Pregnancy And Antenatal Care Flashcards
What 3 STIs are part of routine antenatal screening
HIV, STS, hep B
Why do vulval varices occur in pregnancy
Increased intra abdominal pressure
What happens to the glycogen content of the vaginal epithelium in pregnancy
Increases
Vaginal PH on pregnancy increase or decrease
Decrease
STIs linked to infertility or sub fertility
CT, GC, LGV
STIs most likely to affect early pregnancy
BV, STS, TV
STIs most likely to affect late pregnancy
HSV, CT, GC, STS, TV
Complications of BV
Prem membrane rupture (PROM)
Increased risk of uterine and wound infection
Preterm labour and birth
PP endometritis
Pregnancy BV tx
Metronidazole 400mg BD/TDS 5-7 days
Clindamycin 300mg BD 7 days
Increased complications with PV tx in preg
Does routine BV screening affect preterm birth rates
No
TV pregnancy complications
Low birth weight,
Preterm birth
PROM
VVC preg complications
None
Goal of VVC tx in pregnancy
Symptom management
Pregnancy PID complications
Low birth weight
Prem delivery
PROM
Chorioamnionitis
PP sepsis
CT vertical transmission rate
Up to 50%
Can spread at CS
Most common neonatal comp of CT
Conjunctivitis
CT in pregnancy tx
1g Azithromycin
Erythromycin 500mg BD 14 days/QDS 7 days
Amoxicillin 500mg TDS
GC preg complications
Low birth weight
Prem delivery
PROM
PP sepsis
GC intrapartum infection rate if untreated
30-50%
GC pregnancy tx
Ceftriaxone 1g IM
Spectinomycin 2g IM
Azithromycin 2g orally
HSV intrapartum transmission rate in primary infection
30-50%
Does CS negate HSV transmission risk
No, only reduce
How does STS transmit in pregnancy
Trans placentally
Complications of STS tx in pregnancy
Jarisch-Herxheimer reaction - can cause fetal distress/premature labour
STS tx in pregnancy
Benzathine Penicillin 2.4 million units IM once/three times
Exposure therapy required if mother allergic to penicillin
Complications of warts in pregnancy
1 in 400 chance of neonatal transmission
(Causing juvenile respiratory papillomatosis)
Wart tx in pregnancy
Cryo
85% bi/trichloroacetic acid
Surgery
Hep b vertical transmission risk
At birth only
90% if e antigen positive
10% if e antigen negative
Hep B in neonate prevention
Hep B immunoglobulin immediately after birth
Hep B vaccine in 12 hours
3 more doses at 1,2,12 months
HIV in pregnancy modes of transmission
In utero, during delivery, breastfeeding
Maternal risk factors for hiv transmission in pregnancy
High viral load
Low CD 4
Intrapartum risk factors for hiv transmission
Prolonged rupture of membranes in viral load >50
Vaginal delivery if viral load >50
Infant risk factors for hiv transmission
Prematurity
Breastfeeding
Untreated HIV transmission rates
35% (15% breastfeeding)
When is HIV tx advised in trim 1
If CD4 <200 VL>100,000
Otherwise start by wk 24
HSV complications for the mother
Dissemination
HSV risk to neonate
Dissemination (70%)
Significant morbidity and mortality
Skin/eye/mucus membrane infection (30%)
Why is primary HSV so dangerous to neonate
Prolonged cervicitis
High viral load
No time for maternal antibodies to develop
Heart changes in pregnancy
12% enlargement
Lateral displacement of apical beat
Increased intracardiac volume (80ml)
Plasma volume increase in pregnancy
50%
How does estrogen contribute to increased blood circulation in pregnancy
Increased oestrogen stimulates renin angiotensin system, increasing aldosterone, increasing na+ reabsorption
Increased red cell percentage In pregnancy
30%
Cardiac output increase in pregnancy
40%
What causes increased cardiac output in pregnancy
Increased stroke volume and increased heart rate
Changes in BP in pregnancy
Slight drop in systolic
Larger drop in diastolic
Widened pulse pressure
What happens to vascular resistance in pregnancy
Decreases
Common heart murmur of pregnancy
Ejection systolic
Pregnancy ECG changes
15-20 degree left axis shift
St segment depression
T wave flattening
What is the effect of the hyperventilation of pregnancy
Mild respiratory alkalosis (CO2 breathed off)
What are the chances on pregnancy lung volumes
Increased tidal volume
(Smaller inspiritory reserve, smaller expiratory reserve, smaller residual)
Effects on lung capacity in pregnancy
Decreased total capacity
(No change in vital capacity, increase in inspiritory capacity, decrease in functional)
Why why is there increased acidity of stomach acid in pregnancy
Increase in production of gastrin increases stomach volume and acidity of secretions
What clotting factors increase in pregnancy
Fibrinogen and factor VIII +++
Factors VII, IX, X, XII +
What clotting factor is majorly reduced?
Factor XIII
Average weight gain in pregnancy
12.5kg
Base tissue of the placenta
Trophoblast
What is the chorion
Where the trophoblast is penetrated by fetal mesoderm
What does the embryonic body stalk become
Umbilical cord
Why does uterine atony cause pph
Terminal maternal arterioles lose their elastic reticulum - they can’t clamp themselves
What cells produce hcg
Syncytiotrophoblast
What hormones share an alpha subunit?
LH, FSH, TSH, hCG (glycoprotein hormones)
Where is relaxin produced
Corpus luteum
What does the placenta use to make estrogens
DHEAS (comes from fetal adrenal glands)
What is Wharton’s jelly derived from
Primary mesoderm
What is the umbilical vein in an adult
Ligamentum teres
What is ligamentum teres contained in
Falciform ligament
What is the only type of immunoglobulin that can cross the placenta
IgG
Would baby igM be diagnostic of congenital infection
Yes, igM cannot cross the placenta
What does hypersensitivity to GDF15 cause
Hyperemesis gravidarum