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Medicine Year 2 > Week 235 - Pregnancy 2 > Flashcards

Week 235 - Pregnancy 2 Flashcards

1
Q

What is the pre-eclampsia triad?

A

Raised BP
Proteinuria
Pitting oedema

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2
Q

What is the pre-eclampsia triad?

A

Raised BP
Proteinuria
Pitting oedema

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3
Q

How common is pre-eclampsia in pregnancy?

A

Around 1 in 10 pregnancies

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4
Q

What is the cure for severe pre-eclampsia?

A

Placental delivery is the only cure

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5
Q

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

A
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6
Q

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

A

Anti-hypertensives
Magnesium sulphate
Potentially corticosteroids

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7
Q

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

A

labetalol; nifedipine; hydralazine

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8
Q

How does magnesium sulphate help in pre-eclampsia management?

A

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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9
Q

How do corticosteroids help in pre-eclampsia management?

A

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

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10
Q

How common is pre-eclampsia in pregnancy?

A

Around 1 in 10 pregnancies

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11
Q

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

A

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

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12
Q

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

A
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13
Q

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

A

Anti-hypertensives
Magnesium sulphate
Potentially corticosteroids

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14
Q

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

A

labetalol; nifedipine; hydralazine

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15
Q

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

A

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

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16
Q

How does magnesium sulphate help in pre-eclampsia management?

A

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

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17
Q

How do corticosteroids help in pre-eclampsia management?

A

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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18
Q

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

A

termination

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19
Q

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

A

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

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20
Q

What is the pathophysiology of stage 1 pre-eclampsia?

A 
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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21
Q

What is the pathophysiology of stage 2 pre-eclampsia?

A

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

22
Q

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

A

mild: 140-159mmHg

Mod and severe: >160mmHg

23
Q

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

A

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

24
Q

What are the risk factors for pre-eclampsia?

A

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

25
Q

List the absolute indications for c-section (5)

A 
Placenta praevia
Previous classical c-section
Pelvic deformity
Uncorrectable abnormal lie
Severe antenatal compromise
26
Q

List relative indications for c-section

A

Previous c-section
DM
Breech presentation
Older nulliparous woman

27
Q

List the two main reasons form delivery before 34weeks

A

Severe pre-eclampsia

Severe IUGR

28
Q

What are the two main instruments used in operative delivery?

A

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

29
Q

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

A

Forceps more traumatic for mum

Ventouse for baby (tends to be used more now)

30
Q

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

A

Ventouse to help descend and hopefully rotate

If ventouse will no rotate then forceps to do so after descent

31
Q

If occipito-posterior what is the ideal instrumental delivery?

A

180 degree rotation with ventouse or forceps

Either instrument for OA foetal position

32
Q

List 3 predisposing factors to multiple-pregnancy

A

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

33
Q

What is meant by the term “zygosity”?

A

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))

34
Q

What is meant by the term “chorionocity”?

A

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

35
Q

What is meant by the term “amniocity”?

A

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

36
Q

Regarding chorionocity and amniocity what will dizygous twins always be?

A 
Dichorionic Diamniotic (DCDA)
(Monozygous twins can be any combo)
37
Q

What risks foetal are associated with monochorionicity?

A 
Miscarriage
Congenital abnormalities
IUGR
TTT (twin to twin transfusion - one grows at the expense of the other)
Preterm; Perinatal loss
38
Q

Want maternal complications can occur with MC?

A 
Hyperemesis gravis arum
PIH and pre-eclampsia 
Gestational DM
Anaemia
APH/PPH          Placental praevia
39
Q

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

A 
12 = dating scan
20 = anomaly scan
40
Q

When should you plan for uncomplicated DCDA and MCDA delivery?

A

DCDA - 37-38 weeks

MCDA - 36-37

41
Q

List some key changes that occur to the CVS system

A

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)

42
Q

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

A

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)

43
Q

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

A

Increased RAAS activity (retaining sodium and water)

44
Q

What haematological changes do you see in pregnancy?

A

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

45
Q

How is thyroid function affected in pregnancy?

A 
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
46
Q

Why is VTE risk increased in pregnancy?

A

Raised levels of these clotting factors:
I, VII, VIII, IX, X and XII

Reduced protein S
Reduced PT

47
Q

What is the benefit of increased clotting factors?

A

Reduces chances of haemorrhage intra-/postpartum

48
Q

What renal / GU physiological changes occur in pregnancy?

A

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

49
Q

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

A

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

50
Q

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

A

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

51
Q

List GI physiologic changes that occur in pregnancy

A

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

Medicine Year 2 (28 decks)

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