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Pregnancy Flashcards

1
Q

Which twin pregnancy is higher risk - dichronic or monochromic?

A

Monochronic

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2
Q

At what stage is an amniocentesis carried out?

A

15 weeks

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3
Q

At what stage is chorionic villus sampling carried out?

A

12 weeks

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4
Q

Where are the cells in CVS taken from?

A

Placenta

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5
Q

If day one is fertilisation when does implantation into the uterus occur?

A

Day 5-8

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6
Q

At which point is the blastocyst completely buried in the uterine lining?

A

Day 12

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7
Q

By what stage of pregnancy is the placenta and foetal heart function?

A

By the 5th week of pregnancy

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8
Q

What does human chorionic gonadotropin (HCG) do?

A

Signals the corpus luteum to continue secreting progesterone which stimulates decidual cells to concentrate glycogen, proteins and lipids
Also stimulates the development of the testes in a male foetus

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9
Q

What is the intervillous space?

A

The space where the maternal blood passes through the placenta to exchange nutrients and waster material with the foetal blood. Keep separate from the foetal blood via a thin membrane.

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10
Q

What three factors help to supply the foetus with sufficient oxygen?

A

Foetal Hb has an increased ability to carry oxygen
Higher concentration Hb in foetal blood than in adults
Bohr Effect - foetal Hb can carry more oxygen in low pCO2 than in high pCO2

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11
Q

How is water exchanged at the placenta?

A

Water is exchanged via osmosis, the amount increases as the pregnancy progresses.

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12
Q

How are electrolytes exchanged at the placenta?

A

They follow water to the baby - iron and Ca2+ can only pass from mother to child

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13
Q

How is glucose transferred to the foetus?

A

It passes the placenta via simplified transport - high glucose need in 3rd trimester

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14
Q

How are fatty acids transferred across the placenta?

A

Via free diffusion.

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15
Q

How are waste products transferred to the mother?

A

Carried across the placenta via diffusion based on concentration gradient

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16
Q

What does Human Chorionic Somatomammotropin (HCS) hormone do?

A

Similar to a growth hormone - encourages protein tissue formation.
Decreases insulin sensitivity in the mother so that more glucose is available for foetus
Involved in breast development

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17
Q

At what stage in pregnancy is HCS hormone produced?

A

Around week 5

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18
Q

What effect does progesterone have during pregnancy?

A

Development of decidual cells
Decreases uterus contractility
Preparation for lactation

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19
Q

What effect do the oestrogens have during pregnancy?

A

Enlargement of the uterus
Breast Development
Relaxation of ligaments
Estriol level is an indicator of the vitality of the foetus

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20
Q

What happens to the mother’s cardiac output during pregnancy?

A

It increases to 30-50% above the normal - peaking around week 24
It then decreases in the last 8 weeks - uterus starts to compress IVC.
Increases 30% more during labour.
Increases more if pregnant with twins.

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21
Q

What happens to the mother’s heart rate during pregnancy?

A

Increases up to 90 bpm to increase the CO

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22
Q

What happens to the mother’s blood pressure during pregnancy?

A

It drops during the second trimester - peripheral resistance decreases.
Will drop more if pregnant with twins.

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23
Q

What happens to the mother’s plasma volume during pregnancy?

A

Increases proportionally with CO

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24
Q

What happens to the rate of erythropoiesis during pregnancy in the mother?

