Part 9 Flashcards
management of HIV in pregnancy
HAART during pregnancy
4 weeks Post Exposure Prophylaxis for neonate (Truvada and raltegravir)
Exclusive formula feeding
Vaginal delivery if viral load undetected (<50)
C-section if viral load detected
Target site of HIV
CD4 –> MHC2 –> adaptive immune response
<200 = opportunistic infection
What is the maternal part of the foetus called?
Decidua basalis (chorion is the foetal part)
Why does BP decrease in pregnancy
Progesterone = vasodilator
Addition of placenta = low resistance circuit
Why are pregnant ladies prone to UTIs?
Urinary stasis resulting from enlarged uterus pressure on ureters.
What is Pre-eclampsia?
pregnancy induced hypertension (>20 weeks) and proteinuria.
Kidney function declines –> (salt + water retention) oedema
Highest risk = previous pre-eclampsia
Deliver baby at term (37 weeks!!)
What increases and decreases uterine contraction?
Oestrogen + oxytocin (posterior pituitary)
Progesterone decreases it
the cutoff for mammography over US is…
> 35 = mammography
50 yo patient with spontaneous, unilateral, blood stained nipple discharge think…
malignancy or papilloma (if benign)
What is Korsakoff syndrome?
Anterograde amnesia
retrograde amnesia
-due to thiamine (B1) deficiency
can happen secondary to wernicke’s (ataxia, ophthalmoplegia + confusion)
Management of placental abruption
Stabilise Mother - prevent Shock + anaemia [fluid + Blood transfusion] prevent DIC [FFP]
Assess CTG: Stable Foetus - vaginal delivery or conservative (<34 weeks);
Unstable foetus - Urgent C-Section (irrespective of gestational age)
Management of placental praevia
Acute Bleed then use US to determine foetal lie (DONT do digital examination!!! may increase bleed) > stabilise patient > C section if no stabilisation or foetal compromise
ALSO
C/section : If placenta covers os or <2cm from cervical os
Vaginal delivery if placenta>2cm from os and no malpresentation
Management of PPH (70% = atonic; trauma, tissue, thrombin = other causes)
Severe = >1500ml Mild = <500ml
uterine (fundal) massage, IV synctocinon (oxytocin)
Tranexamic acid
Packs + balloons OR Suturing, Hysterectomy
What should be suspected in secondary PPH (>24hrs)?
Infection, Products of conception (do US)
Parameters of HT in pregnancy
> 140/90 on 2 occasions; diastolic >110 on 1 occasion
Pathogenesis of Pre-eclampsia + complications
Abnormal placentation and failure of trophoblast invasion cause spiral arteries to stay as high resistance/low flow vessels, leading to placental ischaemia -> endothelial damage and thrombosis.
eclampsia, pulmonary oedema, stroke, foetal damage (IUGR, placental abruption, still birth).
Pre-eclampsia can increase risk of what…
HELLP Syndrome
Haemolysis; Elevated Liver enzymes; Low Platelets. Liver and blood clotting disorder.
Parkinsonism with orthostatic hypotension + poor response to levodopa
Multiple System Atrophy
imaging for vascular dementia
SPECT Scan (shows vascular insults not seen with MRI or CT)
imaging for fronto-temporal dementia
MRI
What should you tell pregnant women not to eat?
soft cheese
Listeria
A stroke where can cause full paralysis except blinking + eye movement?
Basilar artery
pain is carried from where at the pelvic organs in contact with the perineum (e.g uterus, ovaries and uterine tubes)
visceral afferents alongside sympathetic fibres to T11-L2
How is pain carried from structures below the levator ani (inferior vagina, perineal muscles and skin)?
Pain is carried in somatic sensory fibres in the pudendal nerve to S2-4
Where is pain carried in the the pelvic organs deep in the pelvis (cervix and superior vagina)?
Pain is carried in visceral afferents which run alongside parasympathetics to S2-4
