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Conditions + definitions > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

What does Laxin do?

A

Relaxes joints

This includes non-mobile joints like the pubic symphysis

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2
Q

Why is anaesthesia dangerous in pregnancy?

A

It often leads to aspiration

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3
Q

Why are pregnant women likey to get oedema?

A

They are less likely to secrete sodium ions, leading to accumulation of fluid

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4
Q

What is oedema associated with in pregnancy?

A

Preeclampsia

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5
Q

How much weight do women tend to gain in pregnancy?

A

10-14kg

Split in to 2kg in first semester, 5kg in second/third

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6
Q

Why are pregnant women more susceptible to thyroid issues?

A

Relative iodine pregnancy as actively transported to child
Thyroid often increases in size
Note - if already deficient, can lead to goitre

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7
Q

What are the changes in breast in pregnant women?

A 
Increased size and vascularity
Increased pigmentation of areola/nipple
Secondary areola ppears
Montogomery tubercles appear on areola
Fluid can be secreted from 3rd month
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8
Q

What was the biggest cause of maternal death in pregancy in previous years?

A

Cardio vascular diseasecomplications

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9
Q

What are the cardiovascular changes in pregnant women?

A

Increased circulating blood volume (50-70%)
Systemic vascular resistance falls (prostaglandins partially responsible)
Increased blood flow
Increase Cardiac output, and heart rate (upto 10-20)
Increase oxygen consumption

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10
Q

Why is it dangerous to be in the supine position when pregnant?

A

Can compress IVC

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11
Q

Why are epidurals the preferred pain reduction method?

A

Anaesthesia can cause regurg

Also reduces peripheral resistance so decreases cardiac problems

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12
Q

What are the intrapartum cardiovascular changes?

A

Autotransfusions of contractions
Pain due to increasing catecholamines
Cardiac outputs increase by 10% in labour
By 80% in post delivery hour although not safe until after 3 months

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13
Q

What are the respiratory changes in a pregnant woman?

A

Increase in oxygen demand
Increase in ventilation/resp rate
Increased tidal volume
PEFR + PEV1 unchanged
PCO2 decreases (like mild respiratory alkalosis)
Work harder, but reduced expansion potential

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14
Q

What are the renal changes in a pregnant woman?

A

Dilation or urinary collecting system, more dramatic on right
Increased renal plasma flow
Increased GFR + creatine clearance (up to 50%)
Protein excretion increased
Microscopic haematuria may be present
Glycosuria common
Decreased urea, increased urate, decreased ceatinine

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15
Q

How does uric acid change in pregnancy?

A

Increases with gestational age
Almost 10x per gestational week

Also rises in preeeclampsia
Above 600 risk of neonatal death

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16
Q

What are the haematological changes in pregnancy?

A 
Plasma volume increases
Decreased haemoglobin (dilutional)
Decreased platlet count
Increased need of iron (iron def. anaemia common) + folate
WCC increases (although relative immunocompromised)
Hypercoagulable (DVT ~1%)
Albumin drop (oedema common)
Alk phos up (placenta, within thousands)
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17
Q

What is labour?

A

The process where the placenta, foetus and membranes are expeled into the birth canal

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18
Q

What is normal labour?

A

Wher labour occurs spontaneously at term(37-42 weeks)
WIth foestus presenting by vertex and resulting in spontaneous vaginal birth
May not feel normal to mother

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19
Q

What must occur for labour to happen?

A

Cervix softening
Myometrial tone changes to allow for co-ordinated contractions
Progesterone decreases whilst oxytocin increases to initiate labour

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20
Q

What are the subcategories of the first stage of labour?

A

Latent stage

Established stage

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21
Q

What is the latent part of the first stage of labour?

A

Stage of intermittent, often irregular, painful contractions
Bring some cervical enlargement up to 4 cm
Can last a long time

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22
Q

What is the established part of the first stage of labour?

A

Regular, painful contractions resulting in progressive effacement and dilation of cervix from 4cm

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23
Q

When is the first stage of labour complete?

A

At 10 cm dilation

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24
Q

What is the anticipated progress of the first stage of labour?

