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PATH 161 > PATH 161 - Pregnancy and Disease > Flashcards

PATH 161 - Pregnancy and Disease Flashcards

1
Q

Fetal Development

8個步驟

A
  1. Fertilization, result in zygote
  2. rapid mitosis
  3. implantation in uterus
  4. placental development
  5. embryonic stage (3-8 weeks)
    • development of major organs
  6. fetus term applied after 8 weeks
  7. continuation of development
  8. important for regular prenatal care during
    pregnancy
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2
Q

Diagnosis of Pregnancy

A
  1. Based on hCG level in blood or urine
  2. Absolute sings occur later in pregnancy
    • ultrasound evidence
    • auscultation of fetal heart
    • fetal movements
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3
Q

Gestation

A
  1. duration of pregnancy
  2. normal length is 40 weeks / 280 days
  3. divided into three, 3-month trimesters
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4
Q

EDC

A
  1. estimated date of confinement
  2. calculated based on lst day of LMP

LMP = last menstrual period

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5
Q

Gravidity

  • nulli
  • primi
  • multi
A

refers to number of pregnancies

  1. NULLIgravida
    never been pregnant
  2. PRIMIgravida
    currently pregnant, for the first time
  3. MULTIgravida
    currently pregnant for the 2nd, 3rd, etc
    time
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6
Q

Parity

  • nulli
  • primi
  • multi

viability (常指胎兒, 嬰兒的)成活力

A

refers to number of pregnancies in which the fetus has reached viability approx 22 weeks gestation

1. NULLIpara
   never borne a viable infant
2. PRIMIpara
   has completed one pregnancy to the point
   of viability
3. MULTIpara
    has completed two or more pregnancies 
    to the point of viability
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7
Q

TPAL

A

term deliveries
preterm deliveries
abortive outcomes
living children

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8
Q

Physiological Changes of Pregnancy

Hormonal Changes

A 
1. increase estrogen & progesterone
    essential for:
    - development of uterus
    - maintenance of pregnancy
    - preparation of breasts for lactation
2. increase thyroxine 甲狀腺素
    due to thryoid hyperplasia 畸形生長
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9
Q

Physiological Changes of Pregnancy

Reproductive System

A
  1. increase size of uterus
    pressure on surrounding structures
  2. increase vascularity and blood flow to
    uterus, cervix & vagina
  3. increase amount and thickness of cervical
    mucus
  4. increase vaginal secretions, with increase
    acidity
  5. breast enlargement
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10
Q

Physiological Changes of Pregnancy

Weight gain and nutritional requirements

A
  1. avg weight gain 25-30 lbs mostly in 3rd
    trimester
  2. increase demand for (protein, minerals,
    (especially iron) fat, and carbohydrates
  3. Ca+ important for development
  4. food cravings may occur
  5. risk for development of gestational diabetes
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11
Q

Physiological Changes of Pregnancy

Digestive System

A
  1. nausea & vomiting in 1st trimester
  2. hyperemesis 劇吐 gravidarum 妊娠期
  3. reflux and bloating 膨脹
  4. constipation and hemorrhoids
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12
Q

Physiological Changes of Pregnancy

Musculoskeletal System

A
  1. relaxation of pelvic joints

2. lordosis 脊柱前彎症 and backache

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13
Q

Physiological Changes of Pregnancy

Cardiovascular System

A 
1. increase BV (fluid & electrolytes)
    congestion and edema in tissues
2. increase blood supply to uterus and 
    kidneys
3. decrease vascular resistance
4. decrease hgb due to increase need for 
    iron
5. varicose veins
    increase risk for thrombus formation
    restricted venous blood flow in legs
6. supine position
    decrease venous return to heart and CO
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14
Q

Potential Complication of Pregnancy

Abortive Outcomes - 2 types

A
  1. Spontaneous Abortion

2. Induced / therapeutic Abortion

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15
Q

Spontaneous Abortion

6 types

A
  1. Threatened abortion
  2. Inevitable abortion
  3. Incomplete abortion
  4. Complete abortion
  5. Missed abortion
  6. Habitual abortion
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16
Q

Induced / therapeutic Abortion

A

the termination of pregnancy before fetal viability in order to save the life of the mother

  1. surgical therapy
  2. medical therapy
17
Q

Potential Complication of Pregnancy

(Placental problems:
Previa vs Abruptio)

A 
1. Placenta Previa
   placenta is implanted the lower or over the
   cervical
2. Abruptio Placenta
   premature separation of normally 
   implanted placenta
18
Q

Potential Complication of Pregnancy

(Blood Clotting problems:
Thrombus vs embolus)

