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Year 3 - Reproduction and Sexual Health > Week 5 > Flashcards

Week 5 Flashcards

1
Q

What are the 3 shunts found in foetal circulation?

What does this mean for oxygenation of blood?

A

Ductus venosus

Ductus arteriosus

Foramen ovale

These shunts mean that blood doesn’t travel to the lungs for oxygenation

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2
Q

At how many weeks gestation are the following lung developmental phases?

  • pseudoglandular
  • canalicular
  • saccular
  • alveolar

At what point does surfactant production begin?

A

Pseudoglandular - 3 weeks

Canalicular - 16 weeks

Saccular - 24 weeks

Alveolar - 36 weeks

Surfactant is produced from the saccular stage onwards (i.e. from 24 weeks)

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3
Q

What are some of the preparations made by the foetus in the 3rd trimester for delivery?

A

Production of surfactant

Accumulation of glycogen in the liver, muscles and heart

Accumulation of brown fat between the scapulae and around internal organs

Accumulation of subcutaneous fat

Swallowing of amniotic fluid

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4
Q

Describe what happens to a baby within the first few seconds of birth

A

Initially blue, then starts to breathe

Cries, which increases intrathoracic pressure and pushes fluid out of the air spaces in the lungs and into the interstitial tissues

Baby gradually goes pink as O2 sats go up to about 90% within the first 10 mins of life

Cord is then cut after 1-2 mins, too soon and the baby may become hypovolaemic/anaemic (more of a problem in pre-term babies)

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5
Q

What various changes occur in foetal circulation as it transitions to post-birth?

A

Pulmonary vascular resistance drops

Systemic vascular resistance rises

Oxygen tension rises

Circulating prostaglandins drop (due to removal of the placenta)

Ducts constrict and the foramen ovale closes

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6
Q

How is the ductus arteriosus closed at birth?

A

O2 is typically a potent vasodilator, however in the ducts it is a potent vasoconstrictor - as respiration begins this causes closure

Removal of the placenta (a v. low resistance organ) causes systemic resistance to rise, and blood to flow to the lungs where previously it hadn’t

The placenta also produces prostaglandins, specifically prostaglandin E2 to keep the DA open. Upon removal of the placenta, this removes the amounts of prostaglandins in the circulation and causes constriction of the ducts.

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7
Q

How can a patent ductus arteriosus be managed?

A

Conservative - watchful waiting to see if the duct closes itself

Medically - prostaglandin inhibitors may be given (either indomethacin or ibuprofen)

Surgically

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8
Q

What happens to the 3 shunts following changes in systemic circulation at birth?

A

Foramen ovale - closes, or remains patent in 10% of cases

Ductus arteriosus - becomes the ligamentum arteriosus, or may remain patent

Ductus venosus - becomes the ligamentum teres on the liver

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9
Q

What condition arises if normal circulatory transition fails?

What are the features of this condition?

A

Persistent pulmonary hypertension of the Newborn (PPHN)

Pulmonary hypertension, causing hypoxaemia (metabolic acidosis) secondary to a right-to-left shunting of blood at the foramen ovale and ductus arteriosus

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10
Q

How is PPHN managed?

A

Ventilation

Oxygen (babies tend to be resuscitated with normal air, not O2)

Nitric oxide (very potent vasodilator), works in a lot of babies, depending on the aetiology

Sedation

Inotropes - milrinone, vasodilator

Extra-corporeal life support (ECLS) - ECMO requires anticoagulants so has risks of clotting. This is a very specialised treatment

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11
Q

Why are newborn babies at risk of being too cold?

A

Large surface area in relation to their body weight + wet when born

Heat loss occurs by…

  • babies being unable to shiver
  • main source of heat production is non-shivering thermogenesis, which is inefficient in the first 12 hours of life
  • peripheral vasoconstriction
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12
Q

Which babies are at greater risk of developing hypothermia?

How is this risk managed in post-natal care?

A

Small for dates/pre-term babies are at greater risk, but all babies need help to maintain their temperature

Smaller/pre-term babies have low stores of brown fat, little sub. cut. fat and a large surface area:volume

Hypothermia is managed with…

  • drying the baby as soon as it is born
  • dressing them in a hat and blanket/clothes
  • skin-to-skin contact with mum as soon as possible
  • heated mattresses
  • incubators
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13
Q

How might a newborn baby develop hypoglycaemia?

