passmed q's w/c25/12/23 Flashcards
pregnancy physiological changes
respiratory system?
pulmonary ventilation : UP 40%
TV 500ml-700ml
oxygen requirements increase by 20%
pregnancy physiological changes
Cardiovascular
what effect does the enlarged uterus have
SV up 30%
HR up 15
CO 40%
enlarged uterus =
venous return> ankle oedema>supine hypotension and varicose veins
maternal blood volume up 20%
what constitutes this?
RBC by 20%
plasma up 50% so HB fall
blood - effects of pregnancy
rise in fibrinogen and factors 7,8,10
placental suppresion of fibrinolytic activity
platelets fall
WCC and ESR rise
urinary system - pregnancy related changes
blood flow?
increases - 30%
GFR- 30/60%
reduced urea, reduced creatinine, increase urinary protein loss
Proteinuria in normal pregnancy
GFR increases by 50%
renal plasma flow increases by 80%
increased perfusion to the kidneys in pregnancy
instrumental delivery requirements?
Fully dilated cervix generally the second stage of labour must have been reached
OA position preferably OP delivery is possible with Keillands forceps and ventouse. The position of the head must be known as incorrect placement of forceps or ventouse could lead to maternal or fetal trauma and failure
Ruptured Membranes
Cephalic presentation
Engaged presenting part i.e. head at or below ischial spines the head must not be palpable abdominally
Pain relief
Sphincter (bladder) empty this will usually require catheterization
lochia?
how long does it last?
is the passage of blood, mucus and uterine tissue that occurs during the puerperium
4-6 weeks
what are the 3 stages of lochia?
rubra - red (4days))
serosa - yellow (brown/red; 2/3 weeks
alba - white
abruption
A for Abruption previously;
B for Blood pressure (i.e. hypertension or pre-eclampsia);
R for Ruptured membranes, either premature or prolonged;
U for Uterine injury (i.e. trauma to the abdomen- C-section);
P for Polyhydramnios;
T for Twins or multiple gestation/multiparity;
I for Infection in the uterus, especially chorioamnionitis;
O for Older age (i.e. aged over 35 years old);
N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)
vasa praevia
foetal distress
bradycardia, late decelerations
ROM - blood from fetus
PLACENTA PRAEVIA
PLACENTA PRAEVIA = baby fine usually, just painless PV bleed
PRE -ECLAMPSIA MAGNesium treatment when should it be stopped
24hours after seizure / delivery whichever is last
umblical cord prolapse
insert urinary catheter and filld bladder with saline in an effort to lift presenting part of the cord
placental abruption management
fetus not indistress <36 weeks?
admit mother
adminster steroids (fetal lung development)
threshold to deliver
hydaridiform mole
pre-cancerous form of gestational trophoblastic disease
abnormal trophoblastic tissue can produce excessive amounts of hcg
hydatidiform mole
what is needed for the definitive diagnosis?
histopathological examination
32 weeks pregnant presents to ED with painless leakage
PPROM
severe pen allergy
mx for infection control?
10 days erythromycin
downs’ syndrome and turner are both associated with ___ _____ defects
congenital heart defects
> increase lymphatic accumulation
(weak pumping)
= increased nuchal translucency
Nuchal translucency is a sign of ?
foetal oedema
causes of hyperechogenic bowel?
CF
down’s
cytomegalovirus
what is used to detect antibodies in maternal blood?
indirect coombs
what drug must be avoided in pregnancy?
associated with a condition that causes
Encephlopathy
fatty liver damage
elevated transaminases
aspirin
> metabolic acidosis of infant
increases risk of reye’s syndrome
what type of insulin in diabetes
short acting
what drug to adminster whilst awaiting surgery for umbilical cord prolapse?
terbutaline
tocolytic
reduces uterus contraction
erb’s plasy
damage to brachial plexus
adducted and internat rotation
waiter’s tip
Klumpke’s palsy
lower brachial plexus
innervating hand
