Pregnancy and Perinatal Health Flashcards
What are examples of fertility issues? (7)
- Age
- Smoking
- BMI
- Exercise
- Drugs
- Folate (neural tube defects like spina bifida are more likely to happen if folic acid levels are low so anyone considering pregnancy should be taking folic acid supplements)
- Alcohol (now recognised as being a major issue in causing a range of neurological changes and developmental changes - all termed foetal alcohol syndrome)
What can be considered when fertility is a problem?
- Assisted conception
When is early pregnancy times from?
- Timed from the date of conception - this can be difficult to ascertain
When is the first trimester from?
- Up to 12 weeks
- Typically during this trimester the structures of the embryo are forming and the tissues are differentiating
When is the second trimester from?
- 12-28 weeks
- There is more specialisation and final differentiation
When is the third trimester from?
- 28-40 weeks
- Largely all that is happening is growth and acquisition of changes necessary for successful birth
What are the different types of maternal changes that happen in pregnancy? (5)
- Physical changes
- Hormonal changes
- Haematological changes
- Cardiovascular changes
- Coagulation changes
What is the overall weigh gain of a women during pregnancy?
11-16kg
What is the weight gain in the breasts for a women during pregnancy?
0.5kg
What is the weight gain in the placenta for a women during pregnancy?
0.7kg
What is the weight gain in the uterus for a women during pregnancy?
1.6kg
What is the weight gain of the baby for a women during pregnancy?
3.5kg
What is the weight gain in the amniotic fluid for a women during pregnancy?
1-1.5kg
What is the weight gain in the extra blood volume and fluid for a women during pregnancy?
4kg
Why is it important that more blood volume is produced in a women in pregnancy?
- It is important that more blood volume is produced because there will be blood loss during birth
- Allowing for that by making the circulation larger, it protects the mother against hypovolaemia should there be a significant amount of bleeding at the time of delivery
Why is there increased oestrogen and progesterone in pregnancy? (6)
- Act on kidneys to increase renin secretion
- Increased salt & water retention
Increased plasma volume by 45%
- Dilution effect makes Hb fall from 15-12g/dL
- Protects against haemorrhage at birth
- The patient will appear to have a low haemoglobin but because this is being measured against a larger circulating volume - the absolute amount of haemoglobin carrying oxygen to the tissues remains high
- Therefore the anaemia of pregnancy is to some extent an artificial name as although the mother is anaemic by normal definitions, she has more haemoglobin but has also more circulating volume
- Often this is treated with extra iron as doctors tend to treat values that they feel are not normal but the dilution that you see within the pregnancy is perfectly normal and is likely to protect against haemorrhage at birth
One maternal change during pregnancy is the lower oesophageal sphincter relaxes, what can this lead to?
- This with an increased abdominal pressure gives increased GORD
One maternal change during pregnancy is that hormonal changes increase reduce insulin sensitivity. What can this result in?
- Diabetes in pregnancy
Give examples of haematological changes in pregnancy? (4)
- Increased production of RC, WC and platelets
- 20% increase in RC mass
- Increased platelet consumption makes platelets normal to low
- Increased WC makes diagnosing infections difficult
One maternal change in pregnancy is relaxation of vascular smooth muscle. What does this lead to? (3)
- Reduced peripheral resistance
- Reduced systolic and diastolic blood pressure
- Compensatory increase in heart rate by 25%
One maternal change in pregnancy is the vascular compression by the uterus - what problem can be caused by this (especially in dentistry)?
- Vena cava and aorta affected
- Difficulty with venous return when supine
- One thing that is important in dentistry is the positioning of the vena cava and the aorta behind the uterus so when the mother is lying supine the pressure of the baby onto these vessels can cause significant vascular compression
- So consider treating the mother slightly propped to one side to prevent vascular compression
In pregnancy coagulation screens remain normal. However what changes? (3)
- Clotting factor production increases
- Fibrinolysis increases
- Increased system sensitivity with increased DVT risk
What is a maternal change that occurs due to the position of the baby in the abdomen?
- There will be increasing compression of the bladder and the bowel as the size of the baby increases and towards the end of pregnancy the urinary frequency and urgency are quite common
What should a women not eat when she is pregnant and what are the dangers associated with it? (6)
Raw/slightly cooked meat and raw fish:
- Danger of infection with toxoplasmosis
Raw eggs:
- Salmonella
Non-pasteurised milk and milk cheese:
- Listeria
Spicy, grilled and fried food:
- Dyspesia and GORD will be promoted
Marlin, tuna and shark:
- Mercury toxicity
- Liver and other entrails and internal organs of a slaughtered animal during the first 3 months of pregnancy
What is dyspepsia?
- A condition where digestion is impaired
In terms of foetal changes when does development start?
- Starts at week 4
- Zygote becomes an embryo
What foetal change happens at week 6?
- Start of embryonic circulation
- weeks 6-10 embryonic development and growth
At what point does the embryo stage end?
- Embryo stage stops at week 10
- At this stage the characteristic shape of the embryo is almost fully present
- It is also a time where the pregnancy will be noticeable to the mother and she may be able to feel the foetus moving around
What occurs with the foetus between weeks 10-14?
- Features and limbs become developed and active
When are miscarriage rates the highest?
