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Pregnancy Flashcards

1
Q

In what conditions is morning sickness worse?

A

-Where Human Chorionic Gonadotrophin (hCG) is higher - twins, molar pregnancies

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2
Q

What can morning sickness progress to?

A

Hyperemesis gravidarum

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3
Q

What happens to cardiac output during pregnancy?

A 
It increases (by 30-50%)
(SV and HR both increase - can cause palpitations)
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4
Q

What happens to blood pressure in the second trimester?

A

Bloop pressure drops

(Expansion of the uteroplacental circulation
A fall in systemic vascular resistance
A reduction in blood viscosity
A reduction in sensitivity to angiotensin)

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5
Q

What happens to urine output in pregnancy?

A

Increased urine output

Increase in Renal plasma flow/GFR, decrease in serum urea and creatinine

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6
Q

What happens to risk of UTI in pregnancy?

A

Increase in UTI risk - due to urinary stasis

Increased risk of pyleonephritis (risk of preterm labour!)

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7
Q

What happens to the percentage of haemoglobin in the blood with pregnancy?

A

It drops

despite a rise in RBC, due to a bigger rise in plasma volume

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8
Q

When should iron supplements be given in pregnancy?

A

If Hb < 110 at booking appointment, or less than 100 at routine testing at 28 weeks.

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9
Q

What happens to respiratory rate in pregnancy?

A

Increases

Increased Tidal Volume and plasma pH

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10
Q

What happens to peristalsis in pregnancy?

A

Peristalsis is slowed (due to ^progesterone and reduced motilin)

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11
Q

What sort of things may be explored in pre-pregnancy counselling?

A 
Diet
Obesity (BMI)
Reducing alcohol
Smoking cessation
Folic acid (400mcg)
Risk Assessment - including age, parity, occupation, substance misuse,
known medical problems
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12
Q

What kind of things should be considered with known medical problems during pregnancy?

A

Optimise maternal health

Psychiatric health is important

Stop/Change any unsuitable drugs

Advise regarding complications associated with maternal medical problems

Occasionally advise against pregnancy

Particular considerations for diabetes, epilepsy and renal problems

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13
Q

What would take place during an antenatal examination?

A

Identify problems w mother, fetus, social

Routine enquiries - feeling well, feeling fetal movements
Blood pressure
Urinalysis
Abdominal Palpation

(Checks for pre-eclampsia, diabetes, UTI)

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14
Q

What would be assessed in abdominal palpation during antenatal examination?

A
  • Assess symphyseal funsal height (SFH)
  • Estimate size of baby
  • Estimate liquor volume
  • Determine fetal presentation/position
  • Listen to fetal heartbeat
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15
Q

What types of infections mat be screened for antenatally?

A 
Rubella
Hepatitis B
Syphilis
HIV
MSSU

(Other screened conditions include iron deficiency anaemia and isoiummunisation (Rhesus disease etc)

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16
Q

What can a screening first visit ultrasound scan reveal?

A

Ensure pregnancy viable
Multiple pregnancy
Identify abnormalities incompatible with life
Offer and carry out Down’s syndrome screening
Estimated Due Date

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17
Q

What factors increase Down’s Syndrome risk?

A

Maternal age

Personal/family history of chromosomal abnormality

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18
Q

When is a first trimester screening carried out?

A

10-14 weeks

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19
Q

What is measured in a first trimester screening?

A

Maternal risk factors,
Serum beta-human chorionic gonadotrophin (beta-hCG)
Pregnancy associated plasma protein A (PAPP-A)
Fetal nuchal translucency (NT) measurement

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20
Q

What aspect of nuchal translucency is related to incidence of chromosomal abnormalities?

A

Size of NT

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21
Q

What other testing may be offered if chance of Down’s Syndrome is >1 in 150

A

CVS (chorionic villus sampling >10-14wks)
Amniocentesis (>15wks)
Non-invasive Prenatal testing

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22
Q

What neural tube defects may be detected in first trimester ultrasound?

A

Anencephaly

Spina Bifida

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23
Q

What is a second trimester ultrasound used to detect?

