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Medicine: PBL wrap-ups > Unit 7 Week 2: Pregnancy > Flashcards

Unit 7 Week 2: Pregnancy Flashcards

1
Q

symptoms of early pregnancy

A

spotting
missed period
vaginal discharge
nausea/vomiting
food aversion/cravings
breast tenderness
cramps
increased urination: increased blood volume: kidneys processing more liquid
mood changes
bloating
constipation
dysgaisia

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2
Q

severe nausea and vomiting

A

hyperemesis gravidarum
leads to weight loss, ketosis and dehydration

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3
Q

bloating in pregnancy

A

progesterone relaxes muscles in womb
allows expansion to grow

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4
Q

dysgaisia

A

metallic taste in mouth

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5
Q

advice for early pregnancy

A

eat little and often
dry food
ginger
fluids
anti nausea wristbands?

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6
Q

common genetic conditions

A

down’s syndrome
Edward’s syndrome
Palau’s syndrome

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7
Q

Down’s syndrome

A

trisomy 21
extra chromosome
tested using blood test and nuchal translucency on ultrasound
not offered if dating scan is after 14 weeks but blood test offered 14-20 weeks

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8
Q

Edward’s syndrome

A

trisomy 18
genetic condition caused by extra copy of chromosome
babies with the condition don’t usually survive longer than a week
same screening as Down’s but 20 week scan for physical conditions

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9
Q

patau’s syndrome

A

trisomy 13
rare genetic disorder caused by additional copy of chromosome 13
some or all body cells

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10
Q

dating scan

A

ultrasound at around 10-14 weeks
checks how far along you are in pregnancy, babies development and if you’re expecting more than one baby

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11
Q

abnormalities detected at dating scan

A

downs
Edwards
spina bifida
pataus

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12
Q

anomaly scan

A

detailed ultrasound 18-21 weeks
checks: bones, heart, brain, spinal cord, face ,kidneys ,abdomen

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13
Q

abnormalities detected at anomaly scan

A

11 rare conditions
anencephaly
open spina bifida
cleft lip
diaphragmatic hernia
gastroschisis
exomphalos
cardiac abnormalities
bilateral renal agenesis
lethal skeletal dysplasia
Edwards
pataus

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14
Q

nuchal translucency

A

measures the fluid behind babies neck in 1st trimester
small amount is normal but greater than 3.5mm is abnomrla
can hep calculate babies chances of chromosomal variant
looks at nuchal fold
done at 11-13 weeks when baby is 45mm and 84mm crown to rump

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15
Q

more fluid in nuchal translucency

A

sign of Edwards, pataus, downs, congenital heart problems

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16
Q

why must nuchal translucency be done 11-13 weeks

A

as fluid can be reabsorbed by 14 weeks

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17
Q

process of genetic screening

A

genetic screening
genetic diagnostic test
genetic disorders
family history assessment

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18
Q

genetic screening

A

how likely the baby will have a condition

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19
Q

genetic diagnostic test

A

definitive test

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20
Q

genetic disorders

A

aneuploidy (trisomy and monosomy)
nutations

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21
Q

aneuploidy

A

abnormal number of chromosomes

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22
Q

trisomy

A

extra chromosome

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23
Q

monosomy

A

missing chromosome

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24
Q

2 types of prenatal testing

A

screening tests and diagnostic tests

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25
Q

genetic screening tests in 1st trimester

A

screening/ sequential screening/ combined test
cell free fetal DNA screening/ non invasive pre natal testing (NIPT)
carrier screening

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26
Q

screening/ sequential screening/ combined test

A

2 maternal blood samples and ultrasound
11-13 weeks gestation
ultrasound: nuchal translucency, fetal development and growth
blood tests: pregnancy associated plasma protein A and HCG

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27
Q

PAPP-A, pregnancy associated plasma protein A results

A

made by placenta
low levels= greater risk of neural tube defects

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28
Q

HCG results

A

hCG made by placenta
high= greater risk of trisomy 21
low levels= greater risks of trisomy 18

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29
Q

cell free fetal DNA screening, cfDNA/ non-invasive pre natal DNA testing (NIPT)

A

analyses maternal blood sample for fetal DNA (free-floating DNA that has been broken down will travel into bloodstream)
may detect genetic condition of the mother
done at 10 weeks or later
chromosomal disorders, sex of baby and Rh blood type
positive test= greater risk