A

0.5-1cm/hour

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25
Q

How long does the first stage of labour take?

A

In a primagravida (first time pregnant) around 8 hours

In a multigravida (more than once) around 5 hours

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26
Q

What are the parts to the second stage of labour?

A

Passive phase

Active phase

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27
Q

What s the second stage of labour?

A

From full cervical dilation to the birth of the baby

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28
Q

What is the passive phase of the second stage of labour?

A

Finding of full dilatation of cervix before (or in abscence of) inv9oluntary expulsive contractions
Allow for further foetal descent

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29
Q

What is the active phase of the second part of labour?

A

Presenting part is visible
Expulsive contractions with finding of full cervix
Active maternal effort following confirmation of full cervix dilatation in absecen of expulsive contractions

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30
Q

How long is birth expected within the second (active phase) of labour starting?

A

2 hours in primagravida

1 hour in multigravida

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31
Q

What is the third stage of labour?

A

From after birth of baby, to expulsion of placenta/membranes

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32
Q

What does the active management of the third stage of labour entail?

A

Routine use of uterotonic drugs
Deferred clamping/cutting of the cord
Controlled cord traction after signs of seperation of placenta

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33
Q

What does the physiological management of the third stage of labour entail?

A

No routine use of uterotonic drugs
No clamping of cord until pulsation has stopped
Delivery of placenta by maternal effort

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34
Q

When do you diagnose a prolonged 3rd stage of labour?

A

30 minutes if active management

60 minutes if physiological management

35
Q

What investigations should be used to monitor labour + its progress?

A

Stats (BP, HR, temp, RR, O2, urine output + urinalysis)
Abdominal palpation
Vaginal examination
Monitor of liquor after rupture of membrane
Foetal heart auscultation (intermittent/continous)
Palpation of uterine muscle contractions
External signs

36
Q

What are the external signs of labour?

A

Rhomboid of michaelis (sacrum pushing outwards)

Anal cleft line restlesness

37
Q

What are you looking for in a vaginal examination during labour?

A 
Assessing presentation
Engagement + station (how far down)
Position
Cervical effacement + dilatiation
Membranes (present/absent?)
38
Q

What are you monitoring with abdominal palpitations?

A

Foetal lie
Presentation
Attitude (posture of foetus - flexion, deflexion, extension)
Denominator (a bony landmark used to denote position, differs by lie)
Position
Engagement

39
Q

What are the different foetal lies?

A

Longitudinal (cephalic, breech)
Oblique
Transverse

40
Q

What is the presentation that has the smallest diameter of the baby’s head through the pelvis?

A

Subocccipitobregmatic

Where baby has chin on chest, with back/top coming first

41
Q

What determines the position in labour?

A

It is in relation to the occiput (posterior fontanelle)

42
Q

What are the mechanisms of labour?

A 
Descent 
Flexion
Internal rotation of head
Crowning/extension of head
Restitiution
Internal rotation of shoulders
External rotation of head
Lateral flexion
43
Q

What analgesia is used in labour?

A 
Breathing, 
massage, 
tens, 
parecetamonl, 
dihydrocodeine
Water
Entonox
Opioids
Epidural
Maternal position
44
Q

What are the risks of induction?

A

Too many contractions (stresses baby)

More pain relief may be needed

45
Q

What are the indications of induction?

A

Dibates (usually earlier than due date)
Post dates
Maternal health problem necessitating it
Foetal reasons (growth concerns etc)

46
Q

What is induction?

A

Artificially instigating labour through medications and/or devices
Followed by artifical rupture of uterine membranes

47
Q

What is used to determine if induction will be successful?

A

Bishop’s score

48
Q

What tools are used to “ripen” the cervix?

A 
Prostaglandin pessarie (pharmacological opening)
Cook baloon (mechanical opening)
49
Q

How do you rupture the foetal membranes?

A

With a sharp device - amniohook

50
Q

When should you adminster Oxytocin IV?

A

After water has been brken

Does not give as good a response if unbroken water

51
Q

What are the benefits of the baloon to the pessary?

A

Only takes 12-24 hours (instead of 2-3 days)

No risk of hyperstimulation of uterus (contractions)

52
Q

What is meant by powers, passage and passenger?