A

Increased energy demands

  • if unwell
  • hypothermia

Low glycogen stores

  • small
  • premature

Inappopriate insulin:glucagon ratios

  • maternal diabetes
  • hyperinsulinism

Some drugs

  • e.g. labetalol (used to treat high maternal blood pressure)
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14
Q

If left untreated, how might hypoglycaemia affect a newborn? How is this avoided/treated?

A

Inappropriately high insulin shuts off ketone production, which can result in brain damage in babies

Managed by…

  • identifying high risk babies
  • feeding effectively
  • keeping babies warm
  • monitoring carefully
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15
Q

How does a baby’s sucking affect the mother’s hypothalamus?

A

Creates a positive feedback loop

Post. pituitary releases oxytocin which causes milk ejection

Ant. pituitary releases prolactin which causes milk production

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16
Q

Describe the change in haemoglobin from neonate to adult. How might this lead to anaemia?

What chromosome is responsible for the different subunits of Hb?

A

Foetal haemoglobin is made up of alpha and gamma subunits

Adult haemoglobin is made up of alpha and beta subunits

At birth, synthesis of foetal haemoglobin ceases, however adult haemoglobin is made slower than foetal haemoglobin is broken down, which can result in physiological anaemia as well as physiological jaundice

Beta and gamma subunits are synthesised on chromosome 11

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17
Q

For how long should folic acid be taken at pregnancy?

A

400 micrograms daily for 3 months prior to conception, and also the first 3 months of pregnancy

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18
Q

What point of a pregnancy is there the greatest amount of teratogenic risk?

A

1st trimester, especially weeks 4-11

1st trimester is when organogenesis takes place, and if possible all drugs should be avoided unless maternal benefit outweighs the risk

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19
Q

Name some known teratogenic drugs. How do they affect the foetus?

A

ACE inhibitors/ARBs - cause renal hypoplasia

Androgens - can cause virilisation of female foetus

Antiepileptics - can cause cardiac, facial, limb and neural tube defects

Cyotoxics (e.g. chemo) - multiple defects, abortions

Lithium - cardiovascular defects

Methotrexate - skeletal defects

Retinoids (used for acne, similar to Vit. A) - ear, cardiovascular and skeletal defects

Warfarin - limb and facial defects

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20
Q

How might some drugs affect outcomes around term? Examples (think labour and baby after delivery)?

A

Adverse effects on labour

  • adaptation of foetal circulation may be affected by NSAIDs resulting in premature closure of ducts
  • suppression of foetal systems e.g. opiates causing respiratory depression
  • bleeding e.g. caused by warfarin

Adverse effects on baby after delivery

  • withdrawal symptoms e.g. caused by SSRIs and opiates
  • sedation
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21
Q

What drug, when taken by mothers to prevent recurrent miscarriage (didn’t work), resulted in their children developing urogenital malignancies?

A

Diethylstilbestrol a.k.a. desplex

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22
Q

What antiepileptic drugs should be avoided in pregnancy?

Is it worth treating epileptic women while pregnant?

A

Avoid phenytoin and valproate

YES! Benefits of treating outweigh the risks in most cases, there is a 20-30% risk of congenital malformations if on 4 drugs, so monotherapy is preferred and be sure to give folic acid as well

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23
Q

Which antihypertensive agents are used in pregnancy?

Which ones should be avoided?

A

Older antihypertensives, as more is known about their effect in pregnancy

Labetalol

Methyldopa

(Nifedipine - not ideal, reserve for patients that don’t tolerate the above)

Avoid ACE inhibitors, ARBs and antidiuretics. Beta blockers may also inhibit foetal growth in late pregnancy

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24
Q

What medications should be used for the following acute problems?

  • nausea and vomiting
  • UTI
  • Pain
  • Heartburn
A

N+V - Cyclizine is safest

UTI - nitrofurantoin, cefalexin, or if 3rd trimester use trimethoprim

Pain - paracetamol

Heartburn - antacids

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25
Q

In breast milk, foremilk is higher in ____, while hindmilk is higher in ____

A

Foremilk is higher in protein

Hindmilk has a higher fat content

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26
Q

What drugs might be unsafe in breastfeeding?