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30
Q

carrier screening

A

blood test/ saliva test/ tissue sample taken from both parents
can identify single gene conditions: cystic fibrosis, sickle cell
find chances of having child with genetic disorder
if blood test shows you’re a carrier then partner should undergo genetic testing

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31
Q

genetic screening tests in 2nd trimesters

A

maternal blood sample
15/16 weeks
measures alpha-fetoprotein, hcg, estriol, inhibit

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32
Q

alpha-fetoprotein results

A

produced by fetal liver
present in amniotic fluid
crosses placenta into mothers blood
abnormal levels= abnormal neural tube defects, chromosomal abnormalities, twins
10-150ng/ml is normal

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33
Q

HCG results second trimester

A

produced by placenta
high = trisomy 21
low= trisomy 18
1400-53,000= normal

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34
Q

estriol (uE3) results

A

produced by placenta
low= trisomy 21 and 18
5-18ng/ml is normal

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35
Q

inhibin results

A

produced by placenta
high= trisomy 21
105-522 pg/ml is normal

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36
Q

uses of genetic screening

A

early detection so parents can make informed decisions and prepare emotionally
improved medical management to support plan and monitor
reduced anxiety/ uncertainty
option for termination if poor QOL for child/impact mother
carrier screening- make informed decisions on having the child, regular check-ups
pharmacogenomics: personalised treatments plans and improve medical efficiency
educate other family members about risk

37
Q

limitations of genetic screening

A

ethical: sex selective termination, termination of pregnancy, discrimination, stigmatisation
limited predictive value
false positives
psychological impact on individual/ families: guilt, blame, anxiety
invasive procedures carry a risk
costly
family/societal pressure

38
Q

method of non-invasive pre-natal screening

A

take blood sample 6-10ml
invert 10 times immediately and if insufficient volume then discard and retry
store at room temp before transport comes
sent to lab within 2 working days of sample being taken
determine proportion of chromosomes compared to normal range
results available in 10 working days and return as low chance, high chance or no call

39
Q

low chance NIPT

A

unlikely the baby will be affected

40
Q

high chance NIPT

A

increased likelihood and recommended invasive diagnostic test

41
Q

no call result NIPT

A

in very small number of cases the test may not yield a result

42
Q

what does NIPT test for

A

downs
Edwards
pataus

43
Q

eligibility for NIPT

A

higher chance result in T21 or joint higher result for T18 and T13 from NHS combined test
higher chance result from T21 in NHS quadruple test
in singleton and twin pregnancies, no higher
10 weeks up to 21 weeks and 6 days

44
Q

when is NIPT not suitable

A

if you have cancer
received blood transfusion in last 4 months
bone marrow/ organ transplant
immunotherapy
stem cell therapy
vanished twin pregnancy/ empty 2nd pregnancy Sac or second sac containing non-viable foetus
mother has T21, 18 or 13

45
Q

choosing whether to have screening tests

A

informed decision
individual differences
cultural and religious factors
do you want to know
will the results influence your behaviour
support
family/societal pressures

46
Q

impact of results of genetic screening

A

deciding further tests
choosing whether to continue pregnancy
false positives or negatives
support
challenges of having child with disability

47
Q

what is medicalisation

A

process by which some aspects of human life came to be considered as medical problems
whereas before they weren’t considered pathological
includes pregnancy and childbirth

48
Q

advantages of medicalisation of maternity care

A

pain prevention methods
unknown factors of how the delivery will go
NICU
dedicated experienced and knowledgeable nursing team
any complications during birth

49
Q

disadvantages of medicalisation of maternity care

A

hospital is new and unfamiliar
stressful
may have to sacrifice own birth preferences
limited birth positions
having to choose between visitors present at birth

50
Q

2 sides of placenta

A

fetal
maternal

51
Q

fetal side of the placenta

A

chorionic plate
covered by amnion
secretes amniotic fluid: protection and exchange
thicker membrane continous with lining of uterine wall
eely in development the plate is covered by chorionic villi adjacent to the decidua capsularies
villi adjacent to the decidua basalis persist increase in size and produce chorion frondosum

52
Q

maternal side of the placenta

A
53
Q

function of the placenta

A

highly specialised
provides nutrition and oxygen to the foetus
removes waste and carbon dioxide
creates separation between maternal and fetal circulation= placental barrier
protects fetes from infections and other maternal disorders
helps develop fetal immune system
endocrine function: secretes hormones such as HCG that affect: pregnancy, metabolism, fetal growth and parturition