A

Soft markers for chromosomal abnormalities

Major structural abnormalities (eg exomphalos, cleft lip)

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24
Q

What is screened for in second trimester biochemical screening?

A

-Alpha fetoprotein

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25
Q

What happens to metabolism during pregnancy?

A

Hypermetabolism

Geared towards fat metabolism

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26
Q

List some general health changes in pregnancy?

A
  • Mechanical (^ Spine curvature)
  • Metabolism (^)
  • Fatigue – particularly early pregnancy
  • Heartburn/reflux
  • Oedema (retain salt/water)
  • Breasts
  • Thyroid
  • General state of immunosuppression
  • Weight gain
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27
Q

List some breast changes during pregnancy?

A
  • Increase size/vascularity
  • Increased pigmentation of areola/nipple
  • Secondary areola appears
  • Appearance of montgomery tubercles on areola
  • Colustrum from end of 3rd month
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28
Q

Roughly how much does circulating blood volume increase by during pregnancy?

A

~50-70%

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29
Q

What happens to systemic vascular resistance during pregnancy?

A

It falls

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30
Q

What happens to cardiac output in pregnancy when in the supine position?

A

It reduces (25%)

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31
Q

What position must a pregnant woman be in during resuscitation?

A

Left lateral tilt

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32
Q

What happens to cardiac output during labour?

A

Increases by 10%

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33
Q

What happens to cardiac output in the first hour post delivery?

A

Increases by 80%

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34
Q

How long do cardiovascular pregnancy changes take to return to normal?

A

3 months

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35
Q

What happens to respiratory rate in pregnancy?

A

Increases

36
Q

What happens to tidal volume in pregnancy?

A

Increases

37
Q

What happens to functional residual capacity in pregnancy?

A

Decreases

38
Q

What happens to PEFR and FEV1 during pregnancy?

A

Unchanged

39
Q

What happens to PCO2 in pregnancy?

A

Decreases

40
Q

What happens to renal plasma flow in pregnancy?

A

Increases

41
Q

What happens to GFR in pregnancy?

A

Increases

42
Q

What happens to creatinine clearance in pregnancy?

A

Increases

43
Q

What happens to protein excretion in pregnancy?

A

Increases

44
Q

What happens to plasma urea in pregnancy?

A

Decreases

45
Q

What happens to WCC in pregnancy?

A

Increases

46
Q

What happens to Platelets in pregnancy?

A

Decreases/Unchanged

47
Q

What happens to CRP in pregnancy?

A

Unchanged

48
Q

What happens to ESR in pregnancy?

A

Increases

49
Q

What happens to plasma creatinine in pregnancy?

A

Decreases

50
Q

What happens to Urate in pregnancy?

A

Decreases, but increases with gestation

51
Q

What happens to 24 hr protein in pregnancy?

A

Increases

52
Q

What happens to Total protein in pregnancy?

A

Decreases

53
Q

What happens to Albumin in pregnancy?

A

Decreases

54
Q

What happens to AST/ALT/GGT in pregnancy?

A

Decreases/Unchanged

55
Q

What happens to Alk Phos in pregnancy?

A

Increases (Placental production)

56
Q

What happens to Bile acids in pregnancy?

A

Unchanged

57
Q

What happens to D dimer in pregnancy?

A

Increases

58
Q

What substances are addictive to the fetus and can cause withdrawals at birth?

A

Heroin
Methadone
Benzodiazepines

59
Q

In phenylkutoneria, the metabolism of what essential amino acid is affected?

A

Phenylalanine

60
Q

What needs to happen to pregnant women with type 2 diabetes on oral hypoglycaemic medication?

A

Switch to insulin

61
Q

What pregnancy complications are diabetic patients more at risk of?

A

Pre-eclampsia
Stillbirth
Macrosomia

62
Q

What is sodium valproate associated with in pregnancy?

A

Spina bifida

63
Q

What is customary for delivery after two previous caesarean sections?

A

Elective caesarean

64
Q

What actions can be taken to reduced recurrence risk of DVT/Pre-eclampsia in a subsequent pregnancy?

A

Thromboprophylaxis

Low dose aspirin

65
Q

What actions can be taken to reduced recurrence risk of pre-term delivery/growth restriction/abnormality in a subsequent pregnancy?

