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Women's Health > Pregnancy & medical disorders I > Flashcards

Pregnancy & medical disorders I Flashcards

1
Q

List the 3 main hormones involved in pregnancy and where they’re produced?

A

hCG: the blastocyst

Progesterone: corpus luteum and after 8 weeks the placenta

Oestrogen: ovary initially, then derived from androgen precursors

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2
Q

What is:

  • the blastocyst
  • the corpus luteum?
A

Blastocyst: the fertilised egg which has developed into a ball of cells

Corpus luteum: the empty follicle where the ova was released from

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3
Q

What does hCG do in pregnancy?

A

Prevents the corpus luteum dying so it can continue making progesterone

If not pregnant corpus luteum dies so progesterone levels drop

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4
Q

What does progesterone do in pregnancy?

A

Proliferation and vascularisation of the endometrium

Promotes myometrium relaxation

Glucose deposition in fat stores

Increases depth of ventilation

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5
Q

What does oestrogen do in pregnancy?

A

Promotes physiological changes to mother’s CV system

Increases no. of P receptors in endometrium, so enhances P action

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6
Q

What is meant by the ‘window of implantation’? When is it?

A

The endometrium is receptive to implantation of blastocyst only temporarily

Day 20-24

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7
Q

What are the spiral arteries? And what happens to them in pregnancy?

A

They supply the endometrium

In pregnancy they are remodelled making them wider and straighter

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8
Q

What can result from failed remodelling of spiral arteries?

A

Pre-eclampsia

Intra-uterine growth restriction

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9
Q

How does the blastocyst not get rejected as foreign by the mothers immune system?

A

Because it is able to turn off some of the maternal genes that code for immune proteins

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10
Q

In labour, what stimulates oxytocin secretion?

A

Myometrial stretching and cervical stimulation

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11
Q

Aside from hormonal changes, what physiological changes take place in the body of a pregnant woman?

A

Plasma blood volume increases

Cardiac output rises
Peripheral resistance falls
Venous pressure raises (leading to varicose veins, oedema)

Ventilation depth increases

Reduced gut motility
Lax lower oesophageal sphincter

Frequency of micturition due to pressure on bladder

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12
Q

List some problems that are brought about by pregnancy?

A

Pre-eclampsia

Thromboembolism

Obstetric cholestasis

Acute fatty liver

Anaemia

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13
Q

What pre-pregnancy care should be give to women suffering from a chronic condition that could be exacerbated by pregnancy?

A

Optimise disease control

Rationalise drug therapy to minimise effects on baby

Advise on the risks there could be to mum and baby

Advise if conception is not safe

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14
Q

What ante-partum (during pregnancy) care should be give to women suffering from a chronic condition that could be exacerbated by pregnancy?

A

Liaison between maternity care and usual care of condition

Extra monitoring

Plan for the delivery:

  • safest method
  • neonatal support
  • anaesthetics
  • HDU/ITU
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15
Q

Why does anaemia occur in pregnant women?

A

Big increase in requirement for iron and folate

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16
Q

What problems are associated with anaemia in pregnancy?

A

Low birth weight

Pre-term delivery

17
Q

Macrocytic anaemia is likely to be what?

Microcytic anaemia is likely to be what?

A

Macro = folate deficiency

Micro = iron deficiency

18
Q

What’s the treatment for anaemia in pregnancy?

A

Replace folate or iron

Monitor that levels are rising

19
Q

What might you find on an ABG of a pregnant woman, which is normal?

A

Mild compensated metabolic alkalosis

pO2 increases
pCO2 decreases

20
Q

What are the effects of asthma on the fetus?

A

If poorly controlled…

Risk of fetal growth restriction due to inadequate placental perfusion

Premature delivery, if mother is not well with it

21
Q

How does obstetric cholestasis present?

A

Itching with no rash is often the only symptom

Sometimes malaise

Very rarely jaundice

22
Q

Obstetric cholestasis goes away within 6 months of birth. true or false?

A

False

It resolves after delivery

23
Q

What is the effect of obstetric cholestasis on the fetus? Why?

A

Bile salts in the blood

Can lead to premature labour and stillbirth

24
Q

What’s the treatment of obstetric cholestasis?

A

ursodeoxycolic acid

25
Q

What are the risks to mother and fetus of hyperthyroidism?

A

Maternal risk of thyroid crisis and cardiac failure

Fetal risk of thyrotoxicosis

26
Q

Management of hyperthyroidism in pregnancy?

A

Anti-thyroid drugs
- carbimazole

Monitor fetal growth

27
Q

Which is more common in pregnancy, hyper or hypothyroidism?

A

Hypothyroidism

28
Q

What are the risks to the fetus of hypothyroidism?

A

Early fetal loss

Neurodevelopmental impairment

29
Q

What’s the management of hypothyroidism in pregnancy?

A

Levo-thyroxine

30
Q

Is the pathophysiology of gestational diabetes more like type 1 or type 2 diabetes?

A

Type 2

Insulin resistance

31
Q

What are the risks to mother and fetus associated with g. diabetes?

A

Mother:

  • DKA
  • hypoglycaemia
  • retinopathy
  • pre-eclampsia
  • premature labour

Baby:

  • miscarriage, still-birth
  • macrosomia, shoulder dystocia
  • abnormalities
  • neonatal hypoglycaemia
32
Q

What is Erb’s palsy?

A

Paralysis of the arm as a result of C5-C6 nerve damage caused by shoulder dystocia

33
Q

How is g. diabetes managed?

A

Insulin
Metformin
Diet

34
Q

Why is renal disease exacerbated by pregnancy?

A

There’s a 50% increase in renal blood flow during pregnancy

35
Q

What are the risks to mother and fetus associated with chronic renal disease?

A

Mother:

  • hypertension
  • poor renal function
  • pre-eclampsia

Fetus:

  • premature
  • growth restriction
  • stillbirth
36
Q

What are the risks to mother and fetus associated with epilepsy?

A

Mother:

  • increased seizure frequency
  • sudden unexpected death in epilepsy

Baby:

  • risk of fetal abnormality
  • also some drugs are teratogenic
  • hypoxia during maternal seizures
37
Q

What are the risk factors of thromboembolism in pregnant women?

A

Older age
High BMI
Operative delivery

38
Q

Management of thromboembolism in pregnant women?

What should you NOT use?

A

Use low molecular weight heparin

Don’t use warfarin b/c it crosses placenta and causes fetal abnormalities and intracranial bleeding

Women's Health (23 decks)

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