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PAR3031 - MATERNITY > WEEK 4 > Flashcards

WEEK 4 Flashcards

1
Q

how does pregnancy affect asthma in women?

A

1/3 remin stable
1/3 get better
1/3 get worse

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2
Q

what is the most common causes of respiratory distress in pregnancy?

A

Asthma most common

  • tuberculosis rising
  • smoking and obesity
  • cystic fibrosis
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3
Q

what are the risks of uncontrolled asthma in pregnancy?

A

increase in maternal mobidity and mortality

  • higher risk of gestational hypertension
  • gestational diabetes
  • placental abruption
  • pulmonary embolism

increased risk of babies who are premature and have low birth weight

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4
Q

What are the respiratory changes during pregnancy?

A 
• Metabolic rate increases 20%
• increase O2 consumption
• increase CO2 release
• increase pulmonary blood flow due to increase cardiac
output
• increase ventilation (40%)
• increase tidal volume (30-40%)
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5
Q

What are the respiratory physiological changes seen in pregnancy?

A

• As uterus grows, diaphragm displaced
upwards by 4 cm

  • Diameter of rib cage increases outwards
  • Total lung capacity  5%

• Breathing becomes thoracic not abdominal
– decreased functional residual capacity
– decreased residual volume

• Slight hyperventilation

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6
Q

what causes changes in ventilation drive in pregnancy?

A

Progesterone and oestrogen increase sensitvity or respiratory centre to CO2

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7
Q

Define asthma?

A

chronic reversible airway disease characterised by constriction of airway smooth muscles & swelling of airways

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8
Q

what is the pathophy of asthma?

A 
– Bronchial inflammation
– Reducing airway diameter
– Constriction bronchial smooth muscle
– Causing further narrowing
– Therefore decreased airway size
– Bronchial muscles & mucous glands enlarge
– Thick tenacious sputum produced
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9
Q

What are the characteristics of asthma

A 
> bronchoconstriction
> oedema
> inflammation
> mucous secretion
> narrowing of airways
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10
Q

what are some reasons for mental health issues during pregnancy?

A

• Misconceptions and pre-conceived notions about
pregnancy
• Tokophobia
• Can be pre-existing or develop during pregnancy
• New onset thought to be less of a risk
• Suicide highest during the 3rd trimester

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11
Q

what are some mental health risk factors during pregnancy?

A 
• Women late in pregnancy (and first 3 months post
partum)
• Previous mental health problems
• Social isolation
• Previous puerperal psychosis
• Recent termination
• Unwanted pregnancy
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12
Q

How do you manage suicide attempts with pregnant patients?

A

Suicide attempts

• If there is a need for peri mortem c-section then transport
immediately

• IV fluids withheld unless SBP <100mmhg (unless evidence of
>500ml blood loss – service dependant)

• Transport in left lateral tilt (15-30 degrees)

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13
Q

define gestational diabetes mellitus (GDM)

A

GDM is defined as glucose intolerance of variable severity

with onset or first recognition during pregnancy.

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14
Q

What causes GDM

A

▪ Thought to be due to placental hormones of pregnancy
causing insulin resistance, leading to higher maternal
glucose levels in order to provide nutrition to the growing
fetus

▪ Insulin levels are usually increased to counteract the
increased resistance and normalise BSL’s.

▪ In some women there is not a large enough increase in
insulin levels and these women develop GDM

▪ Temporary condition that is normally treated with

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15
Q

how many pregnancies (%) develop GDM?

A

2-12%

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16
Q

when does GDM often develop?

A

Onset usually occurs 3rd trimester, detected at routine 24-

28 week glucose challenge test (screening)

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17
Q

How is GDM diagnosed

A

• Diagnosed with glucose tolerance test (OGTT)

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18
Q

What BGL leves are used in diagnosing GDM?

A

No diabetets

  • Fasting = >6
  • 2 hour = <7.8

Pre diabetes

  • Fasting = 6.1 - 6.9
  • 2 hour = 7.8 - 11.0

Diabetes

  • Fasting = >7
  • 2 hour = >11.1
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19
Q

What are the results of GDM for mothers?

A

– Pre-term births; inductions at 38-39/40; caesarean

sections; hypertension & longer stays in hospital

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20
Q

What are the results of GDM for babies?

