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Reproduction > Postnatal > Flashcards

Postnatal Flashcards

1
Q

Function of the placenta?

A
  • fetal homeostasis
  • gas exchange
  • nutrient transport
  • waste product transport
  • acid base balance
  • hormone production
  • transport of IgG
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2
Q

What is contained within the umbilical cord?

A
  • 3 blood vessels
  • 1 x umbilical vein (oxygenated)
  • 2 x umbilical artery (deoxygenated)
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3
Q

What are the 3 fetal shunts?

A
  • ductus venosus
  • foramen ovale
  • ductus arteriosus
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4
Q

Explain ductus venosus?

A
  • connection between the umbilical vein and inferior vena cava
  • at the liver
  • oxygenated
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5
Q

Explain foramen ovale

A
  • right to left shunt in heart

- becomes the fossa ovalis

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6
Q

Why does blood avoid the lungs?

A
  • lungs collapsed and fluid filled
  • high resistance to flow
  • only a small fraction of RV output goes via lungs
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7
Q

Within increasing gestation what do type 2 pneumocytes produce?

A
  • they produce surfactant

- reduces resistance

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8
Q

What hormones prior to and during delivery slow fluid secretion and promote reabsorption?

A
  • cortisol
  • thyroid hormones
  • catecholamines
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9
Q

Explain circulation changes postnatally?

A
  • pulmonary vascular resistance drops
  • systemic vascular resistance rises (prostaglandin drop, oxygen as a constrictor)
  • ductus arterioles constricts
  • foramen ovale closes
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10
Q

Remnant of the ductus arteriosus in an adult is called?

A
  • liagmentum arteriosus
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11
Q

Symptoms of postnatal depression?

A
  • tearfulness, irritability, anxiety, lack of enjoyment, poor sleep
  • develops 2-6weeks post natally
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12
Q

Describe baby blues?

A
  • common/normal
  • develops within days postnatally
  • brief period of emotional instability
  • support and reasurrance
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13
Q

Explain puerperal psychosis?

A
  • usually within 2 weeks postnatally
  • sleep disturbances, confusion, mania, delusions
  • treat as an emergency
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14
Q

Treatment of puerperal psychosis?

A
  • admission
  • antidepressants
  • antipsychotics
  • mood stabilisers
  • ECT
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15
Q

Treatment of mild/moderate postnatal depression

A
  • self help

- counselling

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16
Q

Treatment of moderate/severe postnatal depression

A
  • psychotherapy
  • antidepressants
  • admission
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17
Q

First line antidepressant in pregnancy?

A
  • SSRI

- Sertaline or fluoxetine

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18
Q

Risk of valproate and carbamazepine in pregnancy?

A
  • highly teratogenic

- high risk of NTD

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19
Q

Lithium in pregnancy?

A
  • avoid if possible
  • known association with Ebstein’s anomaly (cardiac defects)
  • do not use in breast feeding
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20
Q

Which antipsychotic should be avoided in pregnancy and why?

A
  • clozapine

- risk of infant agranulocytosis

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21
Q

In utero glucose homeostasis?

A
  • from placenta

- glycogen stores created in liver and muscle

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22
Q

Explain thermoregulation in utero?

A
  • mum responsible

- during 3rd trimester brown fat laid down

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23
Q

Explain thermoregulation after delivery?

A
  • heat produced by breakdown of stored fat

- peripheral vasoconstriction

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24
Q

Explain glucose homeostasis post delivery?

A
  • drop in insulin
  • increase in glucagon
  • mobilisation of hepatic glycogen stores for gluconeogenesis
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25
Q

Primitive reflex involved in breast feeding?

A
  • rooting and suck
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26
Q

Explain haematopoiesis prior and after birth?

A
  • prior birth = liver

- post delivery = bone marrow

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27
Q

Explain physiological jaundice?

A
  • breakdown of fetal haemoglobin
  • immature conjugation pathways
  • rise in circulating unconjugated bilirubin
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28
Q

Concern if high levels of unconjugated bilirubin cross the BBB?

A
  • Kernicterus
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29
Q

Normal weight loss of baby in first few days?

A
  • up to 10% of birth weight
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30
Q

Explain persistent pulmonary hypertension of the newborn?

A
  • failure of the pulmonary circulation pressure to drop

- persistence of ductus arteriosus and foramen ovale

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31
Q

Treatment of persistent pulmonary hypertension of the newborn?

A
  • ventilation
  • nitric oxide (pulmonary vasodilator)
  • sedation
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32
Q

Respiratory distress following c - section?

A
  • transient tachypnoea of the newborn
  • loss of hormonal stress influence
  • fluid filled lungs
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33
Q

Why are smaller babies at greater risk for hypothermia?

A
  • reduced brown fat stores
  • little subcutaneous stores
  • large volume:surface area
34
Q

Neonatal hypoglycaemia may be caused by what?

A
  • maternal diabetes

- inappropriate insulin:glucagon

35
Q

Define the puerperium period?

A
  • from the end of 3rd stage of labour until 6 weeks
36
Q

When is the uterus no longer palpable postpartum?

A
  • after 10days
37
Q

When is the cervical os typically closed by?

A
  • typically 7-10days post partum
38
Q

What is lochia?

A
  • bloodstained for up to 14days
39
Q

When does menstruation typically occur postpartum?

A
  • after 6 weeks
40
Q

When does ovulation typically occur postpartum?

