Obstetrics Flashcards
Approximately how much does vascular volume increase by in pregnancy?
1.5L
By how much does CO increase in pregnancy?
40%
Why is there an increased risk of shock in pregnancy?
Due to having increased physiological parameters mothers can hide shock symptoms much better initially
What blood pressure is important to look at in antenatal notes?
Booking B.P.
How much does heart rate increase by in pregnancy?
Approx 20%
Which type of cell increases in number more than the other in pregnancy WBCs or RBCs?
WBCs
What 3 changes result in obs patients becoming hypercoagulative?
- An increase in clotting factors
- Decreased coagulation inhibitor levels
- Decreased fibrinolytic factors
What 2 main vessels can be compressed by the uterus in pregnancy?
Inferior Vena Cava
Aorta
What action does progesterone have on the GI tract?
It reduces gut motility
By how much can the diaphragm be displaced in pregnancy?
5cm
Why is it important to place an ET tube in a maternal arrest?
The increased risk of acid reflux
What is the process whereby the uterus drops in late pregnancy giving the mother relief when breathing?
Lightening
How do pregnant women allow for increased oxygen demand?
- An increase in tidal volume
- Deeper breaths
NO RR CHANGE
How do we stop the aorta and IVC being compressed?
Left Lateral Tilt
Manual Uterine Displacement
Due to reduced sensitivity of chemoreceptors and increased oxygen uptake what happens to PCO2? What are the risks?
PCO2 falls
This can result in respiratory alkalosis
The pooling of sugar rich urine and relaxed ureters leads to increased risk of what?
UTI’s
The significant RAA system activation and increased ERPF and GRF leads to what change in total body water?
Total body water changes from about 6.5L-8.5L
What condition is characterised by hypertension and protein urea?
Preeclampsia
Why can mothers have decreased levels of iodine?
Iodine is needed for foetal brain development
What can hypercortisolism play a part in the development of?
Gestational diabetes
What do oestrogen and relaxin do during pregnancy? What can that result in?
Soften pelvic connective tissue leading to aches and pains
What happens to levels of oestrogen and progesterone over pregnancy?
They increase progressively and drop off at full term
What hormone causes beta cell hyperplasia in pregnancy?
Oestrogen
List some risk factors for maternal diabetes?
- Obesity
- Age
- Hx of diabetes
- Sedentary lifestyle
- PCOS
What occurs to cause gestational diabetes?
Insulin resistance
Why do protein and fat levels fluctuate in pregnant women
Because fat and protein are vital for foetal development
Why do babies need so much fat?
Because they have not developed the ability to shiver yet so need it for insulation
Why do pregnant mothers need to absorb more calcium?
For foetal bone development and to help undo the damage caused by calcium being broken down from their own bones to help foetal development
In what range of weeks does labour usually occur within?
37 - 42 weeks
What hormone has inhibited labour throughout pregnancy?
Progesterone
What reduces uterine activity (why we need to keep mothers calm in labour)
Adrenaline
How many stages are there to labour?
3
What are the two aspects of mechanical ‘pressure’ that initiate the onset of labour?
- Uterine stretch
2. Pressure on the cervix
What occurs in stage 1 of labour?
Onset of rhythmical contractions until full cervical dilation (10cm)
What is the ‘normal’ presentation of the foetus during labour?
Vertex
What does the muscular shortening and narrowing of the uterus lead to?
Expulsion uterine contractions
What is crowning defined as?
When the foetal head distend soon the vulva and does not recede between contractions
Where should the babies head be facing initially during a normal labour?
The perineum
What is restitution?
When babies head turns towards a either thigh, anterior shoulder under pubic bone
What shoulder should be delivered first?
Anterior shoulder
What is the term for when the baby is born ‘bending’ at the side?
Lateral flexion
What is involved in stage 3 of labour?
Delivery of the placenta
What are indications of placental separation?
Contractions - fungus narrowing and rising
Lengthening of umbilical cord
Trickling of blood
Why do you want to avoid mum pushing very hard when she is crowing?
To avoid perineal trauma
What 4 things are essential in your assessment of a newborn
Colour
Tone
Breathing
Heart Rate
If you have to clamp the cord when can you do this?
After it has stopped pulsing
What are the 2 types of antepartum haemorrhage? >24 weeks
- Placenta praevia
- Placental abruption
What are the causes (4T’s) of PPH
- Tone (uterine atony - most common cause)
- Tissue
- Thrombin
- Trauma
Under what number of weeks is a baby defined as ‘pre - term’
<37 weeks
What 4 things make up your immediate assessment of a newborn?
Colour
Tone
Breathing
Heart Rate
What is placenta praevia?
It is when the placenta develops low down in the uterus partially or completely covering the cervix
What is placental abruption?
When bleeding occurs between the placenta and wall of the uterus due to a detachment of the placenta
What are the two kinds of placental abruption?
- Concealed
- Revealed
What are two possible diagnoses for bleeding in early pregnancy? <24 weeks
Ectopic pregnancy
Miscarriage
What is the flow of actions in newborn life support?
- Assess (C.T.B.HR)
- 5 INFLATION breaths
- Assess (C.T.B.HR)
- Ventilate 30 seconds
- Assess (C.T.B.HR)
- CPR (3:1)
- Assess HR every 30 seconds
Under what HR value in a newborn is it necessary to start resuscitation?
<60/min
What can be done to treat a PPH?
Uterine rub Misoprostol (Sublingual or PR) TXA Fluids Direct pressure Bi-Manual compression
Between what weeks is the ‘first trimester’?
1-12
Between what weeks is the ‘second trimester’?
13-26
Between what weeks is the ‘third trimester’?
27-end of pregnancy (37-42)
What two main things can cause a placental abruption?
Hypertension (preclampsia)
Trauma
