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BDS3 BAMS Diseases of Human Systems > pregnancy and perinatal health > Flashcards

pregnancy and perinatal health Flashcards

1
Q

contraception

A

used to help avoid pregnancy

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2
Q

conception

A

look for time in cycle when ovulation happens before and therefore pregnancy more likely

more often due to chance

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3
Q

possible fertility issues

7

A

social and environmental factors

  • Age
  • Smoking
  • BMI
  • Exercise
  • Drugs
  • Folate
  • Alcohol
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4
Q

folate and fertilisation

A

folic acid become increasingly recognised for a normal successful pregnancy

  • neural tube defects e.g. Spina Bifida
    • more likely to happen if folate is low – should take supplements
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5
Q

alcohol and fertiliry

A

neurological and developmental changes

  • foetal alcohol syndrome (very early into pregnancy)
    • avoid alcohol when trying
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6
Q

BMI and fertilisation

A

higher = harder

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7
Q

assisted contraception used when

A

fertility is a problem

IVF

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8
Q

age and fertilisation

natural Vs IVF

A
  • Chances of successful pregnancy reduce as female gets older
    • Success of IVF has similar trend
  • IVF success is the same as natural pregnancy success
    • Once fertilisation has occurred the implantation of the embryo has less chance of succeeding with age of mother (large drop after 34)
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9
Q

early pregancy stages

A

Timed from date of conception

  • Ovulation and then fertilisation in fallopian tube

Zygote spends first week travelling down fallopian tube before implanting into uterus (day 8-9)

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10
Q

when embryo implanted into uterus

A
  • undergoes developmental changes and maturity
    • Significant change in size and complexity
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11
Q

stages of pregnancy

A

3 trimesters

  • 0-12
  • 13-28
  • 29-40

characteristed by differnt stages in development

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12
Q

1st trimester development

A

0-12 weeks

structures of embryo are formed, tissues are differentiating

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13
Q

2nd trimester development

A

13-28 weeks

more specialisation and final differentiations

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14
Q

3rd trimester development

A

29-40 weeks

growth and acquisition of changes needed for successful birth

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15
Q

5 categories maternal changes in pregnancy

A
  • Physical changes
  • Hormonal changes
  • Haematological changes
  • Cardiovascular changes
  • Coagulation Changes
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16
Q

physical changes in pregnancy

A
  • total weight gain is 11-16kg
    • Breasts 0.5kg; Placenta 0.7kg; Uterus 1.6kg; Baby 3.5kg; Amniotic Fluid 1-1.5kg; Extra blood volumes and fluids 4kg (important as blood loss during birth – protects mother from hypovolaemia if significant bleeding at birth)
  • largest at 36 weeks before baby moves into birthing position lower down
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17
Q

3 hormonal changes in pregnancy

A
  • increased oestrogen and progestogen
  • lower oesphageal sphincter relaxes
  • hormonal changes increase reduce insulin sensitivity
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18
Q

effect of increased osetrogen and progestogen in pregnancy

A

act on kidney to increase Renin secretion

  • Increased salt & water retention
    • Increased plasma volume by 45%
      • Dilution effect makes Hb fall from 15-12g/dL - NORMAL
        • Doesn’t keep place with increased plasma volume – will appear low Hb compared to volume, but the absolute amount of Hb carrying oxygen to tissues remains high
        • Anaemia in pregnancy is often artificial anaemia as higher circulating volume but same Hb
      • Protects against haemorrhage at birth
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19
Q

how does hormonal changes in pregnancy protect against haemorrhage at birth

A

increased oestrogen and progestogen = increase renin secretion = increase salt and water retention

  • increased plasma volume by 45%
  • Dilution effect makes - Hb fall from 15-12g/dL - NORMAL
    • Doesn’t keep place with increased plasma volume – will appear low Hb compared to volume, but the absolute amount of Hb carrying oxygen to tissues remains high

Anaemia in pregnancy is often artificial anaemia as higher circulating volume but same Hb

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20
Q

effect of lower oesphageal sphincter relaxing in pregnancy

A

with increase abdominal pressure gievs increased risk of GORD

  • issue - be aware
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21
Q

effect of reduced insulin sensitivity in pregnancy due to hormonal changes

A

diabetes in pregnancy - esp if somone prone to type II

  • can result in change to mother and foetus
    • larger, heavier baby =complications on delivery
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22
Q

4 haematological changes in pregancy

A
  • increased production of RC, WC, Platelets
  • 20% increase in RC mass
  • Increased platelet consumption makes platelets normal to low
  • Increased WC makes diagnosing infections difficult
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23
Q