A

Phenobarbitone - causes suckling difficulties

Amiodarone - can cause neonatal hypothyroidism

Cytotoxics - causes bone marrow suppression

BZDs - causes drowsiness

Bromocriptine - suppresses lactation

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27
Q

This drug causes teeth staining in children

A

Tetracyclines

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28
Q

This drug can cause spina bifida and anencephaly

A

Sodium valproate

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29
Q

This drug can cause cleft palates/lips

A

Phenytoin

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30
Q

What is considered a normal weight range for a newborn baby?

A

‘Normal’ = 2.5 - 4kg

Over 4kg = large for gestational age (LGA)

Under 2.5kg = small for gestational age (SMA)

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31
Q

What is the Apgar score? What score is considered normal?

A

Used post-birth as an objective measure of perinatal adaptation

Score is given out of 10 in the categories of… (0, 1 or 2)

  • Heart rate
  • Resp rate
  • Responsiveness
  • Tone
  • Colour

Normal = 8 or more

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32
Q

What infections might a newborn be at risk of, based on maternal history?

A

Hepatitis B

Hepatitis C

HIV

Syphilis

TB

Group B Strep

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33
Q

What vitamin deficiency is the cause for Haemorrhagic Disease of the Newborn? (and subsequently, replacement is the treatment)

A

Vitamin K

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34
Q

Name some conditions that are screened for in newborn babies

How is this done?

A

Newborn examination checks immediately after birth

Universal hearing screening

Hip screening - both clinical and USS

Guthrie blood-spotting card

  • CF
  • Haemoglobinopathies
  • Hypothyroidism
  • Various metabolic diseases (PKU, maple syrup urine disease, isovaleric acidaemia etc.)
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35
Q

Define the terms “term” and “post-term”

A

Term - after 37 weeks of gestation are complete

Post-term - after 41 weeks of gestation are complete

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36
Q

What tissue type is largely accumulated in the 3rd trimester that aids the neonate immediately after birth?

How does this differ at a) 28 weeks and b) at term?

A

Fat is accumulated in the third trimester, with a gain of approximately 7g of fat in the final 4 weeks of gestation

At 28 weeks, an average male will have a body fat % of 3.5%

At term, an average male will have a body fat % of 15%

This is relevent in the case of pre-term infants

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37
Q

T/F - a baby must be regularly fed within the first 24 hours after birth

A

False - allow babies to feed when they want, they will use brown fat as their main energy source initially

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38
Q

How might a mother become infected with hepatitis B? How can transmission to her baby be prevented?

A

Hepatitis B infection via blood transfusions, IVDU or sex

Transmission can be prevented via immediate vaccination after birth (if mother is infected, otherwise vaccine is typically done at 2 months), or via immunoglobulins

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39
Q

Name some swellings that may develop in a baby’s head as a result of Ventouse/forceps delivery

A

Cephalhaematoma - well demarcated swelling (blood) between the epicranial aponeurosis and the periosteum. Spread is stopped by suture lines. May cause anaemia (left image)

Caput Succedaneum - more diffuse swelling (right image)

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40
Q

When screening the neonate, what features are inspected for in the eyes?

A

Size

Presence of red reflex (absence could indicate retinoblastoma)

Conjunctival haemorrhage

Squints (common, tend not to require intervention)

Iris abnormalities

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41
Q

When screening the neonate, what features are inspected for in the ears?

A

Position

Is there an external auditory canal present?

Tags/pits

Folding

Is there a family history of hearing loss?

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42
Q

When screening the neonate, what features are inspected for in the mouth?

A

Shape

Philtrum

Palate

Tongue tie

Neonatal teeth

Sucking reflex

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43
Q

When screening the neonate, what is looked for when assessing respiratory and cardiovascular functions?

A

Respiratory

  • Chest shape
  • Nasal flaring
  • Sternal/Interncostal recessions
  • Tracheal tug
  • Grunting
  • Tachynpnoea
  • Breath sounds

Cardiovascular

  • Colour of the baby
  • O2 saturations
  • Palpation of the femoral pulse - irregularities could indicate coarctation of the aorta
  • Palpation of the apex beats and heaves/thrills
  • Heart sounds
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44
Q

When screening the neonate, what is looked for when assessing the abdomen?

A

Does it move with respiration?

Is there distension?

Presence of hernias?

Assess the umbilicus

Has there been bile-stained vomit?

Has there been passage of meconium?

Assess the anus

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45
Q

When screening the neonate, what is looked for when assessing the genitourinary system?

A

Normal passage of urine?

Normal external genitalia?

Are there undescended testes?

Is there evidence of hypospadias?