- In the first trimester
- Maternal and foetal factors
- But can happen anytime during pregnancy
- Most happens naturally because there is an abnormality in the development of the embryo or the foetus
- This may be a genetic change that is incompatible with life, or it could be a factor affecting the foetus or the embryo’s ability to maintain nutrients from the mother
- Sometimes they are so early that the women did not realise she was pregnant at all
When does the second trimester start?
- From week 14
What happens at week 14?
- Hair, nails, toenails and eyelids start to form
- Movement may be felt
What happens at 18 weeks?
- Toes and fingers formed and hearing starts to respond
What happens between 20-26 weeks?
- Final development of vision and senses
- Brain development and body fat increase
When does the third trimester begin?
- From week 27
What happens in the third trimester?
- Growth and nervous system maturation
- The foetus will build up muscle and fat reserves ready for the trauma of birth ahead
What is the placenta?
- This is what connects the foetus to the mother
- It in an interlinking mesh of blood vessels so that the maternal circulation ands the foetal circulation do not mix but they sit in very close proximity to each other so that the nutrients can diffuse easily from one to the other
- This also allows certain toxins or certain infections to diffuse into the foetus as well
- The placenta is a big organ and is largely vascular so it is a capillary base joined through a stalk to the child - the umbilical cord
What are the stages of labour? (4)
- Induction of labour
- First stage
- Second stage
- Third stage
- These stages depend upon the degree of dilation of the cervix and how far the baby has positioned itself through
What are 3 things that can assist labour to make it easier? (3)
- Forceps
- Ventoux
- Caesarean section
What are forceps used for?
- These will aid in delivery of the baby - not by holding the baby by the head and allowing you to pull it out but instead by pressing the sides of the vagina away from the babies head therefore making more space for the head to move lower down and allow the baby to be born
What is a ventoux used for?
This is more of a suction cup which can be applied to the top of the head
What is a caesarean section?
- This is a cut made through the abdomen and into the uterus which allows the baby to be born
Explain umbilical cord healing?
- After birth the umbilical cord is clamped and this allows the baby circulation to maintain its own oxygenation and once this has happened the vessels, as they note the change of oxygenation within the body will shut themselves off and allow the umbilical stump to necrose and fall off
Why do we carry out screening in the first trimester? (5)
- To establish the dates of pregnancy
- To determine the number of foetuses and identify placenta structures
- To diagnose an ectopic pregnancy or miscarriage
- To examine the uterus and other pelvic anatomy
- In some cases to detect foetal abnormalities
What is an ectopic pregnancy?
- Ectopic pregnancy means that the pregnancy has taken place not within the uterus but the egg has been released into the abdominal cavity or retained within the fallopian tube and implanted somewhere other than the uterus - this will perhaps result in a successful pregnancy but means that delivery will be impossible naturally
When screening in pregnancy what are we looking for in the mother? (2)
- Chronic diseases
- Infectious diseases
When screening in pregnancy what are we looking for in the foetus?
- Genetic and developmental abnormalities
When doing a maternal screening what chronic diseases are we looking for? (2)
- Hypertension (this can result in preeclampsia)
- Diabetes
When doing a maternal screening what infections are we looking for? (4)
- Rubella
- Syphilis
- Hepatitis C
- HIV
What are we looking for in a screening at 18-20 weeks? (10)
- To confirm pregnancy
- 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 behaviour and activity
- To examine the placenta
- To measure the length of the cervix
- To monitor foetal growth
What is FAST?
- Foetal abnormality screening programme
When doing foetal testing in pregnancy what do we do in the first trimester (11-14 weeks)? (3)
- Neuchal translucency - ultrasound
- Maternal hCG - blood
- PAPP-P - blood
- Combined results can suggest a chromosome abnormality
When doing foetal testing in pregnancy what do we do in the second trimester? (2)
- AFP (alpha feta protein)
- Abnormality follow up:
- CVS and amniocentesis - genetic changes
- Ultrasound - spina bifida
Birth testing will happen within the first few minutes of the baby being born. What is tested? (3)
- Physical examination
- Hearing test
- Blood spot (this will allow us to look for any metabolic disorders which might impair the foetus development once birth has taken place)
When doing a birth test we take a blood spot. What are we looking for? (5)
- Phenylketonuria (PKU)
- Hypothyroidism
- Cystic fibrosis
- Sickle cell disease
- MCADD - acyl CoA dehydrogenase deficiency
- These are all manageable if it is known that the child has these problems
What is the APGAR score?
- A = Activity = muscle tone
- P = Pulse = >100/min
- G = grimace = reflex irritability
- A = appearance = colour
- R = Respiration = rate
- Tested at 1 min and at 5 mins
- There should be a significant rise in the score between the 2
- A good APGAR score at minute 5 is associated with a good prognosis
- If there is a depresses APGAR this is where the baby is often transferred to a special care baby unit for monitoring and support
What are the effects on dentistry during pregnancy? (5)
- Cost of dental care (free during pregnancy)
- Drugs in pregnancy (these will affect the baby)
- Pregnancy gingivitis (issue dur to the change in hormone levels making the vascularity of the gingival response to plaque higher)
- Periodontal health in pregnancy
- Position of mother
