Week 235 - Pregnancy 2 Flashcards by Hannah Gregson

What is the pre-eclampsia triad?

Raised BP
Proteinuria
Pitting oedema

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What is the pre-eclampsia triad?

Raised BP
Proteinuria
Pitting oedema

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How common is pre-eclampsia in pregnancy?

Around 1 in 10 pregnancies

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What is the cure for severe pre-eclampsia?

Placental delivery is the only cure

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In what situations is conservative management of pre-eclampsia appropriate?

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What conservative methods are used in the management of pre-eclampsia?

Anti-hypertensives
Magnesium sulphate
Potentially corticosteroids

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What anti-hypertensives are used in pregnancy for management of pre-eclampsia?

labetalol; nifedipine; hydralazine

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How does magnesium sulphate help in pre-eclampsia management?

It helps control / prevent seizures by reducing certain nerve impulses within the muscles. (Good preventative measure as well as treatment measure)

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How do corticosteroids help in pre-eclampsia management?

Aid foetal lung development. Also useful in the management of intrauterine growth restriction (IUGR)

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How common is pre-eclampsia in pregnancy?

Around 1 in 10 pregnancies

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What is HELLP syndrome and what three features may indicate its occurrence?

Liver damage considered a variant of severe pre-eclampsia:
H (haemolysis)
EL (elevated liver enzymes)
LP (Low platelets)

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In what situations is conservative management of pre-eclampsia appropriate?

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What conservative methods are used in the management of pre-eclampsia?

Anti-hypertensives
Magnesium sulphate
Potentially corticosteroids

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What anti-hypertensives are used in pregnancy for management of pre-eclampsia?

labetalol; nifedipine; hydralazine

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List some potential additional symptoms that indicate severe pre-eclampsia rather than moderate

Seizures; headaches; visual disturbances; proteinuria ++; clonus; liver tenderness; epigastric pain; papilloedema; brisk reflexes

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How does magnesium sulphate help in pre-eclampsia management?

It helps control / prevent seizures by reducing certain nerve impulses within the muscles

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How do corticosteroids help in pre-eclampsia management?

If given before induction of labour to aid foetal lung development. Also useful in the management of intrauterine growth restriction (IUGR)

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If a pregnant lady presents with severe pre-eclampsia before 23 weeks gestation what is the advised treatment?

termination

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What is HELLP syndrome and what three features may indicate its occurrence?

Liver damage considered a variant of severe pre-eclampsia:
H (haemolysis)
EL (elevated liver enzymes)
LP (Low platelets)

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What is the pathophysiology of stage 1 pre-eclampsia?

Ø Incomplete trophoblastic invasion
Ø Spiral artery reduction in flow
Ø Reduced uteroplacental blood flow – placental hypoxia
Ø Exaggerated immune response
Ø Endothelial dysfunction

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What is the pathophysiology of stage 2 pre-eclampsia?

Ø Vasoconstriction
Ø Clotting abnormalities (microangiopathic haemolytic anaemia, thrombocytopenia)
Ø Increased vascular permeability

What are the generally accepted systolic BPs for mild, moderate and severe pre-eclampsia?

mild: 140-159mmHg

Mod and severe: >160mmHg

List some potential additional symptoms that indicate severe pre-eclampsia rather than moderate

Seizures; headaches; visual disturbances; proteinuria ++; clonus; liver tenderness; epigastric pain; papilloedema.

What are the risk factors for pre-eclampsia?

Primigravida; Multiparous but with new partner; Previous Pre-eclampsia; Diabetes; Obesity; Renal Failure; 35 years old; Multiple pregnancy