A

Increases

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25
What happens to the Hb in the mother?
It decreases due to dilution -> decreases the blood viscosity
26
What happens to the mother's iron requirements during pregnancy?
Demand increases - supplements needed.
27
What is the effect of progesterone on the mother's respiratory function?
It lowers the CO2 levels (increases CO2 sensitivity in respiratory centres) - increases RR - increases tidal and minute volume - pO2 decreases slightly - vital capacity and PO2 don't change
28
What effect does pregnancy have on the mother's O2 consumption?
Increases to meet the metabolic demand of mother, placenta and foetus
29
What happens to the glomerulate fitration rate in the mother during pregnancy?
Increases 30-50%, peaks at 16-24 weeks
30
What happens to the mother's renal plasma flow during pregnancy?
Increases 30-50%, peaks at 16-24 weeks
31
What postural changes affect the renal function during pregnancy?
Upright position -> decrease Supine position -> increase Lateral position during sleep -> big increase
32
What happens in pre-eclampsia to the renal blood flow and glomerular filtration rate?
It decreases
33
What happens to the kidney function during pre-eclampsia and what does it result in?
It declines leading to salt and water retention - leading to oedema (especially in the hands and face)
34
What are the risk factors for pre-eclampsia?
HISTORY OF PRE-ECLAMPSIA, FH, pre-existing HT, autoimmune diseases, diabetes, obesity, multiple gestations, renal disease
35
What happens in eclampsia?
Vascular spasms, extreme HT, chronic seizures and coma
36
How is eclampsia treated?
With vasodilator and caesarean section.
37
How many extra calories should be ingested each day during pregnancy?
250-300 kcal/day
38
What happens during the mother's anabolic phase of pregnancy?
Insulin sensitivity increases lower plasmatic glucose level lipogenesis, glycogen stores increase growth of breasts, uterus, weight gain
39
What happens during the mother's catabolic phase of pregnancy?
Accelerated starvation Maternal insulin resistance increased transport of nutrients through placental membrane Lipolysis
40
Which hormones cause insulin resistance in the mother during the catabolic phase?
HCG, cortisol and growth hormone
41
What does giving folic acid (folate) reduce the risk of?
Neural tube defects
42
Which hormone increases the contraction and excitability of the uterus and where is it produced?
Oxytocin - maternal posterior pituitary gland
43
What does the stretch of the cervix stimulate?
Uterine contractions and can cause further oxytocin release
44
Which hormone stimulates the growth of the ductile system?
Oestrogen
45
Which hormone stimulates the development of the lobule-alveolar system?
Progesterone
46
Which hormones inhibit milk production?
Oestrogen and progesterone - drop in their levels following birth
47
Which hormone stimulates milk production?
Prolactin
48
At what stage of pregnancy will a multiple pregnancy be detected?
During US scan at 12 weeks
49
How is a multiple pregnancy managed?
- More frequent antenatal visits - detailed 18 week scan - regular scans from 28 wks for growth - routine iron supplementation - warning mother about higher risks
50
What is the maximum amount of weight a woman should put on during pregnancy?
10kg
51
What is the first line hypoglycaemic drug in gestational diabetes?
Metformin - prevents weight gain
52
At what foetal weight will pregnant women with gestational diabetes be offered a caesarean section due to shoulder dystocia risk?
Greater than 4.5kg
53
What is the definition of a pre-term birth?
Delivery between 24 and 36+6 weeks
54
What are the survival rates for a baby born at 24 weeks? And are there any long term impacts?
20-30% | Likely to have cognitive difficulties
55
What are the aetiological factors involved in pre-term birth?
- Infection - Over distension: multiple, polyhydramnios - Placental abruption - Intercurrent illness : UTI, appendicitis, pneumonia - Cervical incompetence - Idiopathic - Teenagers - Smoking - Uterine anomalies
56
How do you class a small for gestational age (SGA) baby?
An infant with a birthweight that is less than the 10th centile for gestation corrected for maternal height, weight, foetal sex and birth order.
57
What effect does smoking have during pregnancy?
Affects the vasculature of the placenta and can result in poor growth of the foetus -> intrauterine growth restriction (IUGR)
58
What are the two types of intrauterine growth restriction?
``` Asymmetrical = normal head and small abdomen Symmetrical = small head and small abdomen ```
59
What is the Hadlock equation?
Used to calculate the foetal weight using the head circumference, the abdominal circumference and the femur length.
60
What does cardiotocography measure?
CTG measures the foetal heartbeat and the uterine contractions during pregnancy
