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Y4 - GOSH > physiology of pregnancy > Flashcards

physiology of pregnancy Flashcards

1
Q

what cause the ovulation

A

day 14 - sudden surge of LH

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2
Q

where does the fertilisation/conception occur

A

in the follpian tube

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3
Q

when does the fertilised egg implant

A

day 23 into the uterus

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4
Q

what is the name of endometrium during pregnancy

A

decidua

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5
Q

how long does it take for a pregnancy test to be able to pick up a pregnancy

A

3-4 weeks after LMP

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6
Q

what produces b-hCG before week 12th of pregnancy

A

the corpus luteum that is implanted into the decidua

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7
Q

what does a pregnancy test test for?

A

beta-hCG

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8
Q

what produces the beta-hCG after week 12th of pregnancy

A

the placenta

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9
Q

Which hormone during pregnancy causes stress incontinence and acid reflux

A

progesterone - as it causes the relaxation of the smooth muscels

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10
Q

in what week can you see the gestational sac

A

4-5 weeks

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11
Q

in what week can you see yolk sac

A

5-6 weeks

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12
Q

in what week can you detect a foetal heart beat

A

6-7 weeks

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13
Q

what is the expected growth of the foetus before 12th weeks

A

double in size every week untill 12th week

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14
Q

in what week can you see the limb buds?

A

8th week

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15
Q

where is the most common place of fertilisation of the zygotes

A

ampulla of the fallopian tubes

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16
Q

when is the highest risk of miscarriage

A

first trimester

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17
Q

what is the major development of 1st trimister

A

foetus organ development

placenta growth and assume more major roles eg gas exchange, waste products removal, setiodgenesis

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18
Q

what is the major development of 2nd trimester

A

organ growth and enlargement

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19
Q

what are the intrinsic factors governing the foetal growth

A

maternal (genetics) - ethnic group, parity, height & weight

foetal - inherited disease, sex

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20
Q

what are the extrinsic factors governing the foetal growth

A

maternal - nutritional status, socioeconomical group, pre-existing conditions, environmetal alttuides, pregnancy related conditions (HTN, cardiac, renal)

foetal - TORCH syndrome, nutritional status, teratogenic substance eg tobacco

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21
Q

where would you find the fundus of the uterus at week 14?

A

just above the pubic sympthus

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22
Q

where would you find the fundus of the uterus at week 20 ?

A

directly underneath the umbilicus

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23
Q

where would you find the fundus of the uterus at week 36-40 ?

A

just below the ribs of the mother

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24
Q

how would you assess the foetus biophysical profile

A

foetal breathing movement
foetal movement
foetal tone
amniotic fluid volume

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25
Q

how would you assess the placementa?

A

by doppler studies

  • look at the blood flow characteristic
  • pulsatility index
  • resistance index
26
Q

what blood test are carried out in the booking visit

A

FBC - anaemia? - most commonly due to iron deficiency

GS+S - for future surgical purpose

Haemoglobinpathies - sickle cells, thalassaemia

blood group and antibody screen - rhesus

HIV

Hep B
Syphilis
Rubella

27
Q

what can be done to avoid vertical transmission of HIV

A

treat mum with antiviral
treat baby postnatally for 6 weeks

C-section

avoid breastfeeding

28
Q

what are some of the potentially sensitising events that might require Anti-D therapy

A 
TOP
ectopic pregnancy
ECV 
blunt abdo trauma 
invasive uterine procedure eg aminocentesis or CVS 
intra-uterine death 
delivery
29
Q

when are pregnant women checked for anti-D antibodies?

A

at booking visit,

week 28 and 34

30
Q

who else should be checked for rhesus status?

A

other mums –> partner

31
Q

what should you do if mum anti-D antibodies +ve

A

check for signs of foetal anaemia - peak systolic velocity of the foetal middle cerebral artery (MCA) once a week - if increased the FBS

32
Q

what pre-natal treatment can be given to foetus with intra-utrine haemolytic anaemia?

A

blood transfusion

33
Q

when are prophylactic Anti-D given to women who are rhesus -ve

A

IM anti-D immunoglobulin at week 28 and 34

34
Q

what are the routine screening test available?