A

Powers - contraction
Passage - birth canal
Passenger - baby

53
Q

What can lead to inadequate progress?

A 
Cephalopelvic disproportion (rare!)
Malposition
Malpresentation
Inadequate uterine activity
Other obstruction
54
Q

What is the risk of an obstructed uterus?

A

Uterine rupture

55
Q

What is used to determine the progress of labour?

A

Cervical effacement + dilation

Descent of foetal head through maternal pelvis

56
Q

What is inadequate uterine activity?

A

Where contractions are inadequate resulting in no descent of the foetal head through the pelvis
Cervix does not dilate

57
Q

What is presentation?

A

Is the part of the baby heading towards the vagina

58
Q

Why is cord prolapse an obstetric emergency?

A

The cord vasospams when it hits cold air and starves child of oxygen
Needs immediate delivery

59
Q

What is malposition?

A

Where cervic presentation isn’t Occiptal anterior

60
Q

What positions can be birthed?

A

OA

OP (with some difficulty)

61
Q

How do you monitor the foetus during labour?

A

Austlation of heart (intermittent/continuous)
Foetal blood sampling
Foetal ECG

62
Q

When would you take a foetal blood sample?

A

When there is an abnormal CTG

63
Q

What does a goetal blood sample provide?

A

pH + base excess

pH = hypoxia? (if acidic)

64
Q

How do you interpret a CTG?

A

Deceleration = stress
Multiple changes is good
Flat, long to change bad

65
Q

When do you advise against labour?

A 
Obstruction to birth canal
Malpresentations (transverse, shoulder, hand)
Some medical conditions
Specific previous labour complications
Foetal conditions
66
Q

What are the two types of instruments used to help birth?

A

Forceps

Vacuum cup

67
Q

What are the benefits/negatives of a c section?

A

Carries risk of bleeding, visceral injury + VTE

Reduced risk of perniela injury

68
Q

What are the 4ts of post partum haemorrhage?

A

Tears (trauma)
Tone
Tissue
Thrombin

69
Q

What are the complications of the 3rd stage of labour?

A

Retained placenta

Post partum haemorrhage

70
Q

What is the puerperium?

A

A post partum period where you bleed after giving birth

71
Q

How is the mother managed after giving birth?

A

Midwife looks after for first 9-10 days
GP checks after 6 weeks
Look for signs of abnormal bleeding
Evidence of infection

72
Q

What are teh common problems with mothers after birth?

A

Problems with infant feeding
Problems with bonding
Social issues

73
Q

What are the common post natal problems?

A 
Post partum haemorrhage
Venous thromboembolism
Sepsis
Psychiatrid disorders
Pre-eclampsia
74
Q

What is primary post partum haemorrhage?

A

Blood loss great than 500mls within 24 hours of delivery

75
Q

What is secondary post partum haemorrhage?

A

Blood loss more than 500ml from 24hours post partum to 6 weeks

76
Q

What can cause secondary post partum haemorrhage?

A

Retained tissue
Endometritis
Tears/trauma

77
Q

When should you suspect thromboembolic disease?

A

Women with unilateral leg swelling/pain
SOB/chest pain
Unexplained tachycardia
C-section/immobilisation

Retain high index of suspicion in pregnant/post natal woman as hypercoaguable state

78
Q

How do you investigate thromboembolic disease in pregnancy/post partum?

A

ECG
Leg gopplers
CXR / VQ scan

NOT D-dimer

79
Q

How do you treat thromboembolic disease in pregnant women?

A

LMWH (heparin)

Warfarin in breast feeding okay, but teratogenic

80
Q

What is the leading cause of maternal death?

A

Sepsis

81
Q

How should you treat sepsis in a pregnant woman (or suspicion of)

A

IV antibiotics ASAP

82
Q

What are the types of psychiatric problems post natally?

A 
Baby blues (normal)
Post-natal depression (classical depressive symptoms - treat)
Puerperal psychosis (dangerous to baby/mum should be detained)
83
Q

When do most eclamptic periods occur?

A

In post natal period

May worsen several days following delivery, or develop post natally

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