwife led unit

High risk- obstetric led unit

20
Q

Pain relief during labour

A

Non Pharmacological:
Breathing exercises, partner support, family and friends, relaxing music, warm water, massage, doula

Pharmacological:
Entonox- gas and air
Epidural- spinal anaesthesia

21
Q

What is pre eclampsia?

A

Pregnancy induced hypertension
Hypertension after 20 weeks
Effects multiple systems

22
Q

Pathophysiology of pre eclampsia

A

Failure of the trophoblast plug to regress and opening up of spiral arteries so spiral arteries remain vasoactive can respond to vasoconstrictors
Resolves 10 days after delivery

23
Q

Risk factors for Preeclampsia

A

High risk: Chronic HTN, HTN, CKD, Autoimmune- SLE, APS, Preeclampsia in 2 or more previous pregnancies, Preeclampsia<34 weeks

Moderate risk: Age>=40, BMI>=35, Nulliparous, Multiple pregnancy, Pregnancy Interval>10yrs, FHx

In need of Aspirin 75mg from 12 weeks- 1 high risk or 2 moderate risk factors

24
Q

Clinical presentation of pre eclampsia

A 
Headache, 
Oedema- facial swelling, papilloedema
Epigastric pain 
Visual disturbances- Blurred vision 
Proteinuria 
HTN
N&V
25
Q

Investigations

A 
BP at all antenatal appointments
Urine dip
Bloods- FBC, U&E, LFTs 
PGF- screening tool 
Umbilical artery Doppler
26
Q

Diagnostic criteria for Preeclampsia

A

BP>=160/110 severe
BP>=140/90 with proteinuria or one of: Epigastric pain, oedema, blurred vision, ALP>70, liver tenderness, clonus- tremor

HELLP syndrome- Haemolysis, Elevated Liver enzymes, Low Platelets

27
Q

Management of Preeclampsia

A

Admit if BP rises by >30/20 or if BP>160/110 or 140/90 with proteinuria

Labetalol/ nifedipine/ methyldopa (change after delivery as SE postnatal depression)

Severe PET- MgSO4 prophylaxis prevent eclampsia

Definitive management- Delivery but can get post partum pre eclampsia within 72hrs

28
Q

What is eclampsia and it’s management?

A

Pre eclampsia that has progressed to seizures

Management:
IV MgSO4 SE: Resp depression so stop if RR<14 or loss of tendon reflexes or urine output <20ml/hr
Reverse toxicity with Ca gluconate

If seizures still continue- diazepam, ventilate and consider other causes

Avoid discharge < 5days post partum

29
Q

Puerperal sepsis

A

Infection
Clinical presentation- Fever, chills rigors, offensive vaginal discharge, abdominal pain, N&V, diarrhoea, rash, wound infection

Risk factors- obesity, C section, cervical cerclage, immunosuppressed, prolonged SROM, vaginal trauma, RPOC

Investigations- O2 saturations, ABG, bloods- blood cultures, lactate, FBC, U&E, LFT, CRP, ESR,
Monitor Urine output, urine dip

Management: IV Abx, IV fluids, O2 maintain sats>94%

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