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46
Q

When screening the neonate, what is looked for when assessing the muskuloskeletal system?

A

Movement and posture

Limbs and digits

Spine and hip examination (may indicate, for example, spina bifida or need for a Pavlik harness)

47
Q

When screening the neonate, what is looked for when assessing the neurological system? (inlcuding primitive reflexes, 5)

A

Is the baby alert and responsive?

Do they cry?

Is there tone?

Posture and movement

Primitive Reflexes

  • Moro (startle) reflex
  • Sucking
  • Rooting
  • Asymmetric Tonic Neck Reflex (ATNR) a.k.a. fencing reflex
  • Stepping
  • Grasp
48
Q

Name some skin conditions that may be seen in the neonate, including one that may point to an underlying condition

A

Erythema toxicum neonatum - benign

Mongolian blue spot - benign melanocytic naevus that is often mistaken for bruising

Strawberry haemangioma (naevus) - benign, gets bigger before disappearing

Haemangioma on the face, “port wine stain” - may indicate underlying Sturge-Weber Syndrome

49
Q

How long is the neonate period?

A

0-27 days

50
Q

How is a sick neonate initially managed?

A

ABC approach

Check and manage temperature

Airway and breathing - do they require oxygen?

Circulation - do they require fluids or inotropes?

Metabolic balances - do they require glucose management or acid-base correction?

Antibiotics

51
Q

What pathogen causes most perinatal infections in the neonate?

What other bacteria cause problems in the neonate?

A

Group B Strep

E. coli

Listeria monocytogenes

Staph aureus

Staph epidermidis (NB - remember this is coagulase negative, and is associated with babies that have lines in)

52
Q

What viruses cause problems in the neonate?

A

CMV

Parvovirus

Herpes viruses

Enteroviruses

Toxoplasma

HIV

Hepatitis

Rubella

53
Q

What mode of delivery is more likely to result in development of Transient Tachypnoea of the Newborn (TTN)?

A

C-section

54
Q

What cardiac conditions might present in the neonate that are related to pregnancy/birth specifically?

A

Heart failure as a result of Hydrops faetalis (fluid where there shouldn’t be fluid e.g. around the heart, in the lungs etc.). Caused by Rhesus, parvovirus, chromosomal factors etc.

Persistent Pulmonary Hypertension in the Newborn - caused because pressure in the lungs is too high and blood cannot flow into them

55
Q

Name some congenital cardiac abnormalities

A

Tetralogy of Fallot

Atrial/Ventricular septal defects

Transposition of the great arteries

Coarctation of the aorta

Total Anomylous Pulmonary Venous Drainage (TAPVD)

56
Q

What are the 4 components of Tetralogy of Fallot?

A

Pulmonary stenosis

Right ventricular hypertrophy

Ventricular septal defect

Overriding aorta

57
Q

What is “pre-term” defined as?

A

Birth occurring before 37 weeks of gestation have been completed

58
Q

What public health intervention saw premature births fall by 10%?

A

The smoking ban

59
Q

Globally, the number of pre-term babies being born is rising/declining

Why is this the case?

A

Rising

Increased maternal age

Increase in pregnancy-related complications

Greater use of infertility treatments

More c-section deliveries before term

60
Q

What are some of the risk factors for pre-term birth?

A

Interval of less than 6 months between pregnancies

Conceiving through IVF

Smoking, drinking alcohol, illicit drugs

Poor nutrition

Some chronic conditions

Mutliple miscarriages/abortions

61
Q

What are some common conditions affecting premature babies?

A

Temperature control issues

Feeding/nutrition issues

Sepsis

System immaturities and dysafunctions e.g. respiratory distress, PDA, intraventricular haemorrhage, NEC

62
Q

What is necrotising enterocolitis (NEC)? What are the main features?

A

Seen in pre-term/unwell infants (7% of preterm infants develop NEC), a portion of the bowel dies.

Symptoms - poor feeding, bloating, decreased activity, blood in the stool, vomiting bile

Treatment - bowel rest, orogastric tube, IV fluids and antibiotics

If free air is seen in the abdomen, surgery is required

Among those affected, approx 25% die

63
Q

Why is thermal regulation inefficient in a pre-term baby?

A

They have low basal metabolic rates

There is minimal muscular activity (can’t shiver)

Subcutaneous fat insulation is markedly reduced compared to a term baby

There is a high ratio of surface area to body weight

64
Q

How is growth/nutrition impaired in pre-term babies?

