Pregnancy & Perinatal Health Flashcards
What factors affect fertility?
- age (decreases with age)
- smoking
- BMI (decreases with high BMI)
- exercise
- drugs
- folate (neural tube defects due to deficiency)
- alcohol (foetal alcohol syndrome)
How does IVF success with age compare to natural pregnancy success?
- very similar
- both decrease after 35-40
Detail the timescales of each trimester of pregnancy
1st - 0-12 weeks
2nd - 12-24 weeks
3rd - 24-40 weeks
What happens during the first trimester?
Structures of the embryo form and tissues differentiate
What happens during the second trimester?
Specialisation and final differentiation of tissues
What happens during the third trimester?
Growth and physiological changes for successful birth
Outline the maternal changes during pregnancy
- physical changes
- hormonal changes
- haematological changes
- cardiovascular changes
- coagulation changes
What causes increased weight during pregnancy?
- increased tissue size
- functionality
- increased fluid volume
- compensates for blood loss during birth
- protects against hypovolaemia
- growth of foetus
What are the hormonal changes during pregnancy?
- increased oestrogen and progestogen
- act on kidney to increase renin secretion
- increased salt and water retention
- reduced insulin sensitivity
- gestational diabetes
- changes to mother and foetus
- larger, heavier baby
- delivery complications
What are the physical changes during pregnancy?
- relaxation of lower oesophageal sphincter
- accompanied by increased abdominal pressure
- increased GORD
- particularly towards the end of pregnancy
- increased bladder and bowel compression
- increases with baby’s size
- urgency and frequency increase
What are the haematological changes during pregnancy?
- increased plasma volume by 45%
- as a result of salt and water retention
- dilution of blood makes Hb fall
- 15g/dL to 12g/dL Hb
- protects against haemorrhage at birth
- artificial anaemia, often treated with iron
- increased cell production
- red blood cells
- white blood cells (infection diagnosis difficult)
- platelets (increased consumption makes platelets look low)
- increased cell mass
- red blood cells
- normal coagulation screens
- clotting factor production increased
- fibrinolysis increased
- increased system sensitivity
- increased DVT risk
What are the cardiovascular changes during pregnancy?
- relaxation of vascular smooth muscle
- reduced peripheral resistance
- reduced systolic and diastolic blood pressure
- compensatory increase in heart rate by 25%
- all aid to cope with increased vascular load
- vascular compression by uterus
- vena cava and aorta
- difficulty with venous return when supine
What are the cardiovascular changes during pregnancy?
- relaxation of vascular smooth muscle
- reduced peripheral resistance
- reduced systolic and diastolic blood pressure
- compensatory increase in heart rate by 25%
- all aid to cope with increased vascular load
- vascular compression by uterus
- vena cava and aorta
- difficulty with venous return when supine
What should not be eaten during pregnancy?
- raw/slightly cooked meat and raw fish
- danger of toxoplasmosis infection
- raw eggs
- salmonella risk
- non-pasteurised milk and cheese
- listeria risk
- spicy, grilled and fried foods
- dyspepsia
- worsens gastro-oesophageal reflux
- marlin, tuna and shark
- risk of mercury toxicity
- liver, entrails and internal organs
- must be avoided in first trimester
What happens to the zygote at week 4?
It becomes an embryo
- neural tube, gut tube and brain begin developing
What happens between weeks 6-10 of pregnancy?
- embryonic development and growth
- start of embryonic circulation
What happens between weeks 10-14 of pregnancy?
- embryo becomes a foetus
- features and limbs become developed and active
- likely the first time the pregnancy is noticeable to the mother
During which trimester is miscarriage most likely?
- first trimester
- can happen so early pregnancy is not noticed
What causes miscarriage?
- maternal and foetal factors
- most commonly embryo/foetus development abnormalities
What happens to the foetus from week 14?
- hair, nails, toenails and eyelids form
- movement may be felt by the mother
What happens to the foetus from 18 weeks?
- toes and fingers are formed
- hearing begins to respond
What happens to a foetus during weeks 20-26?
