Pregnancy & Parturition

Question 1

At what stage does preeclampsia effect pregnant women?

Answer 1

from 20 weeks (but usually in 3rd trimester) to up to 6 weeks after delivery

Question 2

What is preeclampsia

Answer 2

new onset hypertension (>140/>90) and proteinuria (marker of kidney damage) in pregnant women

Question 3

When does preeclampsia become eclampsia and why is does this occur?

Answer 3

when a woman with preeclampsia develops seizures

seizures are due to CEREBRAL OEDEMA caused by fluid leaking out of vessels with dysfunctional endothelium (and loss of protein)

Question 4

Risk factors for preeclampsia

Answer 4

first pregnancy 
mothers over 35
hypertension
diabetes
family history

Question 5

What is the pathophysiology of preeclampsia

Answer 5

Hypertension: spiral arteries do not dilate so placenta is hypo-perfused; it released pro-inflammatory proteins which enter mothers circulation and cause endothelial cell dysfunction/damage > this results in vasoconstriction and kidneys retaining more salt > which causes hypertension.

Proteinuria: local vasospasm decreases perfusion of the kidneys and causes glomerular damage > this causes impaired GFR, proteinuria and low urine output (oliguria); leaky damaged endothelium is also responsible for protein getting into filtrate

Vasospasm occurs in vessels supplying various different organs > reduced blood flow causes problems with the organs; liver (epigastric pain) and eyes (visual disturbances) and brain (convulsions)

Question 6

complications of preeclampsia

Answer 6

extreme hypertension can lead to hemorrhagic stroke or placental abruption (detached from uterine wall)

Question 7

How can preeclampsia cause oedema, (generalized, cerebral, pulmonary)

Answer 7

dysfunctional endothelium in vessels > vessels become leaky and fluid leaks into tissues; also reduced protein in blood pulls more fluid into tissues

see a puffy looking face

Question 8

What are braxton-hicks contractions

Answer 8

“false labor” contractions experienced during pregnancy

Question 9

function of progesterone during pregnancy

Answer 9

Prevents smooth muscle contraction. Particularly uterus, but also ureters, and smooth muscle of rectum leading to constipation. Also in diaphragm and intercostal muscles giving increased tidal volume.

Also maintains endometrial lining.

Question 10

function of oestrogen (oestriol) during pregnancy

Answer 10

increases sensitivity of muscle to oxytocin.

Question 11

function of human chorionic gonadotropin (hCG) during pregnancy

Answer 11

required early in pregnancy to sustain corpus luteum

LHCG receptors

Question 12

Where is oxytocin released from during pregnancy and what is its function

Answer 12

released from posterior pituitary, increases contraction of uterine muscle

Question 13

Where are prostaglandins released from during pregnancy and what is its function

Answer 13

released from membranes, e.g. placenta or the uterine walls when there is a contraction to further increase contraction of uterine muscle (gives positive feedback)

Question 14

Where is relaxin released from during pregnancy and what is its function

Answer 14

released from the placenta/decidua basalis and reduces collagen adherence (softens and widens cervix “cervical ripening”, relaxes pelvic ligaments)

Question 15

What is cervical ripening and effacement and at what stage in pregnancy does it occur

Answer 15

the cervix softens and dilates and is incorporated into the lower uterine segment
week 36 due to relaxin

Question 16

the 3 stages of labour are…

Answer 16

1. dilation
2. expulsion
3. afterbirth

Question 17

stage 2 of labour is expulsion and involves 7 cardinal movements of the baby’s head, the 7 cardinal movements are…

Answer 17

1. engagement
2. descent
3. flexion
4. medial rotation
5. extension
6. lateral rotation
7. expulsion

Question 18

Why are episiotomies done?

Answer 18

prevents a perineal tear progressing to 3rd or 4th degree (damage to rectal mucosa) and vaginal prolapse

Question 19

At what angle should an episiotomy be done

Answer 19

mediolateral 60 degrees

Question 20

at which layer does the placenta detach during the afterbirth

Answer 20

the ducidua basalis

Question 21

What is the biggest cause of post-partum hemorrhage?

Answer 21

Uterine atony.

The uterus fails to contract after the delivery of the baby, and it can lead to a potentially life-threatening condition known as postpartum hemorrhage.

Question 22

What does BP need to be for it to be classed as severe preeclampsia?

Answer 22

Systolic 160 mmHg

Diastolic 110 mmHg

Question 23

How much folic acid are pregnant women advised to take and from-to which point?

Answer 23

400 micrograms daily

3 months post-conception to 3 months gestation