A
  • postpartum 產後的 complications
  • thrombophlebitis [醫]血栓(性)靜脈炎
  • thromboembolism [醫]血栓栓塞
    1. thrombus
    blood clot attached to the wall of a blood
    vessel
    2. embolus
    may be a blood clot or other material
    flows in the circulation until it comes to a
    point where it lodges and obstructs blood
    flow
19
Q

Potential Complication of Pregnancy

Rh Incompatibility

A
  • Results when mom is Rh- and fetus is Rh+
  • mom forms antibodies to Rh+ cells during
    1st pregnancy
  • subsequent pregnancies - maternal Rh
    antibodies cross to fetus, causing
    destruction of feta RBCs
  • hemolytic 參與溶血的 disease of newborn
    aka erythroblastosis fetalis
    胎兒、嬰兒成紅血細胞增多症
20
Q

Potential Complication of Pregnancy

Ectopic Pregnancy
異位的

A
  1. fertilized ovum implants outside the uterus
  2. most common site is Fallopian tube
  3. fetal grow 6-8 wks but not viable
21
Q

Potential Complication of Pregnancy

Ectopic Pregnancy
Manifestation 表現形式

A

similar to threatened abortion
1. may have positive pregnancy text
2. spotting and cramping after first missed
period
3. Unilateral pelvic pain, at site of mass
4. if rupture 破裂
- sharp, lower abdominal pain to shoulder
and back
- hemorrhage and shock
- peritonitis [醫]腹膜炎 (life-threatening!)

22
Q

Potential Complication of Pregnancy

Ectopic Pregnancy
Disgnosis

A
  1. must rule out other causes
    • spontaneous abortion
    • ovarian cyst
    • torsion 【醫】捩轉 of ovary
    • salpingitis [醫]輸卵管炎
    • appendicitis (if pain is in RLQ)
  2. Pregnancy test for hCG level
  3. Pelvic exam
    • tender, boggy uterus
    • extreme pain on palpation of adnexa
      adnexa = 解附件; 胚外結構
  4. U/S (ultrasound)
23
Q

Potential Complication of Pregnancy

Ectopic Pregnancy
Treatment

A
  1. Medical therapy methotrexate (抗腫瘤藥)
    • destroys rapidly dividing cells
    • useful in early stages only
  2. Surgical excision may be required
    • affected tubes
    • try to save ovary on affected side
    • try conserve tube with microscopic
      repair 如果之後還想要懷孕
  3. Supportive therapy
    • analgesics 鎮痛藥
    • supplemental iron
    • blood transfusions if needed
    • antibiotics, if rupture with peritonitis
24
Q

Potential Complication of Pregnancy

Infections

A
  1. localized wound infections
    • episiotomy [醫]外陰切開術
    • vaginal / cervical laceration 裂[傷]口
    • C-section incision
  2. puerperal sepsis
    因生產導致的 / 分娩的, 產後的 [醫]敗血症
    • infection of reproductive tract
  3. endometritis [醫]子宮內膜炎
    • placental tears
    • retained placenta
    • may lead to pelvic cellulitis [醫]蜂窩織炎,
      peritonitis, abscess 膿瘡
25
Q

Potential Complication of Pregnancy

Adolescent Pregnancy

A 
Often higher risk at this age
1. increased nutritional needs
2. physical size / structure (small pelvis)
3. high incidence of teenage 
    smoking/alcohol
4. psychosocial factors/ maturity
    指社會環境影響下的個人心理變化
5. may not seek early and regular prenatal 
    care (higher risk to fetus)
6. PIH common complication

PIH = pregnancy induced hypertension
(high BP)

26
Q

Potential Complication of Pregnancy

PIH = pregnancy induced hypertension

A
  • state of persistently elevated BP
  • develop 20 wks after gestation
  • if not controlled, result in:
    damage blood vessels in tissues of
    kidneys, retina, or to stroke or heart failure
  • risk to fetus due
27
Q

Potential Complication of Pregnancy

(Pre-eclampsia / eclampsia)
[醫]驚厥

pre-eclampsia progress to eclampsia

A
  • BP is higher
  • kidney dysfunction
  • proteinuria [醫]蛋白尿(症)
  • weight gain
  • generalized edema (face, hands, feet/legs)
  • complication may develops for pre-
    eclampsia, such as HELLP
  • hospitalization if required for eclampsia
28
Q

Potential Complication of Pregnancy

HELLP

A 
- stands for
  Hemolysis 溶血, Elevated Liver enzymes 
  and Low Platelets
- complication resulted in manifestation of
  pre-eclampsia
- coagulation disorders: DIC
  disseminated intravascular coagulation

PATH 161 (4 decks)

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