Sem 1- pregnancy, miscarriage and tests
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| What do aldosterone and the steroids of pregnancy promote with regards to a woman's urinary system? | Water and salt retention by the kidneys
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| What happens to a pregnant lady's glomerular filtrate system? | Increases by around 50%
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| What effect does the expanding uterus have upon the bladder? | The expanding uterus presses upon the bladder, reducing its capacity
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| What happens to a woman's skin when pregnant? | 1) Skin grows to accommodate expansion of the abdomen and breast, and the added fat deposition in the hips and thighs
2)Stretching of the dermis often tears connective tissue and could result in stretch marks
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| What happens to melanocyte activity and what does this cause? | 1)Increase in melanocyte activity in some areas
2)Darkens the areolae and linea alba
3)Some women also acquire temporary blotching over the nose and cheeks called a cholasma (usually disappears after pregnancy)
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| What is a miscarriage? | A loss of pregnancy during the first 23 weeks
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| What are signs of a miscarriage? | Vaginal bleeding and cramping pain in the lower abdomen
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| What is the major cause of a miscarriage? | Chromosome abnormalities
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| How does age affect miscarriage occurrence? | <30 = 1/10
35-39 = 2/10
>40 = >1/2
The older you are when you're pregnant, the more likely you are to have chromosome abnormalities in the foetus (as there are fewer viable eggs) which increases the chance of miscarriage
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| What is a recurrent miscarriage? | The loss of 3 or more consecutive pregnancies
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| What screening tests does a recurrent miscarriage clinic offer? | 1)Blood tests to check chromosome number
2)Hormonal profiling of menstrual cycle
3)Blood tests for antiphospholipid syndrome
4)Thyroid function tests
5)Screening for pelvic infections
6)Pelvic scan
7)Investigates to exclude lupus and anaemia
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| Is a local anaesthetic used for chorionic villus biopsy? | Yes (to reduce discomfort)
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| What is the risk of miscarriage due to CVB? | 1%
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| What is the success rate of CVB? | 97.7% successful
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| How long does amniocentesis usually take? | 5-10 mins
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| What is the risk of amniocentesis causing a miscarriage? | 0.5-1% risk
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| What is the success rate of amniocentesis? | 99.5% successful
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| When is the quadruple screening test carried out? | In the second trimester (14-20 weeks). Often if women are too late for the first trimester screening tests or in trusts where the combined test is unavailable
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| What is the detection rate of a quadruple screening test? | 75%
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| What is your systolic blood pressure? | The highest level your blood pressure reaches when your heart beats
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| What is your diastolic blood pressure? | The lowest level your blood pressure reaches between beats
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| What is blood pressure measured? | mmHg (miligrams of mercury)
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| What is examined in urinary dipstick tests? | The urine's: colour, odour, turbidity, glucose, bilirubin, specific gravity, protein content, urobolingogram, pH, haematuria, ketones, leucocyte esterase
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| How are urinary dipstick tests carried out? | All urine samples should be collected midstream in a clean, sterile container. The dipstick should be immersed completely in fresh urine and removed immediately, drawing edge along the rim of container to remove excess
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| What are factors that increase the likelihood of pre-eclampsia? | -First pregnancy
-Had it in previous pregnancies
-Family history of pre-eclampsia
-Over 40 years old
-Expecting multiple babies
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| What causes pre-eclampsia? | The cause is unknown, but it is thought to be linked to the placenta (e.g. if it has an insufficient blood supply)
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| How is pre-eclampsia treated? | -Closely monitored
-The only way is to deliver the baby
-Usually around 37-38 weeks
-This may be induced, or through a caesarian
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| What can progesterone be described as because it affects the walls of the blood vessels? | Vasoactive
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| How does blood pressure change throughout pregnancy? | Blood pressure levels are low in the first two trimesters, and it rises again from 24 weeks, when there are 2.5 extra pints of blood in the woman's body
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| What is the normal range of blood pressure during pregnancy? | <140/90 mmHg
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| What is the mildly high range of blood pressure during pregnancy? | 140/100-149/109 mmHg
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| What is the moderately high range of blood pressure during pregnancy? | 150/100-159/109 mmHg
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| What is the severely high blood pressure range in pregnancy? | >160/110 mmHg
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| What is gestational high blood pressure? | High blood pressure that develops for the first time after the 20th week of pregnancy. It usually returns to normal within 6 weeks of birth
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| How many pregnancies are affected by pre-eclampsia? | Around 5% of pregnancies
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| What are signs and symptoms of pre-eclampsia? | Hypertension, proteinuria, oedema of feet, ankles, face and hands, severe headache, vision problems, and pain just below ribs