A

rhesus
haemoglobinpathies
foetal anmoalies - Down’s, edwards, pateu syndrome
infectious disease - HIV, hep B, syphilis, rubella

35
Q

what screening tests for newborn are not routinely done?

A

Hep C - unless IVDU or previous obstetric cholestac
Chlamydia - encourage if under 25
Group B strep - unless swab/urine test are performed

36
Q

what is the detection rate of combined test

A

85-90%

37
Q

when can you do a CVS for Down’s syndrome diagnosis

A

from week 11

38
Q

when can you do a aminocentesis for Down’s syndrome

A

from week 15

39
Q

what are the risk of miscarriage when carrying out CVS

A

1%

40
Q

what are the risk of miscarriage when carrying out amniocentesis

A

0.8%

41
Q

when is the quadruple test offered?

A

between 15-20 weeks

42
Q

what is in the quadruple test ?

A

blood test consists of 4 different tests

hCG
AFP
inhibin-A
Estriol

43
Q

what is the detection rate of qadriple test

A

74%

44
Q

what is the false +ve rate of qadriple test

A

4.1%

45
Q

how long will it take for you to get the results of the CVS

A

rapid karyotyping (DNA analysisi) - within minutes

46
Q

how long will it take for you to get the results of the aminocentesis

A

mayb take up to 3 weeks for culture

47
Q

what is the indication of CVS

A

after screening test shows aneuploidy in 1st trimester

DNA analysis to diagnose inherited disease if there are parent carries a trait eg cystic fibrosis or thalassemia

48
Q

what is the indication of aminocentesis

A

after screening test shows aneuploidy

DNA analysis to diagnosis inherited disease if there are parent carries a trait eg cystic fibrosis or thalassemia

inborn error

infection - confirm presence of TORCH syndrome

49
Q

what are the food/drinks that a pregnant should avoid in pregnancy

A

caffeine - miscarriage

alcohol &liquor - developmental problems

deep sea fish - risk of high level of mercury - poisonous for foetus

meat related products - salmonella &bacteria which an be harmful

MSG

unpasteurised milk or cheese - could contain liisteria - critical to foetus

raw meats - risk of .COli

50
Q

what is the time period of 1st trimester

A

up to 12th weeks

51
Q

what is the time period of 2nd trimester

A

12-27 weeks

52
Q

what is the time period of 3rd trimester

A

28 till birth

53
Q

How do you confirm diagnosis of pregnancy

A

Beta-hCG and trans abdominal/ transvaginal USS

54
Q

what is the lower limit of hemoglobin for a pregnant lady?

A

105 instead of 115 in non-pregnant lady

55
Q

which foetal cell does maternal antibody target if the mother is rhesus -ve

A

Foetal RBC - leading to foetal haemolytic anaemia

can lead to erythropoiesis inadequately compensate which leads to high output cardiac failure –> foetal hydrop and death

mild case - neonatal anaemia or neonatal jaundice from HB break down

56
Q

why does maternal antibody does not affect the first child but the second child?

A

initially, the antibody is IgM mediated which is too big to cross the placenta

re-exposure leading to memory B cell to produce IgG which can cross the placenta

57
Q

what is the treatment to the baby whose mother has hep B

A

newborn straight onto vaccination program - 5 doses vaccine

If a baby is born to a mother who is either chronic/acute infected with HBV during pregnancy –> vaccination + 1x immunoglobulin at birth

58
Q

what is the treatment for the baby whose mother has syphilis

A

full treatment before 36 weeks, otherwise newborn will get IV treatment

59
Q

the detection rate of Non-invasive Prenatal test?

A

98% but costs 500 pounds

60
Q

when is foetal anomaly USS conducted

A

from 18+6 till 20+6

61
Q

what are some of the risk of CVS

A

vertical transmission of HIV and Hep B due to sampling from the placenta which has a mixture of maternal and foetal blood

miscarriage - 1%

62
Q

what are some of the risk of amniocentesis

A

miscarriage - 1%

Y4 - GOSH (12 decks)

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