Scientific Principles of Maternal & Infant Health Exam Qs Flashcards
Women in their third trimester of pregnancy should be advised to rest on their left side as this will avoid what?
Supine hypotension syndrome which occurs when the weight of the enlarged uterus presses on the inferior vena cava thereby reducing venous return resulting in a drop in cardiac output.
How many more calories should a pregnant woman consume and from when?
An additional 200 kcal/day only in the third trimester
Which of the following crosses a cell membrane by active transport? Water Oxygen Sodium Ions Carbon Dioxide
Sodium Ions
Renal blood flow is known to increase during the first trimester of pregnancy by how much?
60%
The woman may experience increased frequency of micturition during the 1st trimester due to what?
The enlarging uterus remains within the pelvis and therefore compression of the bladder occurs causing frequency.
During pregnancy the cardiovascular system adapts by doing what THREE things?
- Increasing blood volume
- Increasing cardiac output
- Decreasing peripheral resistance.
Name THREE unpleasant symptoms that oestrogen may cause the women?
- Nasal stuffiness
- Hypersecretion of mucus
- Increase in the occurrence of epistaxis
What THREE things increase the risk of a Urinary Tract Infection (UTI) during pregnancy?
- The ureters elongate and lose tone due the effects of progesterone.
- The occurrence of vesico-ureteric reflux increases.
- The influence of compression upon the ureters caused by the enlarged uterus at the pelvic brim
Which hormone stimulates Angiogenesis and what is the result?
Oestrogen
An increase in the number and the length of blood vessels
Progesterone influences the respiratory system during pregnancy by affecting what?
Decreases airway resistance by relaxing the smooth muscles of the bronchioles by up to 50%
Why does lipolysis increase during the third trimester?
Fat acts as an alternative source of energy to conserve glucose for fetal utilisation
Maternal pulmonary ventilation increases by 40 % during pregnancy due to what?
The direct effect of progesterone on respiratory mechanisms within the brainstem
What are the three phases of the ovarian cycle?
Follicular
Ovulatory
Luteal
The hormone MOST associated with childbirth is what?
Oxytocin
During trimesters 1 and 2 fat storage increases due to?
Increased insulin production and the influence of progesterone
Proteins do not pass freely through membranes because?
They are very large molecules
Which of the following transportation mechanisms does NOT obey the "laws of diffusion"? Osmosis Diffusion Active transport Facilitated transport
Active Transport
Human Chorionic Gonadotropin (HCG) is different from other gonadotropins because it does NOT what?
Come from the anterior pituitary
How would you calculate a due date – what information would you require? (4 points)
The pattern of a woman’s menstrual cycle would be investigated with regards to length and regularity (1)
Whether the woman was using contraceptives recently (1)
The first date of the woman’s last menstrual period would be needed: this date is then used in the calculation of her estimated date of delivery (EDD) (1)
Naegele’s Rule would be used taking the first date of the woman’s last menstrual period and for:
• A 28 day cycle: + 7days + 9 months
• A 33 day cycle: + 7 days + 5 days + 9 months
• A 23 days cycle: +7 days – 5 days + 9 months (1)
What further investigation is commonly used to confirm gestational age? (2 points)
The estimated gestational age would be confirmed using an ultrasound booking scan (1), this ideally 10-14 weeks gestation where the crown-rump measurement is assessed (1). If the gestation calculated by the sonographer differs by +/- 5 days from the EDD calculated using Naegele’s rule then the date suggested by the USS is usually adopted
Discuss the actions of Human Chorionic Gonadotrophin, including site of production and the significance of changing levels during pregnancy. (3 points)
HCG is produced by the trophoblast and secreted into the lacunae (pockets) of maternal blood in the syncytiotrophoblast. (1)
Action of the hormone- acts upon the corpus luteum (ovary) maintaining oestrogen and progesterone levels to continue pregnancy. (1)
Changing levels- Levels are high and detected in urine 9 days after fertilisation. HCG levels fall when the placenta becomes fully functioning at 12 weeks gestation. (1)
What is the term used to describe severe nausea or morning sickness?
Hyperemesis
What are the known causes of nausea and vomiting? (3 points)
The cause of nausea and vomiting is unclear however there appears to be a link with increasing levels of Human Chorionic Gonadotrophin (HCG). HCG is produced by the trophoblast of the developing embryo from the point of implantation. (1)
Research has suggested a link between nausea and vomiting and raised levels of T4 and higher levels of Thyroid Stimulating Hormone (TSH) (1)
The effect of progesterone upon the tone of gastric smooth muscle may cause significant symptoms of nausea and vomiting due to the influence upon:
• The patency of the lower oesophageal sphincter.
• The delay in gastric emptying.(1)
What advice would you offer someone with morning sickness?
- Reassurance and Advice: Nausea and vomiting is normal and common during pregnancy and will usually resolve spontaneously by 20 weeks therefore Sumara should not become anxious at this time and there are different options available to ease her symptoms. (1)
- Coping Strategies: Would include having small frequent meals, consuming carbohydrates which are easily digested and a diet which is low in fat, foods which contain ginger may be beneficial. Alternative therapies may be utilised with the aid of a fully qualified therapist. (1)
- Pharmacological / Medication: Anti-histamines or Anti-emetics may be prescribed by a doctor e.g. Cyclizine.(1)
- Hospitalisation: If Sumara does not feel that her symptoms have improved then hospitalisation may be indicated particularly if she becomes unable to tolerate oral fluids and if she becomes ketotic. IV fluids and IM/IV Anti-emetics would be indicated.(1)
When measuring the fundal height where are the points measured from?