A

Treatment of infection
High dose folic acid
Low dose aspirin

66
Q

When may External Cephalic Version (ECV) be offered in pregnancy?

A

If the baby remains in breech position after 36 weeks

If declined or failed, usually delivered by caesarean

67
Q

What can congenital rubella syndrome cause in pregnancy?

A

Mental handicap
Blindness
Deafness
Heart defects

68
Q

What is the natural rate of twinning in pregnancy?

A

1 in 90

69
Q

Why is the natural rate of twinning increasing?

A

Assisted reproduction techniques (ARTs)

Ovulation Induction

70
Q

What factors increase chance of dizygotic twins?

A 
Age
Parity
Weight
Height
Family history
71
Q

What features increase suspicion of diagnosis of multiple pregnancy?

A
  • Large for date uterine size
  • Multiple fetal heart rates are detected
  • Multiple fetal parts are felt
  • HCG + maternal serum alpha-fetoprotein is elevated for gestational age
  • Pregnancy with ART
  • Confirmed by ultrasound
72
Q

What type of twins are most common?

A

Diamniotic/Dichorionic Dizygotic twins

73
Q

What are possible complications of multiple pregnancy?

A
  • High perinatal mortality + morbidity
  • Abortion
  • Nausea + Vomiting
  • Preterm labour
  • IUGR
  • PET
  • Polyhydramnios
  • Congenital anomalies
  • Postpartum haemorrhage
  • Placental abruption, placenta previa
  • Discordant twin growth
  • Malpresentation, cord prolapse, operative delivery
74
Q

How does twin-twin transfusion occur?

A

Monochorionic twins (20-25%) - one fetus donates blood to the other due to vascular anastomosis

Recipient will have heart failure, Polyhydramnios, Hydrops

Donor will have IUGR + Olgiohydramnios

75
Q

What is involved in management of twin-twin transfusion?

A
  • Amnio-reduction of recipient twin
  • Intra-uterine blood transfusion for donor twin
  • Selective fetal reduction
  • Fetoscopic lase ablation of placenta; anastomosis
76
Q

What is involved in antenatal management of multiple pregnancy?

A
  • Adequate nutrition
  • Prevent anaemia
  • Frequent antenatal visits
  • Ultrasound
  • Multifetal reduction may be offered in first trimester
  • Preterm labour risk
77
Q

What happens to mortality and cerebral palsy rates with increased multiple pregnancy?

A

Increases

78
Q

What is the average pregnancy length for twins?

A

36-37 weeks

79
Q

How would a dichorionic diamniotic multiple pregnancy present on scan?

A

Two separate placenta and two sacs

Lamda sign

80
Q

How would a monochorionic monoamniotic multiple pregnancy present on scan?

A

One sac, and one placenta

T sign

81
Q

How should symphysiofundal height be interpreted?

A

Should usually be + or - 3cms of gestational age in weeks

82
Q

What investigations should be used in suspicion of a baby that is small or large for dates?

A

Ultrasound scan

83
Q

What measurements would be used on scan of a baby that is large/small for dates?

A
  • Abdominal circumference
  • Femur length
  • Head circumference
  • Liquor volume (Amniotic fluid index)
84
Q

What factors are associated with small for dates babies?

A 
Low BMI, maternal build
Age
Ethnicity, familial/genetic
Social class
Smoking
Substance misuse
Alcohol use  - Fetal Alcohol syndrome
Maternal disease (Preeclampsia, chronic hypertension, severe asthma, autoimmune disorders eg SLE, repeated antepartum haemorrhages)
Infections (Toxoplasma, CMV)
Fetal abnormality, chromosoal abnormality (Turners)
85
Q

What factors are associated with large for dates babies?

A 
Parity (multiparity)
Ethicity/familail/genetoc/social class
Maternal diabetes
Polyhydramnios
Multiple pregnancy
86
Q

What tests can be used to confirm fetal wellbeing?

A 
Confirm good fetal movement
Fetal Cardiotocograph (CTG)
Good doppler blood flow in umbical artery

Reproduction (15 decks)

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