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Reproduction > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

What is a blastocyst?

A
  • a ball of rapidly diving cells
  • 200-300 cells
  • what implants onto the uterus wall
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2
Q

When does the blastocyst attach to the uterus lining?

A
  • day 5-8
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3
Q

When does the blastocyst implant on the uterus?

A
  • by day 12
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4
Q

The outer cells of the blastocyst form what?

A
  • The placenta
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5
Q

What is the role of the placenta?

A
  • oxygen transport

- nutrient and waste transport

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6
Q

What is the placenta derived from?

A
  • trophoblast and decidual tissue?
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7
Q

Explain how maternal and fetal blood doesn’t mix?

A
  • trophoblast cells -> multinucleate cells -> invade decidua -> breakdown of capillaries
  • formation of cavities filled with maternal blood (intervillous space)
  • foetal umbilical veins and arteries penetrate into intervillous space
  • villus filled with foetal blood
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8
Q

At what stage is the placenta functional?

A
  • by the 5th week
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9
Q

HCG causes what?

A
  • the corpus luteum to secrete progesterone in early pregnancy
  • doubles every 48hrs until week 12-14
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10
Q

Maternal oxygen rich blood enters what?

A
  • umbilical veins
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11
Q

What increases the oxygen transport to the foetus?

A
  • fetal Hb = greater affinity for o2
  • Increased Hb in foetus
  • Bohr effect
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12
Q

Explain the Bohr effect?

A
  • foetal Hb can carry more O2 in lower PCO2 than high
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13
Q

CRH causes??

A
  • acth -> Aldosterone + cortisol

- leading to gestational diabetes and hypertension

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14
Q

Increased HCG may cause?

A
  • hyperthyroidism
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15
Q

What does HCG stand for?

A
  • human chorionic gonadotrophin
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16
Q

Role of HPL

A
  • Human placental lactogen
  • growth hormone
  • decreases insulin sensitivity in mum
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17
Q

Role of progesterone in pregnancy?

A
  • reduces contraction

- preparation of lactation by development of lobular-alveolar system

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18
Q

Role of oestrogens in pregnancy?

A
  • uterus enlargement
  • breast development by growth of ductile system
  • relaxation of ligaments
  • increase in oxytocin receptors
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19
Q

Explain cardiovascular changes in pregnancy?

A
  • increased cardiac output
  • increased heart rate
  • decreased BP in 2nd trimester
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20
Q

Explain haematological changes in pregnancy?

A
  • Increase in plasma volume (can cause increased oedema)
  • increased RBC
  • Decreased Hb
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21
Q

How is anaemia defined in pregnancy?

A
  • 1st trimester Hb< 110

- 2nd or 3rd Hb < 105

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22
Q

Respiratory changes in pregnancy?

A
  • increased respiratory rate
  • increased o2 consumption
  • decreased pco2
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23
Q

Urinary changes in pregnancy?

A
  • GFR and renal plasma flow increases

- increased urine formation

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24
Q

Why is there an increased risk of VTE in pregnancy?

A
  • hypercoaguable state to reduce risk of haemorrhage
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25
Q

Average weight gain in pregnancy?

A

11 kg

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26
Q

What causes maternal insulin resistance?

A
  • HPL
  • CORTISOL
  • GROWTH HORMONES
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27
Q

The 2 metabolic phases of pregnancy?

A
  • 1st trimester = anabolic

- 2nd/3rd = catabolic

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28
Q

Special nutritional needs in pregnancy?

A
  • folic acid
  • vitamin D
  • high protein
  • iron supplementation
  • vitamin b
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29
Q

What may be given to induce labour?

A
  • prostaglandins

- oxytocin

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30
Q

Role of prostaglandins in labour?

A
  • ripen cervix
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31
Q

Role of oxytocin in labour?

A
  • increased contraction

- stimulation of prostaglandins (ripen cervix)

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32
Q

Role of oestrogen in labour?

A
  • increases oxytocin receptors?
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33
Q

3 stages of labour?

A
  • cervical dilation
  • passage of foetus from birth canal
  • passage of placenta
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34
Q

Oxytocin role in lactation?

A
  • milk let down reflex
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35
Q

What hormone stimulates milk?

A
  • prolactin
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36
Q

Define sensitivity?

A

sensitivity = true positives / (positive + false negatives)

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37
Q

When is the booking scan usually performed?

A
  • 8-12weeks
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38
Q

What does the booking exam incorporate?

A
  • medical hx, surgical hx, social and family hx
  • examination
  • bloods
  • USS
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39
Q

Explain how gestation can be calculated before a scan?