A

– miscarriage/stillbirth; congenital abnormalities (cardiac
in particular); prematurity; lower APGAR scores;
resuscitation; high birth weight; larger torso size;
increased likelihood of shoulder dystocia; IUGR;
hypoglycaemia; admission to SCN or NICU; longer
stay in hospital

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21
Q

What are the risk factors for gestational diabetes?

A

▪ Age > 30
▪ Multiple pregnancy (large placenta = increased HPL = increased insulin
resistance = increased glucose levels)
▪ PCOS
▪ BMI >30
▪ Previous macrosomic baby weighing >4.5kg
▪ Previous GDM
▪ Family Hx of diabetes
▪ Family origin with a high prevalence of diabetes (ie South
Asian, Black Caribbean, Middle Eastern)

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22
Q

What are the effects of diabetets on pregnancy?

A
  • increased risk of miscarriage
  • risk of congenital malformation
  • risk of macrosomia
  • increased risk of pre-eclampsia
  • increased risk of stillbirth
  • increased risk of infection
  • increased operative delivery rate
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23
Q

What happens during preganancy in women with type 1 diabetets

A 
▪ Hypoglycaemia- especially in 1st trimester
– Higher than normal levels of progesterone &amp; oestrogen
– Morning sickness
– Rapid growth of fetus
– Precautions - driving/exercise
– Check for hypo awareness
– Glucagon kit (teach partners)
– Review Ketone testing
– Regular meals
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24
Q

What happens during preganancy in women with type 2 diabetets

A

▪ Increased insulin resistance during pregnancy

▪ Increased requirement of insulin

▪ Increased requirement to check BSL’s – 4x daily compared
to previous regime may have been daily or bi-weekly

▪ All oral hypoglycaemics other than Metformin must be
ceased prior to pregnancy (previously it was thought that
Metformin must be ceased prior to 20/40)

▪ Anti-lipid medications must also be ceased

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25
Q

How does metablosim change during pregnancy?

A

Changes in carbohydrate and lipid metabolism occur during pregnancy to
ensure a continuous supply of nutrients to the growing fetus despite
intermittent maternal food intake

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26
Q

How does metablosim change during early pregnancy?

A

▪ Early pregnancy - Low BSL’s
– Normal glucose production, but exaggerated insulin response post
meals
– Changes to lipid metabolism to enhance maternal fat stores

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27
Q

How does metablosim change during late pregnancy?

A

▪ Late pregnancy - High BSL’s

– High glucose production to meet increasing needs of placenta &
fetus

– Insulin doubled, but insulin resistance high due to increased levels
of oestrogen, progesterone & HPL

– Lipid metabolism changes due to HPL to promote fat burning as
alternate energy source for mother

– All serve to increase availability of glucose for fetal use

28
Q

What changes occur during pregnancy regarding oestrogen?

A

▪ Oestrogen
– Levels rise exponentially after 24/40
– Increase insulin production & enhances peripheral glucose
usage = lowers BSL
– Increases plasma cortisol second trimester = increases BSL

29
Q

What changes occur during pregnancy regarding progesterone?

A 
▪ Progesterone
– Levels rise exponentially after 32/40
– Increase insulin resistance
– Exaggerated insulin release after meals
– Net result is increased BSL
30
Q

What changes occur during pregnancy regarding cortisol?

A

▪ Cortisol
– Depletes hepatic glycogen stores & increases hepatic glucose
production = increased BSL

31
Q

What changes occur during pregnancy regarding Human Placental Lactogen (hCS)?

A

▪ Human Placental Lactogen (aka hCS)
– Correlates with fetal & placental weight so highest levels as
pregnancy progresses but drops off from 37/40
– Big placenta (large baby/twins) = more HPL produced
– Increases insulin resistance (antagonist), decreases insulin
production = increased BSL’s
• Glucose sparing mechanism
• More glucose enabled for placenta
– Increases synthesis & availability of lipids (instead of CHO)
• Used as alternate maternal fuel (keeps glucose for baby)

32
Q

what percentage of pregnancies will have hypertention?

A

10-15%

33
Q

How many women die globally from eclampsia annually?

A

50-75k

34
Q

how does the heart change during pregnancy?

