Paediatrics - Pregnancy and Perinatal Health Flashcards
What are fertility issues linked to
age smoking BMI exercise drugs folate alcohol
What does low levels of folic acid put an unborn child at risk of
spina bifida
Describe the stages of early pregnancy
ovulation happens and then fertilization happens while the oocyte is in the fallopian tube
the embryo/zygote spends first week of life transitioning own the fallopian tube before implanting onto the uterus at approximately day 8 or 9
lots of development has taken place by this stage
once the embryo has implanted there are development changes and beginning of maturity
What are the 3 trimesters
first is 12 weeks
second is 12-28 weeks
third is 28-40 weeks
What are the changes that occur across the diff trimesters
1st - structures of embryos forming and differentiating
2nd - more specialization and further differentiation
3rd - all that happens is growth and changes necessary for successful birth
What are the maternal changes in pregnancy
physical changes hormonal changes hematological changes CV changes coagulation changes
What are the hematological changes
large blood volume produced to protect from death from blood loss at birth
What are the hormonal changes in pregnancy
increased estrogen and progestogen
What does the increased estrogen and progestogen do
act on kidney to increase renin secretion
increased salt and water retention
increased plasma volume by 45%
Why does plasma volume increase
protects against hemorrhage at birth
dilution effect makes Hb fall from 15-12g/dL
How do hormonal changes cause diabetes
reduce insulin sensitivity
Why does the lower esophageal sphincter relax
increase abdominal pressure gives increased GORD
What are the hematological changes in pregnancy
increased production of RC< WC, platelets
20% increase in RC mass
increased platelet consumption makes platelets normal to low
What is the issue with increased WC in pregnancy
increased WC makes diagnosing infection difficult
What are the CV changes
relaxation of vascular smooth muscle
vascular compression by uterus
What is the effect of relaxation of vascular smooth muscle
reduced peripheral resistance
reduced systolic and diastolic BP
compensatory increase in HR by 25%
What is the effect of vascular compression by the uterus
compresses vena cava and aorta
results in difficult with venous return when supine so ensure there is a pillow under one side or sit slightly to the side so no pressure on vessels
What are the coagulation changes in pregnancy
clotting factors production increases
fibrinolysis increases
increased system sensitivity with increased DVT risk
What should pregnant women not eat
raw/slightly cooked meat and raw fish raw eggs non pasteurized milk and milk cheeze spicy grilled and fried food marlin, tuna and shark liver and other entrals and internal organs of a slaughtered animal during the first 3 months
Why should they avoid raw /slightly cooked meat and raw fish
danger of infection with toxoplasmosis
Why should they avoid raw eggs
salmonella
Why should they avoid non pasteurized milk and milk cheese
listeria
Why should they avoid spicy, grilled and fried food
dyspesia and GORD
Why should they avoid tuna etc
mercury
What does development start
at 4 weeks
zygote becomes embryo
What happens in week 6
start of embryonic circulation
weeks 6-10 embryonic development and growth
When do embryo stages stop
week 10
it is a fetus from 10-14 weeks
features and limbs become developed and active
When is miscarriage rate highest
first trimester
From week 14-18 what happens
hair, nails, toenails and eyelids start to form and movement may be felt
What happens weeks 18-20
toes and fingers formed and hearing starts to respond
What happens weeks 20-26
final development of vision and senses
brain development and body fat increase
What are foetal changes from week 27
growth and NS maturation
What is placenta
interlinking mesh of VS so maternal and fetal circulation do not mix but are in close proximity and nutrients can diffuse
some infections and toxins can diffuse through fetus
What are the stages of labour
induction
first stage
second stage
third stage
What is looked at in screening pregnancy in first trimester
establish dates of pregnancy
determine the number of fetuses and identify placental structures
to diagnose an ectopic pregnancy or miscarriage
to examine the uterus and the other pelvis anatomy
in some cases to detect foetal abnormalities
What are the mothers screened for
chronic diseases
infectious disease
What are the fetus screened for
genetic and developmental abnormalities
What are chronic diseases that are screened for
hypertension
diabetes
What are infections that are screened for
rubella
syphilis
hep C
HIV
What is screen for at weeks 18-20
confirm pregnancy dates
determine number of fetuses and examine placental structures
assist in prenatal tests such as amniocentesis
examine the foveal anatomy for presence of abnormalities
to check the amount of amniotic fluid
examine blood flow patterns
to observe foetal behavior and activity
to examine the placenta
to measure the length of the cervix
to monitor foetal growth
Whta is FAST
foetal abnormalitiy screening programme
What is screen for in FAST in see 1
neucheal translucency (ultrasound) maternal hCG (blood) PAPP-P blood
looking for chromosome abnormality from combined result
What do we test in the fetus in second trimester
alpha foetus protein
What is the abnormality follow up after AFP
CVS and amniocentesis - genetic changes
ultra sound - spina bifida
What are the birth testing
physical exam
hearing test
blood spot
Whats tested in bloods put
PKU hypothyroidism CF sickle cell mCADD
What does the APGAR score consist of
activity pulse grimace appearance respiration rate done at 1 min and 5 min
What does activity look at
muscle tone
What should pulse be
> 100/min
What does grimace test
reflex irritability
What does appearance look at
colour
What are considerations of pregnancy in dentistry
cost of dental care drugs in pregnancy pregnancy gingivitis periodontal health in pregnancy position of mother
Why is pregnancy gingivitis a thing
hormone levels change
immune response heightened to plaque