A
  • Naegele’s rule = add 280 days onto LMP
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40
Q

Pseudo sac on USS may indicate?

A
  • ectopic pregnancy else where
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41
Q

Placenta previa?

A
  • condition where the placenta lies over the cervix

- c-section will be required

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42
Q

Trisomy 18?

A
  • Edward’s syndrome

- almost always seen on 20 week scan due to multiple abnormalities

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43
Q

Trisomy 21?

A
  • Down syndrome

- may not always be seen on USS as a spectrum disease

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44
Q

Trisomy 21 is also associated with what conditions?

A
  • duodudenal atreasia

- cardiac defect

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45
Q

Trisomy 13?

A
  • Patau’s syndrome
  • multiple physical abnormalities
  • generally fatal
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46
Q

When is trisomy screening performed and what does it include?

A
  • first trimester
  • trisomy 13, 18, 21
  • nuchal translucency test and bloods
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47
Q

Explain nuchal translucency?

A
  • volume of fluid behind the fetal neck

- increased volume associated with increased risk of foetal abnormality

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48
Q

If a pregnancy is deemed high risk of trisomy what test can be done?

A
  • NIPT
  • Non-invasive parental testing
  • screening only
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49
Q

What diagnostic antenatal tests can be performed?

A
  • amniocentesis

- chorionic villus sampling

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50
Q

Maternal anaemia may be due to what?

A
  • iron, folate, B12 deficiency
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51
Q

When is Anti-D injections given to a mother with rhesus negative status?

A
  • 28 weeks

- any sensitising event

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52
Q

Risk factors for gestational diabetes?

A
  • BMI > 30
  • Previous macrosomic baby
  • previous gestational diabetes
  • 1st degree relative with diabetes
  • minority ethnic family origin
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53
Q

How is fetal growth assessed?

A
  • from 24 weeks

- SFH (Symphysis fundal height)

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54
Q

How is pre-eclampsia screened for?

A
  • urinalysis and BP

- High risk advised to take 150mg aspirin

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55
Q

Urinalysis is performed in pregnancy to screen for what>

A
  • UTI
  • Asymptomatic bacteria
  • pre-eclampsia
  • diabetes
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56
Q

Define pharmacokinetics?

A
  • what the body does to the drug
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57
Q

How might absorption of a drug differ in pregnancy?

A
  • morning sickness
  • increased plasma volume
  • increased fat stores
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58
Q

Folic acid recommendation?

A
  • 400mg daily for 3 months prior and first 3 months
59
Q

Name some teratogenic drugs?

A
  • ACEi
  • ARB
  • Lithium
  • Antiepileptics
  • methotrexate
  • androgens
60
Q

What should be used to treat diabetes in pregnancy

A
  • insulin

- off sulphonyureas

61
Q

Epilepsy medication has a risk of?

A
  • congenital abnormalitiy

- increase folic acid to 5mg

62
Q

Drugs used for hypertension in pregnancy?

A
  • labetolol

- methyldopa

63
Q

Amiodarone in breast feeding?

A
  • neonatal hypothyroidism
64
Q

Prophylaxis for high risk VTE in pregnancy

A
  • LMWH
65
Q

Tetracyclines in pregnancy?

A
  • may cause teeth or bone staining

- avoid

66
Q

Alcohol in pregnancy may cause

A
  • fetal alcohol syndrpme
67
Q

Phenytoin is what drug, and why should it be avoided in pregnancy?

A
  • antiepileptic

- cleft lip and palate

68
Q

Valproate may have what affect on feotus

A
  • neural tubal defects

- avoid

69
Q

What is performed in a 1st trimester trisomy screening test?

A
  • nuchal translucency

- serum markers

70
Q

What is a normal nuchal translucency?

A
  • less than 3.5mm
71
Q

If a pregnancy is deemed high risk for trisomy 21 after trisomy screening what is performed?

A
  • NIPT
72
Q

Explain NIPT

A
  • Screening test
  • placental DNA in maternal blood
  • predictive value > 90%
73
Q

Disadvantage of microarray?

A
  • may highlight many polymorphisms
74
Q

When is a foetal MRI used?

A
  • foetal brain abnormalities
75
Q

What is a TORCH screen?

A
  • looking for foetal infections
  • toxoplasosis
  • rubella
  • cytomegalovirus
  • herpes simplex
    HIV
76
Q

What defines a large for date baby?

A
  • Symphyseal-fundal height > 2cm for gestational age
77
Q

Causes of large for dates?

A
  • wrong dates
  • fetal macrosomia
  • polyhdramnios
  • diametes
  • multiple pregnancy
  • obesity
78
Q

What is foetal macrosomia?

