obstetrics Flashcards
gravidity
Number of times a woman has been pregnant regardless of outcome
parity
Number of times a woman has given birth to a foetus (gestational age >/=24 weeks) regardless of whether the child was born alive or was stillborn
estimating gestation
Naegele’s rule: to the first day of the LMP add 1 year, subtract 3 months, add 7 days)
crown-rump length(CRL): measured by ultrasoundscan between 10+0 and 13+6
CV changes in pregnancy
SV up 30%, HR up 15% & cardiac output up 40%
systolic BP is unaltered
diastolic BP is reduced in the 1st and 2nd trimester, returning to non-pregnant levels by term
enlarged uterus may interfere with venous return which can lead to ankle oedema, supine hypotension and varicose veins
resp changes in pregnancy
Pulmonary ventilation up by 40%, tidal volume from 500 - 700ml (due to effect of progesterone on respiratory centre)
Oxygen requirements increase by only 20%, therefore over breathing leads to a fall in pCO2 - this can give rise to a sense of dyspnoea that may be accentuated by elevation of the diaphragm
BMR up 15% - this may be due to increased thyroxine and adrenocortical hormones - women may hence find warm conditions uncomfortable
haem changes in pregnancy
Maternal blood volume up 30%, mostly in 2nd half
red cells up 20% but plasma up 50% → Hb falls
Low grade increase in coagulant activity
rise in fibrinogen and Factors VII, VIII, X
fibrinolytic activity is decreased - returns to normal after delivery (placental suppression?)
prepares the mother for placental delivery
leads to increased risk of thromboembolism
Platelet count falls
WCC & ESR rise
urinary system changes in pregnancy
blood flow increases by 30%
GFR increases by 30-60%
salt and water reabsorption is increased by elevated sex steroid levels
urinary protein losses increase
trace glycosuria is common due to the increased GFR and reduction in tubular reabsorption of filtered glucose
biochem changes in pregnancy
calcium requirements increase during pregnancy
especially during 3rd trimester + continues into lactation
calcium is transported actively across the placenta
serum levels of calcium and phosphate actually fall (with fall in protein)
ionised levels of calcium remain stable
Gut absorption of calcium increases substantially - due to increased 1,25 dihydroxy vitamin D
liver changes in pregnancy
Unlike renal and uterine blood flow, hepatic blood flow doesn’t change
ALP raised 50%
Albumin levels fall
uterus development in pregnancy
100g → 1100g
hyperplasia → hypertrophy later
increase in cervical ectropion & discharge
Braxton-Hicks: non-painful ‘practice contractions’ late in pregnancy (>30 wks)
retroversion may lead to retention (12-16 wks), usually self corrects
baby blues features
typically seen 3-7 days following birth and is more common in primips, Mothers are characteristically anxious, tearful and irritable
baby blues mx
Reassurance and support, the health visitor has a key role
postnatal depression features
Most cases start within a month and typically peaks at 3 months, Features are similar to depression seen in other circumstances
mx postnatal depression
As with the baby blues reassurance and support are important. Cognitive behavioural therapy may be beneficial. Certain SSRIs such as sertraline and paroxetine may be used if symptoms are severe
puerperal psychosis features
Onset usually within the first 2-3 weeks following birth. Features include severe swings in mood (similar to bipolar disorder) and disordered perception (e.g. auditory hallucinations)
mx puerperal psychosis
Admission to hospital is usually required, ideally in a Mother & Baby Unit
screening for postnatal depression
The Edinburgh Postnatal Depression Scale
10-item questionnaire, with a maximum score of 30
indicates how the mother has felt over the previous week
score > 13 indicates a ‘depressive illness of varying severity’
sensitivity and specificity > 90%
includes a question about self-harm
when is the booking apointment
<10w
what happens at the booking appoitnment
education, lifestyle, nutrition
BMI
BP
urine dip
FBC
blood groupo
antibodies and rhesus D
screenin for thalassaemia and sickle cell
offer screenin for HIV, hepB, syphilis
what happens at 11-14w appointment
USS: gestational age, multiple pregnancy
offer anaomaly screening
what happens at the 18-20w appointment
USS: anomalies, placental location
24w scan
measure symothysis-fundal height
monitor hoetal movements
when is the ogtt
24-28w
28w appointment
give rhesus negative anti d
recheck fbc, blood group and antibody levels
discuss birth plans