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Human Development > Puerperium > Flashcards

Puerperium Flashcards

1
Q

How many pregnancies end in miscarriage

A

15%

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2
Q

What are the 3 causes of whole chromosome aneuplodies

A

Malsegregation:
In the gonad during meiosis -> abnormal gametes
During mitosis in the germline -> mosaicism in the gonad
During mitosis in the early embryo -> mosaicism in the embryo

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3
Q

What is trisomy 18

A

Edwards

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4
Q

What is trisomy 13

A

Patau

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5
Q

What is 45, X

A

Turner

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6
Q

What is 47, XXY

A

Klinefelter

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7
Q

What are the two types of translocations

A

Robertsonian and reciprocal

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8
Q

What are Robersonian translocations

A

Result from fusion of two acrocentric chromosomes. Most common are der (13;14), and der (14;21) - balanced carriers phenotypically normal

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9
Q

What are reciprocal translocations

A

Exchange of material between two non-homologous chromosomes

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10
Q

What is Prader Willi Syndrome

A

Paternal deletion and maternal imprinting - chromsome 15

Leads to obesity and T2DM

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11
Q

What is Angelman syndrome

A

Maternal deletion and paternal imprinting

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12
Q

What is FISH

A

Fluorescence in situ hybridisation - in metaphase for confirmation of aCGH and fllow up segments

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13
Q

What is QF-PCR

A

Quantitative Fluorescene PCR

Microsatellites markers used to identify and count chromsomes 13, 18, 21 and X/Y

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14
Q

Who is rapid FISH test used for

A

Carriers of balanced chromosome rearrangements

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15
Q

What is parturition

A

Process of giving birth

Involves softening and effacement of the cervix and development of uterine contractions

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16
Q

What occurs in the initial phase of labour

A

Contractions develop, cervix softens and effaces (4cm)

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17
Q

What happens in the active phase of labour

A

Regular contractions (3 every 10 min) and steady dilation of the cervix (4cm). Progress normal if cervix dilates at least 0.5cm per hour

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18
Q

What happens in stage 2 of labour

A

Cervix fully dilated 10cm, strong propulsive contractions, 1-2 hours. Uncontrollable urge to push.
Diagnosis of delay: 2 hours in nulliparous and 1 hour in parous women

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19
Q

What happens in stage 3 of labour

A

Placental separation, descent to the lower segment and delivered (oxytocin important). Cord and placenta will contain about 1/3 of baby’s blood.

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20
Q

What are the inflammatory mediators in cervix ripening

A

iNOS, COX-s (produces PGE2), matrix metalloproteinases 2 and 9 (stop bacteria from entering), cytokines and immune cells

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21
Q

What instigates the inflammatory process of cervix ripening

A

Hormone changes - functional progesterone withdrawal - inflammation and influx of immune cells, increased corticotrophin releasing hormone and oestrogen, plus cervical distension -> oxytocin -> Ferguson reflex (fetal movement stretches cervix)

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22
Q

What is PGE2 used for

A

Ripen cervix and induction of labour

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23
Q

What contraction associated proteins are induced in the myometrium in labour

A

Prostaglandin receptor, COX-2, oxytocin receptor, gap junctions, calcium signalling proteins

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24
Q

What are gap junctions made from

A

Connexin proteins

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25
Q

What Cx are unregulated during labour

A

Cx43 and Cx26

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26
Q

What happens with increased gap junctions

A

Intercellular communication, more powerful contractions

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27
Q

What initiates labour

A

Fetal HPA axis involvement, but progesterone drop not apparent. Increasing oestrogen concentrations.

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28
Q

What is the estradiol level through gestation

A

Steady rise

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29
Q

What is the progesterone level through gestation

A

Steady rise with plateau at term

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30
Q

What is the role of oxytocin during labour

A

Uterine contraction: Important for cervical dilation before birth, oxytocin causes contractions during the second and third stages of labor

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31
Q

What are important signals in human parturition

A

Fetal hypothalamus increase CRH production -> increase ACTH production
Fetal adrenal increase cortisol and DHEAS
Reduced progesterone responsivenss
Increased fetal membrane COX-2 and prostaglandin
Increased placental CRH and oestrogens

32
Q

Where is milk produced

A

Milk produced in epithelial - surrounded by myoepithelial which can contract to release milk

33
Q

Why is breast tissue unresponsive to prolactin before birth

A

Prolactin secreted from 16 weeks - but steroid block

Withdrawal of oestrogen and progesterone are essential

34
Q

How does suckling ensure milk produciton

A

Neuroendocrine reflex
Suckling: stimulates production of vasoactive intestinal peptide, reduces dopamine release
Strength and duration of suckling determines amount of prolactin released from the anterior pituitary
Milk transported from alveoli to nipple
Suckling stimulates paraventriculuar and supraoptic nuclei to produce and release oxytocin
Oxytocin causes contraction of myoepithelial cells surrounding alveoli full of milk