A
  • USS EFW > 90th centile

- > 4.5kg

79
Q

Risks associated with foetal macrosomia?

A
  • labour dystocia
  • shoulder dystocia
  • PPH
80
Q

When would a c-section be recommended in Fetal macrosomia?

A
  • EFW > 5kg
81
Q

Define polyhydramnios?

A
  • excess amniotic fluid
  • amniotic fluid index > 25cm
  • deepest pool > 8cm
82
Q

Causes of polyhydramnios?

A
  • diabetes
  • gi atresia
  • hydrops fetalis
  • viral infection
  • idiopathic
83
Q

Investigations for polyhydroamnios?

A
  • OGTT
  • Serology
  • antibody screening
  • USS
84
Q

Management of polyamniohydros?

A
  • induced labour by 40weeks
85
Q

Monozygotic?

A
  • one egg divides
86
Q

Dizygotic?

A
  • 2 eggs 2 stem
87
Q

Monochorionic?

A
  • twins share 1 placenta
88
Q

How often should monochorionic twins be USS?

A
  • 2 times per week after 16 weeks
89
Q

How often should dichoronic twins be USS?

A
  • Every 2 weeks after 16 weeks
90
Q

Symptoms of a multiple pregnancy?

A
  • increased symptoms
  • increased AFP
  • Large for dates
91
Q

What should be given to multiple pregnancy?

A
  • iron supplements
  • folic acid
  • low does aspirin
92
Q

Complications of a multiple pregnancy?

A
  • single fetal death
  • twin-to-twin transfusion syndrome
  • twin anaemia polycthaemia sequence
93
Q

Explain twin-to-twin transfusion syndrome? And its treatment

A
  • anastomosis of arterial and venous
  • one twin is the donor (olgiohydraminos)
  • one twin is the receipt (polyhydraminos)
  • treatment < 26weeks = fetoscopic laser ablation
  • treatment > 26 weeks = aminoreduction
94
Q

Complication of fetoscopic laser ablation in twin-to-twin transfusion syndrome?

A
  • twin anemia polycthaemia sequence
95
Q

Complication of diabetes in pregnancy?

A
  • pre-eclampsia
  • polyhyfdramnios
  • macrosomia
  • neonatal hypoglycaemia
96
Q

What additional antenatal care should be given to a diabetic mum?

A
  • folic acid 5mg (3 months before to 12weeks)

- low dose aspirin (12weeks to delivery)

97
Q

Risk factors for gestational diabetes?

A
  • previous gdm
  • BMI > 30
  • 1st degree relative
  • polyhydraminos
  • glycosuria
98
Q

Labour risk in gestational diabetes

A
  • labour dystocia
  • shoulder dystocia
  • neonatal hypoglycaemia
99
Q

Hormones that can cause gestational diabetes?

A
  • human placenta lactogen
  • cortisol
  • growth hormone
100
Q

How is Gestational diabetes diagnosed

A
  • screening at 24-28 weeks for all
  • high risk screening in 1st trimester
  • Fasting BG > 5.1
  • 2hr BG > 8.5
101
Q

Folic acid supplementation

A
  • 400mmg 12weeks-12weeks

- 5mg in
obese, diabetics, history of NTD, on anti-epileptics

102
Q

Typical vitamin D supplementations?

A
  • 10mg supplementation
103
Q

Pre-pregnancy risks associated with obesity?

A
  • menstrual disorders

- subfertility

104
Q

Obesity management in pregnancy?

A
  • Gestational diabetes screening
  • Hypertension screening
  • folic acid 5mg
  • Vitamin D 10mg
  • aspirin 150mg
  • Serial growth scans
  • VTE risk assessment
105
Q

Obesity effect on the foetus?

A
  • congenital anomaly
  • macrosomia
  • shoulder dystocia
  • still birth
  • neonatal death
106
Q

Symptoms of a dural venous sinus thrombosis?

A
  • severe headache

- can cause brain damage

107
Q

What is Virchow’s triad?

A
  • hypercoaguble state
  • venous stasis
  • vascular damage
108
Q

What is used in the prophylaxis and treatment of VTE?

A
  • LMWH
109
Q

Warfarin in pregnancy?

A
  • should be avoided
  • teratogenic
  • crosses the placenta
110
Q

Symptoms of DVT

A
  • Swelling
  • oedema
  • groin pain
  • fever
  • increased leg temperature
111
Q

Symptoms of obstetric cholestasis?