From the symphysis pubis bone to the top of the fundus (Ideally turn the measuring tape away from the midwife to reduce possible bias)
What would be the expected measurement range of fundal height for a woman who is 28 weeks pregnant?
28cm +/- 3cm
What are the weaknesses of measuring fundal height?
Weakness of the procedure is the subjective nature of the assessment operator error/ inconsistencies can occur
During pregnancy changes occur within the muscle cells of the myometrium – outline the four adaptations which take place.
- Hyperplasia: the development of new muscle fibres
- Hypertrophy: increase in length and thickness of the muscle fibres
- Within the muscle cells there is an increase in the number of contractile proteins, gap junctions, sacroplasmic reticulum and mitochondria
- The three layers of the myometrium become more clearly defined
Which FOUR of the following constituents of blood are ABNORMAL in glomerular filtrate? Water Sodium Potassium Glucose Urea Creatinine Proteins Uric Acid Red Blood Cells White Blood Cells Platelets
- Proteins
- Red Blood Cells
- White Blood Cells
- Platelets
Which FIVE of the following constituents of blood are ABNORMAL in urine? Water Sodium Potassium Glucose Urea Creatinine Proteins Uric Acid Red Blood Cells White Blood Cells Platelets
- Proteins
- Red Blood Cells
- White Blood Cells
- Platelets
- Glucose
What condition may be suggested by the presence of glucose in a woman’s urine?
Gestational diabetes
Why would further tests be required to confirm gestational diabetes?
Further tests would be required to confirm this condition due to the effect of insulin resistance triggered by the hormone progesterone and Human Placental Lactogen (HPL).
The effect of these hormones results in increased blood glucose levels. As glomerular filtration increases during pregnancy the maximum capacity for glucose reabsorption in the renal tubule is exceeded resulting in glucose being excreted in the urine as a normal adaptation during pregnancy.
To confirm gestational diabetes a Glucose Tolerance Test would be required.
Outline the normal physiological adaptations which occur antenatally to the maternal respiratory system (7 points)
- Changes occur to meet the increased metabolic demands of the maternal body and fetus
- Changes are initiated by hormonal, biochemical and mechanical effects
- Muscles and cartilage in the thorax relax due to the effect of progesterone
- The diaphragm rises by 4cm (prior to increasing fundal height)
- The chest broadens and tidal volumes increase by up to 40%
- Alveolar ventilation increases by 70%
- A mild respiratory alkalosis is created which is essential to allow gaseous exchange between the maternal and fetal circulations
Outline the role and functions of the chorionic villi (3 points)
- Finger like projections from the cells of the trophoblast
- Anchor and secure the trophoblast to the endometrium
- By the 3rd week fetal blood circulates through the chorionic villi allowing exchange between (not mixing) of maternal and fetal circulation
Outline the role and functions of the placenta (4 points)
- Transport of nutrients to the fetus
- Waste products are removed with urea, uric acid and bilirubin excreted
- Hormone production
- Protective role – physical barrier to certain substances and also an immunological role
Outline the role and functions of the umbilical cord (3 points)
- Transportation of oxygenated and deoxygenated blood
- Transportation of nutrients from the maternal to the fetal circulation
- Transportation of waste products from the fetal to the maternal circulation
Identify and the temporary structures within the fetal circulatory system and state their function
UMBILICAL CORD/UMBILICAL VEIN:
Oxygenated blood from the placenta enters into the fetal abdomen towards the inferior vena cava.
DUCTUS VENOSUS:
Temporary structure which diverts the majority of the blood from the umbilical vein into the inferior vena cava. (A small amount of blood travels along the portal vein to the liver).
Oxygenated blood from the Ductus Venosus and Deoxygenated blood from the lower limbs and liver mix therefore all other organs receive mixed oxygenated and deoxygenated blood.
FORAMEN OVALE
Situated between the atria through blood flows to bypass the pulmonary circulation ensuring a good supply to the brain.
DUCTUS ARTERIOSUS
Found between the pulmonary arteries and the aorta which directs most of the blood from the pulmonary arteries into the aorta and then into the systemic circulation
HYPOGASTRIC ARTERIES
Branches off from each iliac artery. The majority of the blood flows through the hypogastric arteries to the umbilical arteries and then on to the placenta with a small amount flowing to the lower limbs.
State the changes which women should expect to experience with their breasts during each trimester of pregnancy
FIRST TRIMESTER
• Increased blood supply
• Hyperplasia and hypertrophy of the myoepithelial cells
• Under the influence of oestrogen blood vessels become more prominent – fair skin may appear marbled
SECOND TRIMESTER
• Pigmentation of nipple and areolar and thickening of nipple skin
• Montgomery’s tubercles become more prominent
• Breast secretion may occur – precursor of colostrum
THIRD TRIMESTER
• Human Placental lactogen and progesterone ensure maturation of the alveoli and initiates milk production
• Colostrum and milk secretion is suppressed by high progesterone levels
Identify and explain the action of the two main hormones which control lactation
PROLACTIN
• Released from the anterior pituitary gland
• Stimulates alveolar cells to produce milk
• Levels increase towards the end of a feed therefore producing milk for the next feed
OXYTOCIN
• Stored and released from the posterior pituitary gland
• Stimulates contraction of the myoepithelial cells surrounding the alveoli causing an ejection reflex
• Has an immediate effect providing milk for the current feed
What are the benefits of rooming in? (4 points)
- Increases feelings / strength of a mother’s attachment to her baby
- Mother’s learn quickly how to respond to, care, soothe and comfort their babies
- Babies spend more time quietly sleeping which therefore allow their mothers to rest
- Can assist with breastfeeding: babies feed more effectively and consume more breast milk and subsequently babies gain more weight