A

▪ Rotates up and to the left ≈ 1-1.5cm as uterus
enlarges and causes diaphragm to elevate
▪ Apex located at the 4th not the 5th I/C space
▪ Left axis shift on ECG
▪ ECG changes in lead 3 –
– Q wave &
– inverted T wave

35
Q

what are the cardiovascular changes in pregnancy?

A

▪ Resting heart rate may increase by 10-15 bpm
▪ Systolic murmurs may be heard
– gentle, soft & usually heard best in the pulmonic area and apex
▪ Plasma volume ↑ 50%
▪ RBC volume ↑ 18-20% by 30-34 weeks
gestation

36
Q

How does cardiac output change during pregnancy?

A

▪ ↑ 35-50% in CO plateaus @ 24/40

▪ Heart volume increases from 70ml → 80ml

▪ Due to ↑ stroke volume & ↑heart rate

▪ Blood flow to:
– kidneys, brain & coronary arteries no change
– Uterus ↑’s 3%-17% from 1st to 3rd trimester
– Breast 1%-2% - early pregnancy to term

37
Q

What changes occur in blood as a result of pregnancy?

A

▪ Blood Volume increases 30%-50%
– Protects mum & baby;
– meets foetal needs
– Assists perfusion & demands of other organs
– Safeguards against blood loss @ delivery

▪ Red cell mass increases 18-20%

▪ Produces haemodilution
– Leads to Physiological aneamia
• Decreased plasma proteins
–Decreased oncotic pressure

38
Q

What blood pressure changes occur due to pregnancy?

A 
▪ Arterial BP decreases due to:
– decreased Peripheral &amp; Pulmonary Vascular resistance
• Lowest in 2nd trimester
–nearly normal by term
• Progesterone peaks by 32-34/40
▪ Diastolic ↓’s in 1st trimester
– ↓’s 10-15mmHg by 24/40
▪ Systolic generally unchanged
– ↓’s maximum of 5-10mmHg
▪ Pre-pregnant values return in 3rd trimester
39
Q

What are the types of hypertension in pregnancy?

A

– Preeclampsia
• Eclampsia
• HELLP syndrome

– Non- proteinuric pregnancy induced hypertension (Gestational HTN)

– Chronic hypertension

40
Q

WHat classifies Chronic hypertension in oregnancy?

A

Chronic Hypertension
▪Hypertension prior to pregnancy or
▪↑ BP >140/90 Hg < 20 weeks &
▪Persists up to 6 weeks post natal

41
Q

What are the risk factors for Chronic hypertension in pregnancy?

A 
oRenal disease
oDiabetes
oObesity
oAge >40
oHTN on the OCP
42
Q

WHat classifies gestational hypertension in pregnancy?

A

Gestational Hypertension
▪ Hypertension >140/90 on > 2 occasions
▪ No other signs of pre-eclampsia
▪ Occurs >20 weeks

43
Q

What are the risk factors for gestational hypertension in pregnancy?

A 
o Primiparity/first child with new partner
o Obesity
o Diabetes
o Previous severe pre-eclampsia
o Pre-existing cardiovascular disease
o Age >40
44
Q

WHat classifies pre-eclampsia in pregnancy?

A

WHat classifies gestational hypertension in pregnancy?

  • renal involvement
  • haematological involvement
  • liver involvement
  • neurological involvement
45
Q

what are the renal factors involved with pre-eclampsia?

A

•Significant proteinuria – a spot urine
protein/creatinine ratio ≥ 30mg/mmol
•Serum or plasma creatinine > 90 μmol/L
•Oliguria: <80mL/4 hour

46
Q

what are the haemotological factors involved with pre-eclampsia?

A

▪Thrombocytopenia
▪Haemolysis
▪DIC

47
Q

what are the liver factors involved with pre-eclampsia?

A
  • Abnormal LFTs

* Severe epigastric / RUQ pain

48
Q

what are the neurological factors involved with pre-eclampsia?

A
  • Convulsions (Eclampsia)
  • Hypereflexia
  • New headache
  • Visual distrubances
  • Stroke
49
Q

Define pre-eclampsia

A

hypertension of at least 140/90 recorded on at least 2 seperate occasions and at least 300mg of protein in a 24 hor collection of urine, arising after the 20th week of pregnancy in a previously normotensive woman and resolving completely by the 6th postpartum week.