61
What is meant by accelerations on a CTG?
An increase in foetal heart rate at the start of a uterine contraction and returning to the baseline rate before or sometimes after the contraction - this indicates good reflex reactivity of the foetal circulation.
62
What does the loss of baseline variability mean in a CTG?
This is when the baseline foetal heart rate has a variability of less than 5 bpm - can be caused by sedative or analgesic drugs used in labour. Babies can sleep for about 45 mins but after that begin to get concerned about asphyxia.
63
What are late decelerations associated with on an CTG?
When the deceleration's lowest point is past the peak of the uterine contraction - usually associated with asphyxia. The longer the lag time, the more serious the foetal asphyxia. Want to deliver the baby right away.
64
When there is restriction in the blood flow to the foetus resulting in weight restriction what will a middle cerebral artery Doppler show?
Increased blood flow to the brain - brain is prioritised, When the blood flow to the brain decreases that you want to become concerned.
65
Which Doppler scan is the last to become abnormal in foetal complications?
The ductus venosus Doppler.
66
When does pregnancy induced hypertension typically occur?
Within the second half of pregnancy. And should resolve around 6 weeks after delivery
67
What are the characteristic symptoms of pre-eclampsia?
Hypertension Proteinuria Oedema
68
What is the pathogenesis involved in pre-eclampsia?
In the first stage there is abnormal placental perfusion. | Second stage involves the maternal syndrome - thrombophilia, hyperpermeability etc.
69
Which antihypertensives can be given during pregnancy?
IV Labetolol | IV Hydralazine
70
What is given to treat seizures in eclampsia?
IV Magnesium Sulphate | If persistent can consider diazepam
71
Which drug can be given as prophylaxis for those at high risk of developing pre-eclampsia?
Low dose aspirin
72
Which psychiatric illness is the baby predisposed to if the mother has a viral illness in the 2nd trimester of pregnancy?
Schizophrenia - small but measurable increase. | More common in spring-born babies as more likely to catch illness over winter months.
73
When should folic acid be taken during pregnancy?
400mcg daily for 3 months prior and first 3 months of pregnancy
74
List some teratogenic drugs
``` ACEI Androgens Antiepileptics Cytotoxics Lithium Methotrexate Retinoids Warfarin ```
75
Which diabetic drugs are not safe to take during pregnancy?
Sulfonylureas
76
Which drug should be given to treat hypertension during pregnancy?
Labetalol | Methyldopa
77
Which drug should be used to treat nausea and vomiting in pregnancy?
Cyclizine safest
78
Which drug can be used to treat a UTI during pregnancy?
Amoxicillin or cefalexin
79
Which drug should be given to women with significant risk factors for DVT?
Low molecular weight heparin
80
What are the signs of foetal alcohol syndrome?
``` Short palpebral fissures Flat midface Short nose Indistinct philtrum Thin upper lip ```
81
Which drug is partially associated with cleft lip and palate?
Phenytoin - antiepileptic
82
What foetal effects can taking valproate during pregnancy have?
Neural tube defects - spina bifida and anencephaly
83
How can cocaine affect pregnancy?
Causes vasoconstriction within the placenta causing it to separate -> Placental abruption
84
What are the clinical features of placental abruption
Sudden tender abdomen Vaginal bleeding Tense uterus Uterus feels large for dates
85
What is placenta praevia?
Abnormally sited placenta
86
What are the clinical features of placental praevia?
``` Painless High presenting part - head not engaged 3rd trimester bleeding - variable amount Soft uterus Malpresentation ```
87
How is placental praevia diagnosed?
During the 20 week scan and 32/34week scan
88
What is placenta accrete?
Blood vessels and tissues from the placenta invade the myometrium of the uterine wall
89
What is placenta percreta?
When the placenta tissue invades deep enough to reach the serosa
90
How is a uterine rupture managed?
Caesarean section
91
What is the first observation to change in a pregnant woman with blood loss?
Pulse - rises before there is any affect on blood pressure | Good sign of significant hypovolaemia = pulse rate rises above her systolic blood pressure
92
Which hormone causes morning sickness in the first trimester of pregnancy?
beta-HCG
93
When are foetal movements usually first felt in pregnancy?
20 weeks in a primigravida mother | 16-18 weeks in subsequent pregnancies
94
When during pregnancy can amniocentesis be carried out?
15-20 weeks
95
When during pregnancy can chorionic villus sampling be carried out?
11-14 weeks
96
When during pregnancy can foetal blood sampling be carried out?
18+ weeks

Reproduction (12 decks)

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