54
Q

location of the placenta

A
55
Q

what is rhesus disease

A

haemolytic disease
mothers blood is Rh-negative and baby blood is Rh positive
Rh= contains Rh factor protein and negative lacks the protein

56
Q

pathogenesis/ pathophysiology of rhesus disease

A
57
Q

treatments of rhesus disease

A

Rh immunoglobulin medication
intrauterine transfusion
early deliver y

58
Q

rh immunoglobulin medication

A

given to mothers who are Rh negative during pregnancy and after delivery to prevent sensitisation

59
Q

intrauterine medication

A

in case where Rh causes severe anaemia
Rh blood transfusion, baby’s umbilical vein to replace damaged blood cells

60
Q

early delivery

A

prevent any further damage if baby is at risk of severe anaemia

61
Q

what is sickle cell anaemia

A

group of inherited red blood cell disorder
haemoglobin is abnormal
causes RBC to be hard, sticky and C shaped
sickle cells die early and cause constant shortage of RBC

62
Q

different types of SCD

A

HbSS, most severe
HbSc
HbS beta thalassemia

63
Q

HbSS

A
64
Q

HbSC

A
65
Q

HbS beta thalassemia

A
66
Q

normal types of haemoglobin

A

A and F

67
Q

haemoglobin A

A

most common in healthy adults

68
Q

haemoglobin F

A

fetal
unborn babies and newborns
replaced with A after birth

69
Q

abnormal haemoglobin type

A

S
C
E

70
Q

haemoglobin S

A

sickle cell disease
stiff snd sickle shaped
can gert stuck in blood vessels and cause severe and chronic pain
infections and other complications

71
Q

haemoglobin C

A

doesnt carry oxygen well
mild form of anaemia

72
Q

haemoglobin E

A

mostly found in people with south East Asian descent
normally no symptoms/ mild anaemia symptoms

73
Q

complications of sickle cell

A

acute chest syndrome
anaemia
avascular necrosis
blood clots
dactylics
feer
infection
kidney problems
leg ulcers
liver problems
organ damage
pain
priapism
pulmonary hypertension
sleep-disordered breathing
splenic sequestration
stroke
vision loss

74
Q

acute chest syndrome

A

life threatening
can result in lung injury
breathing difficulty
low O2
usually caused by infection
medical emergency

75
Q

avascular necrosis

A

when bone doesnt get enough hO2
bone tissue can die

76
Q

investigations to see if mother is a carrier of sickle cell

A

questionnaire
FBC
haemoglobin electrophoresis
DNA testing

77
Q

FBC sickle cell

A

haemoglobin levels
reticulocyte levels: normally low
white blood cells count: ormally low

78
Q

haemoglobin electrophoresis sickle cell

A

test for different Hb types
separates the types using electrophoresis: electric current applied to blood sample
appears as different coloured bands

79
Q

DNA testing sickle cell

A

Done to test which type of sickle cell you have
When electrophoresis is inconclusive

80
Q

methods of testing foetal SCD

A

CVS sampling
chorionic villus sampling
placental DNA at 9-14
amniocentesis

81
Q

what is CVS

A

Transabdominal or trans cervical
removing and testing small sample of placental cells
11to 14 weeks
Test for genetic disorders
Risk of miscarriage

82
Q

types of CVS

A

transabdominal
transcervical

83
Q

amniocentesis

A

Small amount of amniotic fluid is removed from amniotic sac for testing
Contains fetal cells and alpha fetoprotein
To look for birth defects
From week 15
Risk of miscarriage

84
Q

newborn sickle cell anaemia testing

A

heel-prick test
part of newborns blood spot test

85
Q

newborn blood spot test

A

9 rare but serious conditions
sickle cell disease SCD
cystic fibrosis CF
congenital hypothyroidism CHT
phenylketonuria PKU
medium chain acyl-CoA dehydrogenase deficiency Mac DD
maple syrup urine disease MSUD
isovaleric academia IVA
glutamic acuduria type 1 GAI

86
Q

role of the community midwife

A

team of community middwives provide antenatal, intra-natal and post natal care to women and their families
Health promotion and early pregnancy advice
arranging booking appointments and discussing choice on where to give birth
provide antenatal care in local coommnuity, GP surgeries and homes

87
Q

booking appointment

A
88
Q

diet and nutrition advice

A
89
Q

role of genetic counsellor

A

Medicine: PBL wrap-ups (21 decks)

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