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| What are prostaglandins? | A group of hormones involved in many body functions including; -contraction and relaxation of smooth muscle
-dilation and constriction of blood vessels
-control of blood vessels
-modulation of inflammation
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| What is prostaglandin F2-alpha, and what does it stimulate? | It's a stable prostaglandin that stimulates the contraction of uterine and bronchial smooth muscle, and produces vasoconstriction of some blood vessels
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| If tests results from recurrent miscarriage clinics are normal, what action is taken? | A folic acid supplement is usually recommended, antenatal care is booked, and a reassurance scan is booked at 7 weeks for any future pregnancies
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| What happens if test results from recurrent miscarriage clinics are abnormal? | The couple is referred to a specialist. Recurrent miscarriage clinics offer emotional support for couples and can refer them to specialist counselling if necessary
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| What does being older and pregnant increase the risk of? | High blood pressure, gestational diabetes, ectopic pregnancies, miscarriage, placenta praevia, pre-eclampsia, premature birth
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| What term is given to a woman aged 35 or over and pregnant? | Elderly primagravida
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| What changes occur to a woman's digestive system, nutrition and metabolism when she's pregnant? | Develops morning system, constipation, heart burn, basal metabolic rate rises by about 15% in the second half of gestation
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| What causes morning sickness? | Unknown. One theory is that it's dues to intestinal motility caused by the steroid hormones of pregnancy. Another is that it's an evolutionary response to protect the foetus from toxins
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| What causes constipation during pregnancy? | Reduced intestinal motility
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| What causes heart burn during pregnancy? | Caused by the enlargement of the uterus which pushes upwards on the stomach, causing the reflux of gastric contents into the oesophagus
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| When is amniocentesis offered? | Offered at 15 weeks of pregnancy if there's a high risk result for Down's syndrome
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| Outline the process of amniocentesis? | A fine needle is passed through the wall of the abdomen into the amniotic fluid that surrounds the foetus in the uterus. The cells within the uterus contain some of the same cells as the baby. A small sample of amniotic fluid (15-20mL) is then removed.
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| What happens to a woman's respiratory rate during pregnancy? | It remains constant
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| What happens to a woman's tidal volume and minute ventilation when pregnant? And Why? | Increases by about 40% as 1) Oxygen demands rise in proportion to increased metabolic rate and needs of the foetus
2) Progesterone increases the sensitivity of the woman's CO2 chemoreceptors, so ventilation is adjusted to keep her CO2 lower than usual
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| What changes occur to a woman's circulatory system when she's pregnant? | -Placenta requires ~625 mL/min of blood
-Mother's blood volume rises by about 30% during pregnancy due to fluid retention and haemopoiesis
-Cardiac output rises about 30-40% above normal by 27 weeks, drops to almost normal in the last 8 weeks
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| When the pregnant uterus puts pressure on large blood vessels, what might this result in? | Can interfere with venous return from the legs and pelvic region, This can result in haemorrhoids, varicose veins and oedema of the feet
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| When is serum screening carried out? | Performed at 10-13 weeks
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| What is tested for in serum screening? | Pregnancy associated plasma protein a (PAPP-A) and free beta- human chorionic gonadotrophin (free beta-hCG)
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| What are the four hormones tested for in a Quad screening test, and where are they secreted from? | 1)beta hCG - placenta
2) inhibin A - placenta
3) (unconjugated) oestriol - foetus and placenta
4) alphafetoprotein (AFP) - foetus
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| How is the quadruple screening test carried out? | A needle is inserted to draw blood
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| What might low levels of AFP and oestriol, but high levels of beta-hCG and inhibin A indicate? | Down's syndrome or Edward's syndrome
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| What might cause increased levels of AFP? | Absence of brain and part of skull (anencephaly), defect in foetus' intestines, death of foetus inside womb, spina bifida, tetraology of Fallot or Turner syndrome
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| What is the combined test during pregnancy? | Combination of blood (serum) screening and nuchal translucency membrane tests
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| What might low levels of PAPP-A and high levels of free beta-hCG indicate? | Down's syndrome pregnancy
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| What might raised nucha levels indicate? | Down's syndrome pregnancy
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| How is the nuchal translucency measurement carried out? | Ultrasound is used to measure fluid-filled apce at the back of the foetus' neck
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| When is the nuchal translucency measurement carried out? | 11-14 weeks
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| When is chorionic villus biopsy carried out? | 11 weeks of pregnancy
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| Outline the process of CVB | An ultrasound guide is used. A fine needle is inserted into the placenta via the abdomen. A fine tube is passed through the vagina and cervix into the womb. A small piece of chorionic villus tissue is withdrawn and the chromosomes are examined
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