A
  • disease of pregnancy
  • diagnosis of exclusion
  • severe puritis on palms and soles of feet
112
Q

Investigations for obstetric cholestasis?

A
  • LFTs deranged
  • viral serology
  • autoantibodies
113
Q

1st line investigation for a pregnant woman suspected of having a PE?

A
  • V/Q scan (less radiation)

- CTPA can be done but higher risk

114
Q

Risks of epilepsy in pregnancy?

A
  • maternal abdo trauma
  • PPROM
  • Pre-term birth
  • hypoxia
  • childhood epilepsy
115
Q

Considerations of anti-epileptic drugs in pregnancy?

A
  • teratogenic
  • lowest effective dose should be used
  • sodium valproate, teratogenic!
116
Q

Management of an intra-partum seizure?

A
  • continuous fetal monitoring
  • left lateral tilt
  • IV lorazepam
  • PR diazepam
  • may require c-section
117
Q

Increased MI in pregnancy?

A
  • 3 or 4 times risk of MI
118
Q

Potential cause of orthopnea in pregnancy?

A
  • peri-partum cardiomyopathy

- presents with orthopnoea (inability to lie flat)

119
Q

Cardiac changes in pregnancy?

A
  • increased plasma volume
  • increased cardiac output
  • increased stroke volume
  • decreased peripheral resistance
120
Q

How is hypertension in pregnancy diagnosed?

A
  • 2 readings of > 140/90

- 1 reading of > 160/110

121
Q

Types of hypertension in pregnancy?

A
  • pre-existing
  • pregnancy induced
  • pre-eclampsia
122
Q

Triad in pre-eclampsia

A
  • hypertension >140/90
  • proteinuria uPCR > 30
  • oedema
123
Q

Early vs late pre-eclampsia?

A
  • early = diagnosed before 34 weeks, associated with greater placental damage
  • late = diagnosed after 34 weeks
124
Q

Explain the pathogenesis of pre-eclampsia?

A
  • abnormal placental perfusion due to failure of trophoblastic invasion of spiral arteries
  • leading to low capacity - high resistance arterial supply
  • placental hypoperfusion
125
Q

Investigations for pre-eclampsia?

A
  • bp
  • urinalysis
  • colour doppler of uterine artery
  • CTG of fetous
126
Q

Consequences of pre-eclampsia?

A
  • HELLP syndrome
  • eclampsia
  • pulmonary oedema
  • placental abruption
  • cerebral haemorrhage
127
Q

What is hellp syndrome and its symptoms?

A
  • haemolysis, elevated liver enzymes, low platelets
  • epigastric/RUQ pain
  • abnormal enzyme,es
128
Q

Symptoms of pre-eclampsia?

A
  • headache
  • visual changes
  • epigastric pain
  • nausea
  • oedema
129
Q

What drug should be given in pre-eclampsia and why?

A
  • low dose aspirin between 16-36weeks

- reduces risk of eclampsia

130
Q

Cure for pre-eclampsia?

A
  • deliver the baby
131
Q

When should drug treatment for pre-eclampsia be commenced?

A
  • when blood pressure> 150/100
132
Q

Drugs used for hypertension in pregnancy>

A
  • labetolol
  • nifidipiene
  • methylpoda (contraindicated in depression)
133
Q

What is eclampsia?

A
  • tonic colonic seizures occurring with features of pre-eclampsia
  • commoner in teenagers
  • 44% occur post-partum
134
Q

Management of eclampsia?

A
  • control BP (IV labtolol, IV hydralazine)
  • prevent seizures (magnesium sulphate)
  • delivery of baby
135
Q

Magnesium sulphate dosage in eclampsia?

A
  • loading dose 4g

- infusion 1g/hrs

136
Q

Define small for gestational age?

A
  • infant born with birth weight < 10th centile
137
Q

Causes of small for gestational age?

A
  • placental infarction
  • Maternal alcohol, drugs, smoking
  • maternal height and weight
  • maternal age
  • chronic hypertension
138
Q

What classifies low birth weight?

A
  • infant born < 2500g
139
Q

What is fetal growth restriction?

A
  • failure to achieve genetic potential for growth

- implies pathological restriction

140
Q

Below 3rd centile delivery time?

A
  • aim to deliver by 37weeks
141
Q

Between 3rd and 10th centile delivery time?

A
  • aim to deliver by 39 weeks
142
Q

Why is magnesium sulfate given in pre-term labour

A
  • reduce seizure risk
143
Q

What should be seen on umbilical artery doppler?

A
  • forward flow even in maternal diastole
144
Q

How is SGA identified?

A
  • GROW chart
  • USS
  • Symphysis fundal height

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