Pregnancy Flashcards
what are the signs of pre-eclampsia
increased BP
proteinuria
+/- derranged renal and hepatic function
eclampsia (seizures)
define a preterm labour
unset of labour after age of foetal viability before 37wks
what are the increased risks of a primigravida labour
inefficient uterine contraction
risk of cephalopelvic disproportion
foetal trauma
what causes anaemia in pregnancy
50% increase in plasma volume
2-3x iron requirement
10-20x folate requirement
from the pelvic brim to pelvic floor which direction does the head rotate to and from
pelvic brim –> LOL
pelvic floor –> DOA
what is obstetric cholestasis
the build up of bile salts in blood which as a result flow through the bile duct
what is gestational trophoblastic disease
chorionic villi abnormally expand and develop vesicles
may cause haemorrhage, clotting abnormalities, hypertension and later cancer development
define caput
oedema of baby’s scalp caused by pressure of head on cervix
what increases the risk of hyperemesis gravidarum
UTI
viral herpes
multiple pregnancy
molar pregnancy
define head engagement
descent of the foetal head through the pelvic brim
if the head is at the level of the ischeal spine it is engaged unless there is caput
at which diameter should the baby’s head present in delivery
suboccipito bregmatic
what classes as a positive screen in the triple test
> 1 in 150 risk of Down’s syndrome
how would you diagnose an ectopic pregnancy
USS
HCG
laparoscopy
who is gestational trophoblastic disease most likely to occur in
very young/old mothers
define foetal presentation
part of the foetus at the lower pole of the uterus
cephalic vertex breach
define the foetal lie
relationship of the longitudinal axis of the baby in relation to the mother’s spine
longitudinal, oblique, transverse
define liquor
amniotic fluid
what is the third stage of labour
delivery of the baby –> expulsion of the placenta and membrances
the cord lengthens, gush of blood and the fundus of the uterus rises
how do you manage obstetric cholestasis
Emollients antihistamines ursodeoxycholic acid vitamin K deliver at 37-38 weeks
what is carboprost used for
post partum haemorrhage
define crowning
when the foetal head is +4
why are pregnant women more susceptible to developing a UTI
dilation of urinary collection system
relaxation of smooth muscle
compression from the uterus
how do you manage pregnancy induced hypertension
anti-hypertensives
regular monitoring
baby delivered at term
what does syntocin do?
synthetic oxytocin
acts in 2 mins when given IM
causes rhythmical uterine contractions
define operculum/show
blood stained mucous discharge occuring in 2/3 of women before the onset of labour
what connective tissue disorders may present with PUO
RA/polyarteritis nodosa temporal arteritis/polymyalgia rheumatica SLE Stills disease Rheumatic fever
what are the increased risks of multigravida labour
risk of uterine rupture
disporpotion and dystocia are rare
what test does the NHS use for risk screening of Down’s
triple test
conducted between 15-20wks
uses alpha-feto protein, beta HCG and unconjugated oestrial
how do you manage pre-eclampsia
close monitoring
anti-hypertensises/ magnesium sulphate
early delivery
what occurs in the first stage of labour
onset –> full dilation of the cervix
latent –> effacement
active –> cervical dilatation
what is an APGAR score
assessment system for newborn baby
what malignancies may present with PUO
lymphoma/myeloma
leukaemia
solid tumours (renal/colon)
how much of the foetal head can be felt abdominally if the head is engaged
no more than 2/5ths
what occurs in cervical effacement
cervix flatterns and becomes part of the inferior uterine wall, the mucous plug from pregnancy is lost
effacement and dilatation are the cardinal signs of labour
what occurs during the second stage of labour
full dilation –> delivery of the baby
propulsive phase in full dilatation with head down to level of ischeal spines
expulsive phase irresistable desire to bear down/push
what does ergotamine do
causes sustained contractions of the uterus and reduces uterine bleeding
used to reduce post partum haemorrhage
CONTRAINDICATION in HTN and cardiac disease
what is syntometrine
combination of syntocin(rhythmic) and ergmetrine (sustained)
used in the active management of stage 3
given as anterior shoulder appears under PS
what is carboprost used for
post partum haemorrhage
what does prostin do
causes tetenic contractions
what are the subtypes of miscarriage
threatened inevitable incomplete complete silent
how does an ectopic pregnancy present
pain
vaginal bleeding
pelvic tenderness
cervical excitation
what are the causes of preterm labour
unknown infection multiple pregnancy polyhydramnios cervical incompetency iatrogenic causes
what are the placental causes of ante partum haemorrhage
abruptio placentae (separation fo the placenta from the uterus)
placenta praevia (placenta partially covers the cervix)
what are the local causes of antepartum haemorrhage
cervicitis cervical erosion cervical carcinoma vaginal trauma/infection cervical polyps
what factors increase your risk of a thromboembolism in pregnancy
age obesity thrombophillia immobilisation VT
what are the risks of obstetric cholestasis
spontaneous prematurity
iatrogenic prematurity
intra-uterine death
increased meconium stained liquor
define macrosomia
large baby
define crowning
when fetal head is at +4
define foetal attitude
posture of the foetus
usually flexion in vertex pres
can be : flexion deflexion or extension
what does a cardiotocograph measure
baby’s stress levels
which cardiac abnormalities are associated with Down’s
ASD VSD PDA tetralogy of fallot: 1) pulmonary infundibular stenosis 2) overriding aorta 3) VSD 4) right ventricular hypertrophy
which GI defects are associated with Down’s
oesophageal atresia
duodenal atresia
when do you perform an amniocentesis and how accurate is it
12-18wks
>99% accuracy
<1% miscarriage risk
what monitoring should be in place during the first stage of delivery
vaginal exam - 4hrly maternal urine 4hrly (for ketones-> give 10% dextrose if found) maternal BP and temp -half hourly contractions -15mins foetal hr - 15mins
what is the normal rate of dilatation
1-3cm/hour
what is the normal time to achieve full dilatation
12h primip
7h multi
what is the normal duration of the second stage of labour
40-120min pri
15-45 min multi
what 4 Ts are the causes of postpartum haemorrhage
Trauma
Tissue
Thrombin
Tone
which renal pathology is unique to pre-eclampsia
glomerular endotheliosis
which LFT is normally raised in pregnancy
ALP
which antihypertensive medications are contraindicated in pregnancy
ACEI
which antihypertensive is least associated with intra-uterine growth retardation
labetalol (beta blocker)
also used: nifedipine (Ca blocker) and hydralazine (vasodilator
