physiology

Question 1

what are the 5 placental functions?

Answer 1

1. resp
2. renal
3. nutrition
4. immunity
5. hormonal

Question 2

placental function- respiratory?

Answer 2

supplies foetus with 02

Question 3

placental function- renal

Answer 3

purifies blood for foetus

Question 4

placental function- nutrition

Answer 4

contains electrolytes, glucose etc

Question 5

placental function-immunity

Answer 5

IgG can cross the placenta

Question 6

placental function- hormonal

Answer 6

excretes- oestrogen, progesterone, BHCG, HPL

Question 7

what is HPL

Answer 7

human placental lactose
increased risk factors for maternal gestational diabetes

Question 8

how is fetus monitored

Answer 8

with ultrasound

Question 9

in ultrasound weeks 1-8, what do you see

Answer 9

embryo

Question 10

in ultrasound weeks 8-12, what do you see?

Answer 10

50mm
crown rump length

Question 11

in ultrasound weeks 21, what do you see?

Answer 11

210 mm

Question 12

when should surfactant be produced?

Answer 12

at 35 weeks

Question 13

big problem being born premature? what do you give?

Answer 13

surfactant not produced therefore common to go into respiratory distress
so you give maternal corticosteroids and baby surfactant after birth

Question 14

what is surfactant produced by and what does it do?

Answer 14

secreted by type 2 pneumocytes
lowers activation energy making it easier to breath

Question 15

what maternal changes occur at cv?

Answer 15

• decrease in BP
• increase in CO

Question 16

why does Cardiac Output increase?

Answer 16

because SV increases as more volume to supply foetus
but HR only slightly increases

Question 17

why does BP decrease?

Answer 17

BP= CO X TPR
only slight increase in CO compared to
massive decrease in TPR as you want no resistance when supplying baby

Question 18

how are mothers advised to sleep and why?

Answer 18

to sleep on side
DECUBITUS
as sleeping on back there is a risk od inferior vena cava being compressed

Question 19

what are the maternal changes in haem

Answer 19

anaemia as you have the same number of RBC but a bigger CO therefore there is a dilution
increased d dimer as there is an increase in oestrogen and progesterone that can affect ability to coagulate

Question 20

what are the maternal changes in GI

Answer 20

Dysmotility therefore causing constipation and GORD

Question 21

what are the maternal changes in immunity

Answer 21

decrease immune response

Question 22

what are the maternal changes in endocrine

Answer 22

poorer glycemic control- therefore hypos increased in DM

Question 23

maternal changes In GU

Answer 23

increased renal excretion and increased UTI risk

Question 24

maternal changes in hormones

Answer 24

increased oestrogen, progesterone, PRL, T3,T4,BHCG,ALP,ESR,CRP

Question 25

visual maternal changes

Answer 25

linea nigra, striae gravidarium polymorphic eruptions of pregnancy

Question 26

what is the main thing the midwife regularly checks

Answer 26

to monitor each appt is symphysial fundal height, +- 2cm for gestational age

Question 27

who does the checks in pregnancy

Answer 27

complicated- DR uncomplicated- MIDWIFE

Question 28

what are all mums advised

Answer 28

- vid d supplements 20mcg/day - folate for 1/3 - smoking cessation - no alc - healthy eating

Question 29

in weeks 8-12 what check happens

Answer 29

BOOKING - hep B, HIV, Sickle cell, Thalassemia, syphillis , BMI, BP,FBC

Question 30

in weeks 11-13 and 6w what check happens

Answer 30

to more accurately date the pregnancy- USS do combined USS- N.T ( measuring fluid at the back of the babys neck) , checking BHCG levels, to screen for chromosomal abnormalities- PAPP-A,- trisomy - 13,18,21

Question 31

in downs what would the tests look like

Answer 31

increased BHCG decreased PAPP-A >6mm NT ( thicker fluid increases risk of chromosomal conditions)

Question 32

what does PAPP-A stand for

Answer 32

pregnancy associated plasma protein A

Question 33

in weeks 18-20+ 6 weeks what check occurs

Answer 33

ANOMALY USS checking for - CHD, NTD, Gastroschisis and omphalocele, placenta previa, cleft lip, anencephaly

Question 34

what is gastroschisis and omphalocele

Answer 34

Gastroschisis and omphalocele are congenital defects of the abdominal wall resulting in intestinal herniation from the abdominal cavity. omphalocele, there is a sac covering the intestines gastroschisis, there is no sac covering the intestines

Question 35

what is anencephaly

Answer 35

a serious birth defect where a baby is without parts of the brain and skull at birth

Question 36

what tests happens at 28 weeks

Answer 36

OGTT- oral glucose tolerance test + RH blood test if mother Rh+ ( rehus) midwife bp check, sfh, urine dip ( symphysis fundal height)

Question 37

what happens at 34weeks

Answer 37

USS 2nd RhoGam dose ( if mom is - and baby is +) 2nd placental previa scan not strictly routine

Question 38

what happens at 36 weeks

Answer 38

determine presentation if breech offer ECV at 37 weeks

Question 39

what happens at 38 weeks

Answer 39

discuss long pregnancy

Question 40

what happens at 41 weeks

Answer 40

discuss inducing labour- start with membrane sweep

Question 41

what other tests do you do?

Answer 41

CVS- 11-14 weeks- sample chorionic vili - amniocentesis- 15 weeks- sample amniotic fluid NIPT - 15-20 weeks- sample mums blood for cff DNA- 99% for downs

Question 42

what is a risk for or doing the cvs test and amniocentesis

Answer 42

0.5-1%- miscarriage- precipitation of RHD, clubfoot, infection

Question 43

what test is done for downs

Answer 43

quad test

Question 44

when is the quads test done

Answer 44

15 weeks

Question 45

what would a positive result of quad test show?

Answer 45

increased BHCG decreased AFD decreased E3 increased inhibin A

Question 46

what is Hyperechogenic bowel associated with?

Answer 46

- downs syndrome - cystic fibrosis - cmv + b19