A

Limited reserve of nutrients

Potential gut immaturity

Potentially immature metabolic pathways

Increased nutrient demands

65
Q

What are the two categories of neonatal sepsis, and what are the most common causative organisms of each?

A

Early onset - mainly due to bacteria acquired before and during delivery

  • Group B strep
  • Gram negatives

Late onset - acquired after delivery (nosocomial/community sources)

  • Coagulase negative staphylococci (e.g. Staph epidermidis)
  • Gram negatives
  • Staph aureus
66
Q

What are some of the respiratory complications of prematurity?

A

Respiratory Distress Syndrome (RDS)

Apnoea of prematurity

Bronchopulmonary dysplasia

67
Q

What are some of the primary and secondary causes of Respiratory Distress Syndrome in neonates?

How common is this condition?

A

Primary

  • surfactant deficiency
  • structural immaturity

Secondary

  • alveolar damage
  • formation of exudate from leaky capillaries
  • inflammation
  • repair

This condition is common in premature babies - experienced by 75% of infants born before week 29, and 10% of infants born after week 32

68
Q

Respiratory Distress Syndrome - signs/symptoms and treatment

A

Signs and Symptoms

  • tachypnoea
  • grunting
  • intercostal/sternal recessions
  • nasal flaring and tracheal tugging
  • cyanosis
  • worsens over minutes to hours, reaching its worst between 2-4 days, then gradually getting better

Treatment

  • maternal steroids
  • surfactant
  • ventilation (either invasive or non-invasive)
69
Q

How are intraventricular haemorrhages classified? What is associated with the grades?

A

Graded I-IV

Grades I and II - neurodevelopmental delay in up to 20% of infants, and mortality of 10%

Grades III and IV - neurodevelopmental delay in up to 80% of infants and mortality of 50%

70
Q

What does restricted foetal growth indicate if it is a) symmetrical and b) asymmetrical?

A

a) symmetrical growth restriction indicates that a genetic cause is more likely
b) asymmetrical growth indicates placental failure/malnutrition, as cranial growth will be prioritised

71
Q

What easy, non-invasive test can be done to establish the sex of a foetus in utero?

A

Testing maternal blood for foetal DNA

72
Q

What would the following drugs cause if used during pregnancy?

  • ACE inhibitors/ARBs
  • Androgens
  • Anti-epileptics
A

ACEI/ARBs - renal hypoplasia of foetus

Androgens - virilisation of female foetus

Anti-epileptics - cardiac, facial, limb, neural tube defects

73
Q

What would the following drugs cause if used during pregnancy?

  • Lithium
  • Methotrexate
  • Warfarin
A

Lithium - cardiovascular defects

Methotrexate - skeletal defects

Warfarin - limb and facial defects

74
Q

What cautions should be taken when prescribing any drug during pregnancy?

A

Consider non-drug alternatives

Only prescribe if benefits outweigh the risks

Use the lowest effective dose for the shortest duration possible

Discuss the risks and benefits, and document this

Use older drugs with established safety records

75
Q

Most drugs do/do not cross the placenta

What is the exception?

A

Most drugs DO cross the placenta

Exception - large molecular weight drugs, such as heparin

76
Q

How might the pharmacokinetics of a drug (the absorption, distribution, metabolism and excretion) be affected by pregnancy?

A

Absorption - may be affected by morning sickness

Distribution - increased body fat stores meaning Vd increasess

Metabolism - increased liver metabolism of some drugs e.g. Phenytoin

Excretion - increased GFR means renally excreted drugs are eliminated more quickly

77
Q

Which part of pregnancy is the period with the greatest risk of teratogenicity?

Why?

A

The 1st trimester (4th-11th week) - organogenesis occurs

There is also a risk of early miscarriage

If possible, all medications should be avoided at this time, unless maternal benefit outweighs the risk to the foetus

78
Q

How might drugs given in the second and third trimester affect the foetus adversely?

A

Affect growth

Affect functional development - intellectual impairment and behavioural abnormalities

Toxic effects on foetal tissues

79
Q

Around term, what might the following drugs cause if used?

  • NSAIDs
  • Opiates
  • SSRIs
  • Warfarin
A

NSAIDs - may cause a premature closure of the ductus arteriosus, disrupting the adaptation of the foetal circulation

Opiates - respiratory depression in the foetus, as well as withdrawal syndrome

SSRIs - withdrawal syndrome in the foetus

  • Warfarin - excessive bleeding around term
80
Q

What drug was given to pregnant women in the past in an attempt to prevent recurrent miscarriage (unsuccessfully), and resulted in vaginal adenocarcinoma in female children and urological malignancy in male children?

