problems Flashcards
gestational diabetes when
20wks on
foetus can make mother insulin resistant. which hormones does the baby make
hPL PCRH making cortisol and PGH
pregnancy is a naturally …resistant state. why?
insulin
excess glucose is what foetus needs for growth
is gestational dm more like type 1 or 2
a mixture of both. insulin production is restricted from beta cells AND insulin resistance
increased cortisol leads to …resistance
insulin
massive baby might need what when it’s born
glucose drip to wean off hyperinsulinemia
perinatal hypoglycemia
meds for gestational dm
metformin glyburide
what levels of hepcidin in different stages of prg
Up in 1st trimester
Down in 2nd and 3rd trimester
when is gestational anemia more common
2 and 3 trimester
when is amniotic fluid most. how much
28 wks 800ml
what condition oligohydramnios. why?
Potter sequence - flat face, squished face, club foot
normally kidney abnormalities
cytomegalovirus what is it
generic sub-clinical virus but can be dangerous if mum catches primary infection in 1st trimester, 10% of asymptomatic babies and 90% of symptomatic babies have hearing probs (sensory neural deafness), mental retardation, microcephaly
what is the biggest cause of hearing loss in young children
cytomegalovirus
symptomatic baby CMV how does it look
petechial purpuria with jaundice
classic triad of gestational rubella
cardiac. cataract/glaucoma, deafness
cardiac probs:
patent ductus arteriosus, pulmonary valve stenosis
gestational toxoplasmosis
Chorioretinitis , hydrocephalus, intracranial atherosclerosis
mortality in untreated neonate herpes
65%
what sort of bateria is listeria
gram+ rod
congenital syphilis sequelae
Early 0-2 years
Rash
Rhinorrhoea (mucus full of T.pallidum)
Osteochondritis
Perioral fissures
Lymphadenoapthy
Pemphigus syphiliticus
Late >2 years
Hutchinson’s teeth
Clutton’s joints
Saber shins
High arched palate
Deafness
Saddle nose deformity
Frontal bossing
foetus makes what molecule -> Hyperemesis gravidarum
GDF15
which vitamin for morning sickness, when
B6 from point of conception
which is the only viable aneuploidy
Turner’s (X0)
inevitable miscarriage ultrasound
gestational sac is completely detached
recurrent miscarriage
3 or more consecutive miscarriages
where should pregnancy implant
top back wall
Placenta abruption
Placental praevia
Incidental genital tract pathology
Uterine rupture
Vasa praevia
Fetal blood vessels run close to or over opening of the uterus
symptoms of placental abruption
bleeding
tense woody uterus
weak or absent fetal heartrate
what is placental abruption
retroplacental blood clot
placenta praevia tx
lower segment C section
describe the placenta accreta etc problems
what is pre-eclampsia
hypertension after 20 wks, proteinuria, low placental growth factor
in pre-eclampsia, what happens to the spiral arteries
stay narrow so blood is under high pressure, baby gets much less O2
active stage of labour starts when
6cm
what is prolonged labour
> 20h if 1st time
14 if 2nd etc
drugs to help labour along
Oxytocin, misoprostol, mifepristone, oestrogen pessary
how long is max for forceps or ventouse delivery
15 mins or 3 contractions
when can’t you use forceps/ventouse
preterm, breech presentation
which nerve can be damaged by forceps
facial
most common complication of ventouse/forceps
retinal haemorrhage
foetal heartrate should be
120-130
what is monitored in labouring mother
HR sats, contractiona
what heartrate changes is worrying in baby in labour - why
Late decelerations
Vagal stimulation or myocardial depression from placental insufficiency
Late decelerations and bradycardia emergency C-section
what is definition of early deceleration
nadir of HR coincides with peak of contractino
are variable decelerations in foetal HR in labour worrying? whyw?
not usually because different parts of baby being compressed
late decels and bradycardia in labour in foetus ->
emergency caesarian section
early deceleration in foetal HR known as, what shape
type 1 dip, V shape
late deceleration in foetal HR known as, what shape
type 2 dip, U shape
drugs to delay labour
It’s Not My Time
Indomethecin (NSAID Cox inhibitors)
Nifedipine (Ca channel blocker)
Magnesium sulphate (fetal neuroprotection)
Terbutaline (adrenergic agonist (beta)
what to do to support foetal distress
Changing the mother’s position
Increasing maternal hydration
Maintaining oxygenation for the mother
Amnioinfusion, where fluid is inserted into the amniotic cavity to relieve pressure on the umbilical cord
how to check for cyanotic baby
check mucus membranes
danger of meconium in utero
aspiration
discuss APGAR score
shoulder dystocia what is it
shoulder gets stuck under pubic bone
how do you deal with shoulder dystocia
McRoberts manoeuvre
episiotomy
which nerve is normally stretched in shoudler dystocia
radial
which bones can be broken in shoulder dystocia
clavicle and humerus
why does haemorrhage in labour occur
Bleeding happens after the placenta is expelled, because uterine contractions are too weak and cannot provide enough compression to the blood vessels at the site of where the placenta was attached to the uterus
link between multi preg and haemorrhage
over-distension of uterus
best breech presentation
Frank breech
worst breech presentation
footling breech
main symptom of placenta previa
bleeding in 3rd trimester
signs of uterine rupture
Abnormal heart rate in the baby
Abdominal pain and uterine tenderness
Vaginal bleeding
Slow progress in labour
Altered uterine contractions
Rapid heart rate and low blood pressure in the mother
precipitous labour=
birth in <3 hours
complcation of precipitous labour
hypotonic uterus - haemorrhage
changes in uterus from delivery to 6 wks
900g -> 60g
what is leading cause of maternal death in postnatal period (6wks)
thrombosis and thromboembolism
2 examples of uterine infection
endometritis, parametritis
what do you see on MRI if post-partum uterine infections
purulent uterus and gas pockets
causes of post or peri partm haemorrhage (4 T’s)
Tone = 75-80% of cases, overdistension, intrinsic or extrinsic dysfunction
Tissue = retained products of conception
Trauma = tears to vagina, cervix, uterine rupture, instrument delivery
Thrombosis = thrombin, anticoagulant use and bleeding tendency
what suturing is this to stop PPH
B lynch
cause of endometritis
retained products of conceptio
what is Homan’s sign - what condiiton - what tx
forced dosiflexion of foot elicits pain - DVT - heparin
does heparin go to breast milk
no
are SSRI’s teratogenic?
no
which preg related hormone has an effect on serotonin
oestrogen
presentation of HELLP syndrome
right upper quadrant abdominal pain or epigastric pain resulting from liver distension. Individuals may experience general symptoms like nausea, vomiting, generalized edema, malaise, headache, visual changes, or jaundice
What does HELLP syndrome stand for
Haemolysis
Elevated liver enzymes
Low Platelets
which 2 hormones are tested for in Down Syndrome maternal blood test and what are the levels
B-HCG high and PaPPA low
Beta human chorionic gonadotrophin
Pregnancy associated Plasma Protein A
- What cells invade the maternal spiral arteries normally that allow these vessels to become low resistance vessels?
endovascular trophoblasts
what should you do with pregnant mother who is on ACE or ARB
discontinue immediately and commence labetalol