2 cardiovascular changes in pregnancy

A

relaxation of vascular smooth muscle

vascular compresssion by uterus

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24
Q

effect of relaxation of vascular smooth muscle in pregnancy

A
  • Reduced peripheral resistance
  • Reduced systolic and diastolic blood pressure – help cope with inc circulatory load
  • Compensatory increase in heart rate by 25%
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25
Q

effect of vascular compression by uterus in pregnancy

A
  • Vena cava and aorta
  • Difficulty with venous return when supine
    • Pressure on baby on vessels when mother supine can cause significant compression
      • Venous return through vena cava
      • Aorta Arterial supply to body
    • Allow mother to sit to one side or have a pillow under one area to help reduce this in dental care
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26
Q

dental impact of vascular compression by uterus

A

Allow mother to sit to one side or have a pillow under one area to help reduce this in dental care

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27
Q

coagulation changes in pregnancy

A
  • Coagulation screens remain normal
    • Clotting factor production increases
    • Fibrinolysis increases
  • Increased system sensitivity with increased DVT risk
    • can be complication
    • but Increased sensitivity of coagulation system so any haemorrhagic issues in birth can be addressed rapidly
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28
Q

position of baby in abdomen effect

A

Increase compression of bladder and bowel as size of baby increases

  • urgency
  • bladder issues
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29
Q

6 food categories to not eat in pregnancy

A
  • raw/slightly cooked meat and raw fish
  • raw eggs
  • non-pasteurised milk and milk cheese
  • spicy, grilled and fried food
  • marlin, tuna, shark
  • liver and other entrails and internal organs of a slaughtered animal during the initial 3 months of pregnancy (e.g. haggis)

PASSING INFECTION FROM MOTHER TO BABY RISK

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30
Q

risk due to raw/slighly cooked meat and fish

A

danger of infection with toxoplasmosis

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31
Q

danger of raw eggs

A

salmonella

32
Q

danger of non-pasteurised milk and milk cheese

A

listeria

33
Q

danger of spicy, grilled and fried food

A

dyspepsia and GORD

34
Q

danger of marlin, tuna and shark

A

mercury toxicity - on developing foetal brain

35
Q

when does development start

A

week 4

  • zygote becomes and embryo
    • neural tube, gut tube and brain begin
36
Q

week 6

A

start of embryonic circulation

  • Weeks 6-10 embryonic development & growth
    • Embryo stages stops at 10 weeks
37
Q

weeks 10-14

A

foetus

  • features and limbs become developed and active!
    • Mother may feel
38
Q

miscarriage rate highest

A

in first trimester (but can occur at any stage)

39
Q

causes of miscarriage

A
  • Maternal and foetal factors
    • Most naturally – abnormal development in embryo or foetus (genetic change, ability to maintain nutrients)
40
Q

second trimester development

(after week 14)

A
  • Hair, nails toenails and eyelids start to form
    • Movement may be felt
  • 18 weeks – toes and fingers formed and hearing starts to respond (special sensoy start)
  • 20-26 final development of vision and senses
    • Brain development and body fat increase
41
Q

18 weeks

A

toes and fingers formed and hearing starts to respond (special sensoy start)

42
Q

20-26 weeks

A
  • final development of vision and senses
    • Brain development and body fat increase
43
Q

third trimester development

A
  • Growth and nervous system maturation (and lungs)
  • Foetus will build up muscle and fat reserves in preparation of trauma of birth ahead
44
Q

placenta

A

connects baby to mother

  • interlinking mesh – maternal and foetal circulation do not mix
45
Q

how does placenta work

A

sit in close proximity to each other so nutrients can diffuse easily from one to the other

  • allows some infections and toxins to diffuse into foetus as well
    • placental barrier can prevent some
      • HIV cannot cross – acquired at birth
46
Q

how to lower risk of infection spread (HIV esp)

A

HIV cannot cross placenta barrier

acquired through natural birth

  • C-section less risky for child than normal delivery
47
Q

placenta made of

A

Large vascular organ

capillary base joined through a stalk to child,

umbilical cord carries blood from foetal side to placenta (belly button)

48
Q

labour stages

A

induction of labour

  • first stage
  • second stage
  • third stage - placenta delivery

1st and 2nd delivery baby

49
Q

stage of labour determined by

A

Depend on degree of dilation of cervix and how far baby is positioned through birth canal

