3. hormonal changes and adaptations

Question 1

what happens to RBCs

Answer 1

• inrcreased synthesis, stimulated by erythropoietin
• anaemia due to dilution
• haematocrit falls to 32%
• 30% increase in intracellular 2-3, DPG (helps O2 release to fetus)

Question 2

describe the way fatty acids are transported in the placenta

Answer 2

1. triglycerides in LP release NEFAS due to LIPOPROTEIN LIPASE
2. NEFAS transported across trophoblast cells by fatty acids transport proteins (FATP)

Question 3

why is folate important

Answer 3

reduce neural tube defects

Question 4

what are some fetoplacental hormones

Answer 4

oestrogen, progesterone

Question 5

what are some functions of oestrogen

Answer 5

• stim. Renin-Angiotensin-Aldosterone Axis
• synth of liver FA and cholesterol
• growth of uterus
• prime uterus for labour
• anti-insulin activity
• CV adaptations to pregnancy
• cervical ripening

Question 6

what are some functions of progesterone

Answer 6

• prep and maintain endometerium
• suppress maternal immune response to fatal antigens
• parturition
• substrate for glucocorticoid and mineralocorticoid production
• mammary gland growth
• inhibit uterine contractions, prevent cervix ripening
• lower maternal CO2
• stim. renin angiotensin axis

Question 7

role of hCG

Answer 7

maintain corpus lute structure

Question 8

what are the functions of hCG

Answer 8

• stimulate maternal thyroid activity:
  bind to TSH receptor
  LH-hCG receptor thyroid
  stim activity via LH-hCG or TSH receptor

Question 9

what is hPL

Answer 9

human placental lactogen

Question 10

main role of hPL

Answer 10

modify metabolism of mother to facilitate energy supply of fetus

Question 11

what are some functions/actions of hPL

Answer 11

• maternal lipolysis and increase NEFAs
• anti-insulin or diabetogenic action (more insulin = mobilise AA and glucose, and fetal protein synthesis)
• potent angiogenic hormone: fetal vasculature

Question 12

what are some placental proteins

Answer 12

hPL
SP1
PAPP-A (pregnancy associated plasma protein A)
hCG
VEGF (vascular endothelial growth factor)
PLGF (placental growth factor)
Leptin

Question 13

what is the main role of leptin

Answer 13

regulate growth and development
angiogenesis
hematopoiesis

Question 14

functions of leptin

Answer 14

• stim placental AA and FA transport

- leptin=fetal birthweight

Question 15

how is leptin secreted

Answer 15

both cytoplasms and syncitiotrophs

maternal levels higher

Question 16

what observations change in pregnant woman

Answer 16

increase in HR and aortic CO

decerase in TPVR

Question 17

why does TPVR fall in pregnant woman

Answer 17

-increased NO
-increased prostacyclins (PGI2, vasodilator)
-relaxin?
=VASODILATE

Question 18

why does CO increase in pregnant woman

Answer 18

• Na retention
• oest: increase renin-aldosterone
• prog: inc aldosterone
• vasodilatory PGs: inc aldos

-increase renin due to: shunting blood so sympathetic; renal Na loss due to inc GFR; hCG

Question 19

what does increased blood flow to in lead to

Answer 19

• inc skin temp, nail growth and hair growth
• disappearance of Raynaud’s syndrome
• nose bleeds, nasal stuffiness, snoring

Question 20

what kidney changes to GFR occur in pregnancy

Answer 20

increase in GFR and effective renal plasma flow until 26 weeks, after which it decreases

Question 21

what renal changes occur

Answer 21

• plasma conc decrease (urea and creatinine)
• glycosuria
• calciuria
• inc urinary freq
• urinary stasis due to dilation of collecting system

Question 22

what pulmonary changes occur (i.e. breathing)

Answer 22

• inc tidal volume
• deep breathing (progesterone)
• RR unchanged
• expiratory reserve reduced
• lower pCO2, inc pO2, pH unchanged
• altered costal margin and diaphragm

Question 23

what changes are involved in coagulation and fibrinolysis

Answer 23

• inc factors VII, VIII and X
• inc plasma fibrogen –> inc ESR (Erythrocyte sedimentation rate )
• dec. fibrinolytic activity

Question 24

how does the GI tract change

Answer 24

• red. smooth muscle tone = lowered cardiac sphincter tone and lowered motility and mobility
• biliary stasis: inc, gastric reflux (heart burn), nutrient absorption and water reabsorption