List the absolute indications for c-section (5)

``` Placenta praevia Previous classical c-section Pelvic deformity Uncorrectable abnormal lie Severe antenatal compromise ```

List relative indications for c-section

Previous c-section DM Breech presentation Older nulliparous woman

List the two main reasons form delivery before 34weeks

Severe pre-eclampsia | Severe IUGR

What are the two main instruments used in operative delivery?

Forceps (rotational / non-rotational, Kiellands / Neville-Barnes) Ventouse

Which instrument is more traumatic to baby and which to mum?

Forceps more traumatic for mum | Ventouse for baby (tends to be used more now)

In occipito-transverse what is a likely use of instrumentation to help delivery?

Ventouse to help descend and hopefully rotate | If ventouse will no rotate then forceps to do so after descent

If occipito-posterior what is the ideal instrumental delivery?

180 degree rotation with ventouse or forceps | Either instrument for OA foetal position

List 3 predisposing factors to multiple-pregnancy

Increased age IVF treatment (assisted conception) Family history (Race though not sure which)

What is meant by the term "zygosity"?

Whether or not twins in a multiple pregnancy have identical or different genetic material (I.e. 1 egg split in 2 (monozygous) or 2 separate fertilised eggs (dizygous))

What is meant by the term "chorionocity"?

Refers to placentation Shared placenta = monochorionic Two separate placentas = dichorionic

What is meant by the term "amniocity"?

Refers to relation of amniotic membranes between the twins | If dichorionic then must be diamniotic but can be monochorionic and diamniotic or monochorionic and monoamniotic

Regarding chorionocity and amniocity what will dizygous twins always be?

``` Dichorionic Diamniotic (DCDA) (Monozygous twins can be any combo) ```

What risks foetal are associated with monochorionicity?

``` Miscarriage Congenital abnormalities IUGR TTT (twin to twin transfusion - one grows at the expense of the other) Preterm; Perinatal loss ```

Want maternal complications can occur with MC?

``` Hyperemesis gravis arum PIH and pre-eclampsia Gestational DM Anaemia APH/PPH Placental praevia ```

What is the the purpose of the 12 and 20 week scan?

``` 12 = dating scan 20 = anomaly scan ```

When should you plan for uncomplicated DCDA and MCDA delivery?

DCDA - 37-38 weeks | MCDA - 36-37

List some key changes that occur to the CVS system

Increased CO :- SV and HR (starling) Decreased BP initially which creeps up after 24wks to normal by term Increased blood volume and preload Decreased afterload (due to reduced vascular resistance)

In what ways does increased progesterone levels in pregnancy alter physiology?

Relaxes smooth muscle: CVS/Resp: Reduces PVR, induces sense of SOB Renal: increased renal blood flow GU: Ureteric dilatation, can induce urinary incontinence, GI: LOS relaxation > reflux, reduces GI motility, gallbladder dilatation (stones)

How do endocrine and CVS changes in pregnancy jointly cause oedema?

Increased RAAS activity (retaining sodium and water)

What haematological changes do you see in pregnancy?

Increased: blood volume, neutrophil count, RBC mass Reduced: Hb, Hct, ferritin, total protein and albumin and cell-mediate immunity (though numbers not altered)

How is thyroid function affected in pregnancy?

``` Increased TBG (thyroxine binding globulin - which transports thyroxine around the body) > low freeT4 > stimulated TSH secretion > raised serum T3+T4 hCG binds to TSH receptors > further stimulating TSH ```

Why is VTE risk increased in pregnancy?

Raised levels of these clotting factors: I, VII, VIII, IX, X and XII Reduced protein S Reduced PT

What is the benefit of increased clotting factors?

Reduces chances of haemorrhage intra-/postpartum

What renal / GU physiological changes occur in pregnancy?

Increased kidney size Increased renal perfusion and GFR Ureteric dilatation (pelvic obstruction) Altered tubular function > glycosuria, proteinuria, calcuria, bicaronuria Urea + creat reduced Renin, A2 + aldosterone increased but peripheral sensitivity reduced

What renal pathology can result from foetal obstruction or the ureter(s)?

Hydronephrosis - become stretched and swollen due to urine buildup that is forced retrograde (90% right-sided)

What respiratory features alter and which remain the A&E usually in pregnancy?

Tidal volume increases Residual volume decreases Vital capacity and RR remain consistent with non-pregnancy values

List GI physiologic changes that occur in pregnancy

*Reflux Increased appetite *Slow transit > constipation (increased nutrient absorption) N+V, HG *Gallbladder dilatation (many lead to stones). *progesterone related