50
Q

forceps in labour

A

Aid delivery of baby

  • Press sides of vagina away from baby’s - head making room for head to move lower down
    • Should have no contact with baby head
51
Q

ventoux in labour

A
  • Suction cup applied to top of head
52
Q

caesarean section

A

Through abdomen into uterus

  • lower chance of spread of some infections e.g. HIV
53
Q

umbilical cord healing

A

After birth umbilical cord is clamped

  • Allows baby circulation to maintain its own oxygenation
    • Vessels do not change – shut themselves off, allowing umbilical stump to necrose and fall off
54
Q

reason for screening in pregnancy

A

looking to establish certain facts about pregnancy

e.g. dates, number, placental structures, ectopic pregnancy, anatomy

55
Q

screening in pregnancy done by

A

ultrasound

56
Q

6 reasons for screening in first trimester

A
  • establish dates of a pregnancy
  • to determine number of foetuses and identify placental structures
  • diagnose an ectopic preganancy
  • diagnose miscarriage
  • examine the uterus and other pelvic anatomhy
  • detect foetal abnormalities
57
Q

why need to know number of foetuses

A
  • multiple births in humans are not common
    • complicated – tend to result in 2 smaller foetuses (less prepared for birth)
58
Q

ectopic pregnancy

A
  • development not taken place in uterus (implanted somewhere other than uterus)
    • egg released in abdominal cavity or retain within fallopian tube
  • can be a successful pregnancy but delivery will not be possible naturally
59
Q

why need to screen placenta

A
  • structure of placenta – failure of placenta development can compromise pregnancy
60
Q

why look at pelvic anatomy of pregnacy screening

A

assess any possible delivery issues

61
Q

18-20 week scan

10 points

A

detailed ultrasound

  • to confirm pregnancy dates
  • to determine the number of foetuses and examine the placental structures
  • to assist in prenatal tests such as an amniocentesis
  • to examine the foetal anatomy for presence of abnormalities
  • to check the amount of amniotic fluid
  • to examine blood flow patterns
  • to observe foetal behavior and activity
  • to examine the placenta
  • to measure the length of the cervix
  • to monitor foetal growth
62
Q

amniocentesis

A

prenatal test

  • amniotic fluid taken and has cells that have fallen of foetus
    • genetic assessment of DNA of foetus can be made – examine chromosomes
63
Q

screenings for mother for

A

chronic diseases e.g. diabetes

infectious diseases e.g. HIV, Hep B, Hep C

  • can be passed at delivery to baby
    • option for treatment during pregnancy possible but consideration to C section should be made – less chance of transmission
64
Q

foetus scanned for

A

genetic and developmental abnormalities - choice

65
Q

2 chronic diseases mothers screened for

A

hypertension - can cause preeclampsia - complicate pregnancy

diabetes

66
Q

infections mother screened for (5)

A
  • Rubella
  • Syphilis
  • hepatitis B
  • Hepatitis C
  • HIV
67
Q

foetal testing in pregnancy referred to as

A

FAST – foetal abnormality screening programme

68
Q

FAST

A

foetal abnormality screening programme

  • Ultrasound and some blood tests to look for risk of chromosomal abnormalities

Combined results can suggest chromosome abnormality

at 1st and 2nd trimester and then birth

69
Q

FAST tests done in 1st trimester

A

in 1st trimester 11-14 weeks

  • Neuchal Translucency – Ultrasound transparency of tissue around the neck
  • Maternal hCG - blood
  • PAPP-P - blood

combined results can suggest chromosome abnormality

70
Q

FAST tests done in second trimester

A
  • AFP – alpha-fetoprotein
  • Abnormality follow-up - follow up from early suspicion
    • CVS & Amniocentisis – genetic changes
    • Ultrasound – spina bifida
71
Q

FAST tests done at birth

A
  • Physical examination
  • Hearing test
  • Blood spot
72
Q

blood spot done at birth for (5)

A

analysis for any metabolic disorders that will impair development

  • Phenylketonuria - PKU
  • Hypothyroidism
  • Cystic Fibrosis
  • Sickle cell disease
  • MCADD – acyl CoA dehydrogenase deficiency

All manageable if aware the child has these problems – hence early identification key

73
Q

APGAR Score stands for

A

Activity

Muscle tone

Pulse

>100/min

Grimace

Reflex irritability

Appearance

Colour

Respiration

rate

74
Q

APGAR done at

A

1min and 5min

  • should be significant rise in score between
    • good APGAR score at 5 min = good prognosis
    • depressed APGAR -> transfer to special care baby unit

Activity

Muscle tone

Pulse

>100/min

Grimace

Reflex irritability

Appearance

Colour

Respiration

rate

75
Q

5 dental considerations in pregnancy

A
  • Cost of dental care
    • Free during pregnancy
  • Drugs in pregnancy
    • Not just affect the mother but affect foetus too – some may need avoided
  • Pregnancy gingivitis
    • Change in hormone levels making the vascularity response to plaque higher
  • Periodontal health in pregnancy
  • Position of mother
76
Q

pregnancy gingivitis

A

Change in hormone levels making the vascularity response to plaque higher

BDS3 BAMS Diseases of Human Systems (13 decks)

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