A
  • after 28days
41
Q

Risk factors for endometritis?

A
  • prolonged labour
  • prolonged ROM
  • multiple vaginal examinations
  • retained tissue
  • c-section
42
Q

Describe 3rd degree perineal tears?

A
  • 3A < 50% external anal sphincter
  • 3B > 50% external anal sphincter
  • 3C = internal and external anal sphincter
43
Q

Treatment of endometritis?

A
  • IV co-amoxiclav
  • metronidazole
  • +/- gentamicin
44
Q

Define secondary postpartum haemorrhage?

A
  • bleeding 24hrs-6weeks postpartum
45
Q

typical causes of secondary postpartum haemorrhage

A
  • endometritis

- retained placenta

46
Q

Management of urinary retention?

A
  • catherisation
  • underlying cause?
  • trial without in 24hrs
47
Q

Treatment of mastitis?

A
  • oral or IV flucoaxicillin
48
Q

When can POP be started postpartum?

A
  • immediately
49
Q

When can COCP be started postpartum?

A
  • wait 6 weeks
50
Q

When can IUD or IUS be started post-partum?

A
  • immediately within 48hrs or after 6weeks
51
Q

Define micturition and explain the different bladder sphincters?

A
  • micturition = emptying of the bladder
  • internal urethral sphincter = involuntary
  • external urethral sphincter = voluntary
52
Q

Hypogastric innervation to the bladder?

A
  • sympathetic (L1-2)
  • relaxes detrusor, contracts IUS
  • promotes storage
53
Q

Parasympathetic nerves to the bladder?

A
  • from pelvic nerves
  • contraction of detrusor
  • relaxation of IUS
  • promotes micturition
54
Q

What does self-regenerative mean?

A
  • the more the bladder fills the greater the micturition reflex
55
Q

3 main types of urinary incontinence?

A
  • urge (urgency)
  • stress (physical exertion)
  • overactive (urge and frequency)
56
Q

risk factors for urinary incontinence?

A
  • age
  • obesity
  • parity
  • exercise
  • UTI
  • diet
57
Q

Explain stress urinary incontinence?

A
  • when intravesical pressure > urethral closing pressure
  • leakage upon exertion
  • urethral hypermobility (impaired pelvic floor)
  • intrinsic sphincter deficiency (weakness)
58
Q

Overactive bladder may be secondary to what?

A
  • pelvic floor injury

- incontience surgery

59
Q

Taking a history of a women with urinary incontinence should include which 3 headings?

A
  • storage symptoms
  • voiding symptoms
  • post-miturition symptoms
60
Q

Investigations for urinary incontinence?

A
  • urinalysis and culture
  • frequency/volume chart for 3 days
  • USS
  • Cystoscopy
  • urodynamics
61
Q

Conservative management for urge urinary inconetinence?

A
  • lifestyle
  • fluid management
  • bladder retraining
62
Q

Medical management for urge incontinence?

A
  • vaginal oestrogen
  • anti-cholinergic
  • beta 3 agonist
63
Q

Surgical management for urge incontinence?

A
  • botox
  • percutaneous tibial nerve stimulation
  • augmentation cystoplasty
64
Q

Conservative management of stress urinary incontience?

A
  • lifestly
  • pelvic floor training
  • incontinence ring
65
Q

Medical management of stress incontinence?

A
  • vaginal oestrogen

- duloxetine (last resort)

66
Q

Surgical management of stress incontinence?

A
  • bulking agents
  • fascial slings
  • colposuspension
67
Q

Risk factors for prolapse?

A
  • childbirth
  • obesity
  • older
  • heavy lifting
  • previous pelvic surgery
68
Q

Symptoms of pelvic prolapse?

A
  • dragging or pulling sensation
  • tissue protruding
  • back pain
  • urinary or bowel symptoms
69
Q

How is uterovaginal prolapses graded?

A
  • 1st degree uterus in vagina
  • 2nd degree- at introits
  • 3rd degree - outside vagina
  • 4th degree - e.g. procidenta - entirely outside vagina
70
Q

Describe a procidentia prolapse?

A
  • uterus completely outside the vagina
71
Q

Anterior prolapse involved?

A
  • cystocele

- urethrocele

72
Q

Middle prolapse involves?

A
  • enterocele (pouch of Douglas)

- vaginal prolapse

73
Q

Posterior prolapse involves?

A
  • rectocele
74
Q

Conservative treatment of prolapse?

A
  • lifestyle modifications
  • pelvic floor exercises
  • vaginal oestrogen (atrophic vaginitis)
  • pessaries
75
Q

Surgical management in prolapse?

A
  • sacrospinous fixation
  • laparoscopic sacrocolpopexy
  • vaginal hysterectomy
  • manchester repair
76
Q

Describe a ring pessaries?

A
  • 1st line
  • continue sexual relations
  • easy to remove and re insert
77
Q

Describe a gellhorn pessrie

A
  • less rigid that a shelf pessarie

- less routinely used for those sexually active

78
Q

Why is pelvic girdle pain associated with pregnancy?

A
  • relaxin hormone = softens the pubic symphysis
79
Q

DRAM?

A
  • Diastasis rectus abdominis muscle

- stretching of the linea alba

80
Q

Bladder incontinence physio treatment?

A
  • voiding techniques
  • bladder training
  • pelvic floor exercises
81
Q

Bowel symptoms physio training?

A
  • holding on programme

- pelvic floor exercises

Reproduction (25 decks)

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