- final development of vision and senses
- specialised senses working
- brain development continues
- body fat increases
What happens to the foetus from week 27
- growth
- muscle and fat reserves build up
- nervous system matures
- lung growth continues
Describe the structure and function of the placenta
- placenta connects foetus to mother
- facilitates interlinking mesh of blood vessels
- blood supplies do not mix
- nutrients can diffuse
- toxins and some infections can also diffuse
- highly vascular
- capillary base joined through stalk to foetus
Describe the stages of labour and what they involve
- induction of labour
- first stage
- delivery of baby
- second stage
- delivery of baby
- third stage
- delivery of placenta
What are the ways in which labour can be aided?
- forceps
- press the sides of the vaginal wall
- more space for baby’s head
- vontoux
- suction cup applied to top of baby’s head
- Caesarean section
- surgical procedure
Describe umbilical cord healing
- cord clamped
- circulation maintains own oxygenation
- vessels in body shut off to umbilical stump
- umbilical stump necroses and falls off
What is the purpose of screening in the first trimester?
- establish dates of pregnancy
- determine number of foetuses
- smaller foetuses
- less prepared for birth
- identify placental structures
- failure of placental to develop compromises pregnancy
- diagnose ectopic pregnancy or miscarriage
- ectopic develops outweigh uterus
- most commonly abdomen or fallopian tubes
- can be successful but delivery is complex
- examine uterus and pelvic anatomy
- identify potential problems for birth
- detect foetal abnormalities
What does maternal screening look for?
- chronic diseases
- (gestational) diabetes
- hypertension
- infectious diseases
- hepatitis B
- hepatitis C
- HIV
- rubella
- syphilis
What is the effect of hypertension on pregnancy?
Increased risk of pre-eclampsia
What does screening at 18-20 weeks look at?
- confirm pregnancy dates
- determine number of foetuses
- examine placental structures
- assist prenatal tests (e.g. amniocentesis)
- examine foetal anatomy (abnormalities)
- check amniotic fluid volume
- examine blood flow patterns
- observe foetal behaviour and activity
- examine placenta
- measure cervix length
- monitor foetal growth
Why are amniocentesis carried out and what do they involve?
- amniotic fluid samples
- cells from foetus examined for genetic assessment
- can identify Down’s syndrome
What is FAST?
Foetal Abnormality Screening Programme
- looks for chromosomal abnormalities
- 1st trimester: 11-14 weeks
- nuchal translucency (ultrasound)
- maternal hCG (blood)
- PAPP-P (blood)
- 2nd trimester
- alpha-fetaprotein (AFP)
- abnormality follow-up
- CVS and amniocentesis - genetic changes
- spina bifida - ultrasound
What tests are carried out at birth?
- physical examination
- hearing test
- blood spot
- phenylketonuria (PKU)
- hypothyroidism
- cystic fibrosis
- single cell disease
- MCADD (acyl CoA dehydrogenase deficiency)
carried out as soon as baby is born, if problems identified during blood spot, can be managed but only if detected early
What is an APGAR score?
A - activity (muscle tone)
P - pulse (>100bmp)
G - grimace (reflex irritability)
A- appearance (colour)
R - respiration (rate)
- performed at 1 minute and 5 minutes after birth
- should significantly increase
- if depressed transferred to special care unit
What is an APGAR score?
A - activity (muscle tone)
P - pulse (>100bmp)
G - grimace (reflex irritability)
A- appearance (colour)
R - respiration (rate)
- performed at 1 minute and 5 minutes after birth
- should significantly increase
- if depressed transferred to special care unit
What are the dental considerations of pregnancy?
- cost
- dental care is free for all pregnant women
- drugs in pregnancy
- medications affect both mother and baby
- must take care with dental drugs
- pregnancy gingivitis
- changing hormone levels
- higher vascular response to plaque
-periodontal health
- reduced
- must be monitored
- position of mother
- supine position in dental chair can cause vascular compression- venous return through vena cava and arterial supply to lower body reduced
- place pillow under one side to reduce pressure