35
Q

What occurs in stage I of fetal growth

A

Hyperplasia 4-20 weeks

Rapid mitosis and increase of DNA content

36
Q

What occurs in stage II of fetal growth

A

Declining mitosis with increase in cell size 20-28 weeks

37
Q

What occurs in stage III of fetal grwoth

A

Hypertrophy - rapid increase in cell size, accumulation of fat, muscle and connective tissue 28-40 weeks

38
Q

When does the most weight gain ocur

A

95% in second half of pregnancy

39
Q

What is the crown rump length at 8 weeks

A

3cm

40
Q

What is the crown rump length at 32 weeks

A

30cm+

41
Q

What is the weight at 12 weeks

A

90g

42
Q

What is the weight at 26 weeks

A

1200g

43
Q

What is the weight at 38 weeks

A

3350g

44
Q

What is measured at 12 weeks from LMP

A

Viability - crown rump length

45-84mm=11-14 weeks

45
Q

What is measured at 18-20 weeks

A 
Anomaly scan, assess fetal growth, anomalies, placenta site 
Head circumference
Biparietal diameter
Abdominal circumference
Femur length
46
Q

What is difference between SGA and FGR

A

SGA still follows growth curve

47
Q

What causes growth restriction

A

Insufficient nutrient delivery gas exchange
maternal vascular disease e.g. HP, PET< DM
Decrease in maternal O2 capacity (sickle cell)
Placental damage (smoking)

48
Q

What causes intrinsically small foetus

A

Chromosomal/abnormality
Infectious e.g. CMV
Environmental e.g. fetal alcohol syndrome

49
Q

How is SGA defined

A

Birth weight < 10th centile EFW <10th centile

50
Q

What is severe SGA

A

EFW < 3rd centile

Higher chance of FGR

51
Q

What is PAPP-A

A

Pregnancy associated plasma protein A
Low levels associated with poor placentation
Give aspirin 75mg

52
Q

What is uterine artery doppler

A

Maternal artery measurement
Low resistance to flow = reassuring
High resistance to flow at 24 weeks = PI >1.4
Increase risk of SGA/PET

53
Q

How are risks different for twins

A

Dichorionic (two placenta) lower risk of problems

54
Q

What is the management for FGR

A

Early delivery with steroids

55
Q

What is the management for SGA

A

Consider induction at 37 weeks

56
Q

What is normal birth

A

Infant born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy

57
Q

What is used as pain relief in labour

A

Breathing and relaxation, massage, water
Entonox, opioids
Epidural

58
Q

What is the puerperium

A

Time from the end of the third stage through the first few weeks after delivery. 6 weeks in duration

59
Q

What are signs of postpartum haemorrhage

A

Sudden and profuse blood loss or persistent increased blood loss Faintness, dizziness or palpitations

60
Q

What are signs of infection

A

Fever, shivering, abdo pain

61
Q

What are signs of pre-eclampsia

A

Headaches with:

Visual disturbances, nausea, vomiting

62
Q

What are signs of thromboembolism

A

Unilateral calf pain, redness or swelling

Shortness of breath

63
Q

What are metabolic and adaptive responses in pregnancy

A

Increase absorption from GI tract, decreased excretion via kidney, increased bone turnover, amenorrhoea (preserves Fe)

64
Q

What happens with excessive GWG

A

Adverse maternal and neonatal outcomes, postpartum weight retention

65
Q

What is the mean optimal birth weight

A

3.3kg

66
Q

What is the total estimated energy cost over 40 weeks

A

322 MJ

67
Q

What is the blastogenesis stage

A

Weeks 0-2 - zygote rapdily divides and embded into endometrial lining uterus wall

68
Q

What is the recommendation for oral folate

A

All women planning pregnancy 400 ug per day until 12 weeks post conceptually

69
Q

Vit A requirements

A

RNI=600, but high intakes teratogenic in the pre-conceptual period.

70
Q

Vit D requirements

A

Primarily met via sun exposure
Vit D deficiency in pregnancy associated with congenital rickets, impaired fetal/infant skeletal growth.
10 ug/day Vit D supplement

71
Q

Ca requirements

A

RNI=700mg, required for calcification of fetal skeleton

72
Q

Fe requirements

A

Consider Fe supplement if Hb < 110 in the first trimester or <105 in the 2nd trimester

73
Q

What are the breastfeeding recommendations

A

Exclusively breastfed for the first six months, infant formula only recommended an alternative to breastfeeding for infants <12 months

74
Q

When should solid food be introduced

A

6 months

75
Q

What are signs of readiness for solids

A

Can stay in sitting position
Can co-ordinate eyes, hands and mouth
Can swallow food

76
Q

What is DiGeorge Syndrome

A

Microdeletion of chromosome 22q11.2

Presents with palatal abnormlaities, cardiac problems, hypocalcaemia, renal anomalies

Human Development (9 decks)

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