A

Diethylstilbestrol (DesPlex)

81
Q

Should epileptic pregnant women continue to take their anti-epileptic medications?

A

Yes

Incidence of congenital malformations is higher in untreated women with epilepsy than in women without epilepsy

Seizures also increase in 10% of women during pregnancy (related to non-compliance and changes in plasma conc of drug)

Frequent seizures in pregnancy are associated with lower verbal IQs, hypoxia, bradycardia, antenatal death and maternal death

82
Q

How should epilepsy during pregnancy be managed?

A

Monotherapy preferred - lamotrigine, topiramate etc.

AVOID Na valproate and Phenytoin

Also give folic acid 5mg daily

83
Q

How is Diabetes managed during pregnancy?

A

Insulin is thought to be safe, Sulphonylureas are NOT safe

Requirements change during pregnancy. If poorly controlled, risk of congenital malformations and intrauterine death

84
Q

What changes occur to maternal blood pressure during pregnancy?

If it needs to be managed pharmacologically, what medications should be used?

A

BP falls during the second trimester so hypertension may not be as severe

If needed to treat, use either labetalol or methyl-dopa as they are older and more is known about their safety

AVOID ACE inhibitors/ARBs (foetal renal hypoplasia) and beta-blockers (inhibit foetal growth in late pregnancy)

85
Q

Nausea and vomiting is common during pregnancy - what medication is safest to give to manage this?

A

Cyclizine (anticholinergic and antihistamine)

86
Q

UTIs are a common acute problem during pregnancy - what medication(s) are given?

A

Nitrofurantoin

Cefalexin (in the first/second trimester), Trimethoprim (in the third trimester)

87
Q

What painkiller is generally the best option when prescribing in pregnancy?

A

Paracetamol

88
Q

The risk of what vascular pathology is greatly increased during pregnancy?

How is this managed?

A

Risk of venous thromboembolism is increased 10-fold during pregnancy and is a leading cause of maternal death during pregnancy

All pregnant women are assessed for VTE risk, and those with significant risk factors are prescribed LMWH as thromboprophylaxis

(Avoid Warfarin in both early and late pregnancy as it is teratogenic and may cause excess bleeding during delivery)

89
Q

How do foremilk and hindmilk differ in terms of content?

A

Foremilk - protein rich

Hindmilk - higher fat content (meaning it is more likely to contain any fat-soluble drugs that the mother may be taking, however few are in sufficient quantities to cause problems)

90
Q

Which drugs cause problems during breastfeeding?

A

Phenobarbitone - causes suckling difficulties

Amiodarone - may cause neonatal hypothyroidism (amiodarone is an iodine-rich drug)

Cytotoxics e.g. chemo - cause bone marrow suppression in neonate

Benzodiazepines - cause drowsiness

Bromocriptine (dopamine agonist used to treat pituitary tumours, Parkinson’s etc.) - suppresses lactation

91
Q

What foetal defects does Phenytoin cause?

How about Sodium valproate?

A

Phenytoin - cleft lip and palate

Sodium valproate - spina bifida and anencephaly

92
Q

What is the normal weight range for a newborn baby?

A

2.5 - 4kg

Under 2.5 = small for gestational age

Over 4 = large for gestational age

93
Q

What is the APGAR score?

A

Objective measure of perinatal adaptation, scored out of 10, with ‘normal’ being 8 and above

  • Heart rate
  • Respiratory rate
  • Responsiveness
  • Tone
  • Colour
94
Q

How does the risk of breast cancer change in relation to bodyweight?

A

5% increase with every 2kg/m2 of bodyweight

95
Q

What are some of the criteria that have to be met for a woman to be accepted for IVF?

A

BMI must be between 18.5 and 30

Non smokers (both) for >3months

No illegal substance abuse

Both must be methadone free for at least 1 year

Neither partner should drink alcohol

Neither partner should have undergone voluntary sterilisation, even if reversed

96
Q

What are some common MSK-related pregnancy problems?

A

Back pain

Pelvic girdle pain

Diastasis or Rectus Abdominis Muscle (DRAM) - gap developing between rectus abdominis muscle

Carpal tunnel syndrome

97
Q

What MSK observations can be carried out for a pregnant woman?