50
Q

what is classified as MILD PRE-ECLAMPSIA?

A

DBP 90-99

SBP 140-149

51
Q

what is classified as MODERATE PRE-ECLAMPSIA?

A

DBP 100-109

SBP 150-159

52
Q

what is classified as SEVERE PRE-ECLAMPSIA?

A

DBP >110

SBP >160

53
Q

What pathological changes occur during pre-eclampsia in the blood and cardiovascular system?

A

– H/T with endothelial cell damage affects
capillary permeability
– Plasma proteins leak → ↓ plasma colloid
pressure → oedema
– → hypo-volaemia & haemo-concentration

54
Q

What pathological changes occur during pre-eclampsia in the coagulation system

A

Coagulation system
– Altered coagulation cascade
– ↑ platelet consumption → thrombocytopenia
• DIC → occludes kidneys; brain, liver &
placenta

55
Q

What pathological changes occur during pre-eclampsia in the kidneys

A 
– H/T → vasospasm of afferent arterioles
– ↓ blood flow
• → hypoxia &amp; oedema of glomerulus allows
plasma proteins to filter into urine
– Oliguria a late sign
56
Q

What pathological changes occur during pre-eclampsia in the brain

A

– H/T with CVS endothelial damage →
• ↑blood-brain permeability → oedema &
micro-haemorrhaging
– Headaches & convulsions

57
Q

What pathological changes occur during pre-eclampsia in the Liver

A

– Vasoconstriction → hypoxia & oedema
– Epigastric pain & intracapsular haemorrhage
– ↓Albumin & ↑ liver enzymes

58
Q

What pathological changes occur during pre-eclampsia in the Doetoplacental unit

A

– Vasoconstriction ↓ blood flow
– Vascular lesions can occur → abruptio
– Hypoxia → ↓ foetal growth

59
Q

what is the presentation of pre-eclampsia?

A 
▪ BP sharp rise >140/90 in
– 2
nd half of pregnancy
▪ Proteinuria
– Complains of ↓ output
▪ Oedema
– Sudden severe
• widespread
– Non-dependent areas
e.g. face
▪ Hyper-reflexia
60
Q

What are the s&S of pre-eclampsia

A 
▪ Complaints of other symptoms
– Frontal/occipital headache;
blurred vision; epigastric
pain; headache; Visual
disturbances;
Drowsiness/confusion;
Nausea &amp; vomiting;
Epigastric pain
▪ May indicate disease is
deteriorating
61
Q

What are some complications of pre-eclampsia?

A 
▪ Eclampsia
▪ APH Placental abruption
▪ HELLP syndrome
– Haemolysis, Elevated Liver enzymes, Low
Platelets
• Haemtological disturbances
▪ Blindness
▪ Intra uterine hypoxia
– LBW infant; FDIU; Prem. Delivery
62
Q

What is HELLP syndrome?

A 
▪ Considered a variant /
complication of
preeclampsia
Stands for:
▪ Haemolysis
▪ Elevated
▪ Liver enzymes
▪ Low
▪ Platelets
63
Q

What are the risk factors for HELLP syndrome?

A
  • Known pre-eclampsia
  • Multiparity
  • Previous Hx of HELLP
64
Q

What is eclampsia?

A

New onset of convulsions in pregnancy

– May occur independent of pre-eclampsia

65
Q

What are the 4 stages of eclampsia?

A

– Premonitory → Transient & quick
• Roll eyes; muscles twitch

– Tonic → 30secs.
• Violent spasm; Resps. cease → cyanosis

– Clonic → last up to 2 mins
• Jerky muscular movements; frothy blood
stained saliva; stertuous breathing

– Comatose → lasts few minutes to hours
• Deeply unconscious

66
Q

What should we continue to look for on road in monitoring a partient with pre-eclampsia:

A 
▪ Continue to assess for deterioration
– Sharp rise in BP
–  Proteinuria →  Urine Output
– Frontal or occipital headache
– Drowsiness or confusion
– Visual disurbances
– Nausea &amp; vomiting; Epigastric pain
– PV Bleeding → Abruption
67
Q

What does HELLP syndrome stand for?

A 
▪ Haemolysis
▪ Elevated
▪ Liver enzymes
▪ Low
▪ Platelets

PAR3031 - MATERNITY (11 decks)

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