BONUS Q - which gluteal is most likely to fail during pregnancy?

A

Observation - gait, posture, build and bump

Bony landmarks

Muscle activity (strength or weakness, wasting or overactivity)

Neural assessment if deemed necessary

Glut medius is known to fail during pregnancy

98
Q

How might pelvic floor dysfunction present?

A

Incontinence (urine or faeces)

Difficulty with defaecation (issues with control and relaxation)

Pain

Prolapse

99
Q

What grading system is used to assess pelvic floor strength?

A

Modified Oxford Scale

Grade 0 - no discernable contraction

Grade 1 - flicker

Grade 2 - weak contraction

Grade 3 - moderate contraction

Grade 4 - good contraction

Grade 5 - strong contraction against maximal resistance

100
Q

How is pelvic floor dysfunction managed?

A

Lifestyle - smoking cessation, healthy BMI, moderating ADLs/doing appropriate exercises

Bladder symptom management - caffeine reduction, bladder training/drill, voiding techniques, pelvic floor exercises +/- biofeedback training, core stability exercises

101
Q

How are pelvic floor exercises delivered?

A

Structured programme ensuring correct technique

Individualised to account for slow and fast twicth muscle fibres

Learning to engage pelvic floor prior to increases in intra-abdominal pressure

Exercises are performed until muscle fatigue several times a day

102
Q

What is vuvlodynia and how is it best managed?

A

Chronic pain around the vagina with no obvious identifiable cause

Physio exercises have been seen to be the most effective management

103
Q

A new mother with hepatitis C and currently on methadone is wondering if she can breastfeed - what do you say?

A

Hep C - okay

Methadone - okay, minimal exposure to baby

104
Q

What is considered a normal temperature for a newborn baby?

Why might newborn babies be cold?

A

36.5 degrees upwards

Babies are born wet, and have an increased surface area to bodyweight

105
Q

What are some of the risk factors for a newborn baby becoming hypoglycaemic?

A

Low birth weight (less resources)

Maternal/Gestational DM

Blood pressure medications in the mother, especially Labetolol

Low temperature

Being pre-term

106
Q

Which of the following times after birth would it be abnormal for a baby to be jaundiced?

  • 0-24 hours
  • 2-3 days
  • 14+ days

What potentially serious complication could result from early neonatal jaundice?

A

0-24 hours - abnormal

2-3 days - normal

14+ days - abnormal, suggests liver pathology/biliary atresia

If a baby is significantly jaundiced following birth (<24 hours), they could develop kernicterus which could result in impaired neural development

107
Q

How is kernicterus managed?

A

Kernicterus risk if hyperbilirubinaemia <24 hours after birth

Manage with immediate exchange transfusion, phototherapy (first line for neonatal jaundice in general, do this first and see effect to determine if exchange transfusion is required), hydration and IV immunoglobulin

108
Q

How is phototherapy used to treat hyperbilirubinaemia?

A

Isomerises bilirubin, making it water soluble and able to be passed more easily

109
Q

In a neonate expressing methadone withdrawal symptoms, what can the mother do that might help?

A

Express milk - may contain a small amount of methadone to help the baby with withdrawal symptoms

110
Q

What is a NAS score? What parameters are measured?

A

Neonatal Abstinence Syndrome

  • sweating
  • diarrhoea and vomiting
  • nappy rash
  • tachypnoea
  • irritability and tremors
  • uncoordinated feeding
  • seizures if extreme
111
Q

What is a Guthrie card and what is it used for?

A

Blood spotting card, ideally used when baby is 5 days old, screens for a variety of infections

  • Sickle cell disease
  • Cystic Fibrosis
  • Inherited Metabolic Diseases (PKU, maple syrup urine disease etc.)
  • Congenital hypothyroidism
112
Q

How is Neonatal Abstinence Syndrome managed pharmacologically?

A

If there are 2 consecutive raised NAS scores, oramorph can be given

Weaning can take weeks

113
Q

It is normal/abnormal for babies to lose weight initially after birth

A

Normal - babies lose weight through fluid loss, using reserves etc.

Up to 10% bodyweight loss initially is acceptable

114
Q

What is the definition of ‘prolonged neonatal jaundice’ in…

  • pre-term babies
  • term babies
A

Pre-term - +21 days

Term - +14 days

Year 3 - Reproduction and Sexual Health (7 decks)

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