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Reproduction Week 3 2018/19 > 5: Physiology of pregnancy and the peurperium > Flashcards

5: Physiology of pregnancy and the peurperium Flashcards

1
Q

After fertilisation, zygotes divide into a ___ and then a ___.

A

morula

blastocyst

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2
Q

What part of the blastocyst

a) implants in the uterus and becomes the placenta
b) becomes the foetus itself?

A

a) Trophoblast layer

b) Inner cell mass

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3
Q

Where does fertilisation occur?

A

Ampulla of the uterine tubes

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4
Q

Where does implantation occur?

A

Body of the uterus

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5
Q

Which layer of the uterus is invaded by trophoblasts?

A

Endometrium

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6
Q

What are the outer cells of the blastocyst called?

A

Trophoblasts

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7
Q

Why do trophoblasts invade the endometrium?

A

To make space for the blastocyst

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8
Q

While the trophoblasts carve out a space in the endometrium for the blastocyst, what develops in the inner cell mass?

A

Amniotic cavity

where the foetus itself will develop

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9
Q

What is the decidua?

A

Endometrium during pregnancy

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10
Q

What is the chorion?

A

Outer layer of the embryo

whatever that’s called at the time

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11
Q

Which cells break down maternal capillaries to form cavities filled with maternal blood?

A

Syncytiotrophoblasts

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12
Q

What structures extend from the placenta into the endometrium to exchange gas and nutrients with the maternal blood?

A

Chorionic / placental villi

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13
Q

What is another name for placental villi?

A

Chorionic villi

sampled for genetic analysis

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14
Q

What stops foetal and maternal blood from coming into direct contact?

A

Thin membrane of chorionic villi

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15
Q

By which week in development are the placenta and foetal heart functional?

A

Week 5

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16
Q

The framework of the placenta i.e foetal/maternal gas and nutrient exchange via chorionic villi is in place by Week 5.

How does the embryo survive before this?

A

Trophoblasts have invaded the endometrium

Endometrium is highly concentrated with protein, glycogen and lipids

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17
Q

Which hormone, released by the corpus luteum, stimulates the endometrium to concentrate glycogen, protein and lipids?

A

Progesterone

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18
Q

Which structure extends projections into the endometrium to supply the foetus with nutrients and oxygen?

A

Placenta

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19
Q

During development, the foetus’ lungs are deflated.

Which structure plays the role of the lungs?

A

Placenta

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20
Q

What are the relative oxygen concentrations of the maternal and foetal blood?

A

Maternal blood - greater oxygen concentration

Foetal blood - less oxygen because arterial and venous blood mixes in the placenta

So diffusion occurs from mother to child

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21
Q

What are the relative carbon dioxide concentrations of the maternal and foetal blood?

A

Maternal blood - less carbon dioxide

Foetal blood - more carbon dioxide

So diffusion occurs from foetus to mother

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22
Q

What blood vessels are contained in the umbilical cord?

A

2 umbilical arteries

1 umbilical vein

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23
Q

Why does the umbilical cord have two arteries?

A

Unknown

deal with it

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24
Q

Which vessel carries oxygen-rich blood from the placenta to the foetus via the umbilical cord?

A

Umbilical vein

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25
Q

Which vessels carry poorly oxygenated blood from the foetus to the placenta via the umbilical cord?

A

Umbilical arteries

just like the pulmonary arteries and veins, it’s the opposite of normal

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26
Q

Once poorly oxygenated blood has returned to the mother FROM the foetus via the umbilical arteries, which vessels carry it to the maternal IVC?

A

Uterine veins –> Internal iliac veins –> Common iliac veins –> IVC

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27
Q

Once deoxygenated blood has passed from the foetus to the mother via the umbilical arteries –> placenta, which blood vessels carry it to the maternal heart?

A

Uterine veins –> Internal iliac veins –> Common iliac veins –> IVC

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28
Q

What is the main difference between foetal and maternal haemoglobin?

A

Foetal Hb has a greater oxygen affinity than adult Hb

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29
Q

Why does foetal Hb have a greater oxygen affinity than adult Hb?

A

Foetal haemoglobin interacts less with 2,3-diphosphoglycerate (2,3-DPG)

2,3-DPG shifts the oxygen-Hb dissociation curve to the RIGHT i.e less affinity

So less interaction with 2,3-DPG shifts the curve to the LEFT i.e greater affinity

30
Q

Foetal blood has an (increased / decreased) concentration of Hb compared to adult blood.

A

increased concentration of Hb

31
Q

What is the Bohr effect?

A

CO2 displaces oxygen from Hb

So increased concentrations of CO2 means decreased affinity of Hb for oxygen

32
Q

In relation to pregnancy, what is the double Bohr effect?

A

Remember that increased CO2 conc. = decreased affinity of Hb for oxygen

Foetus exchanges CO2 with mother via placenta - foetal Hb has GREATER affinity for O2 due to decreased CO2 conc.

Mother accepts CO2 from foetus via placenta down concentration gradient - adult Hb has REDUCED affinity for O2 due to increased CO2 conc

The displaced oxygen from adult Hb is exchanged with the foetus via placenta

Double Bohr effect

33
Q

What three factors re: Hb allow for oxygenation of the foetus during pregnancy?

A

1. Foetal Hb oxygen affinity > Adult Hb oxygen affinity (reduced interaction with 2,3-DPG, shifts curve to the left)

2. [Foetal Hb] > [Adult Hb]

3. Double Bohr effect

34
Q

The foetus obtains all the nutrients it requires from the mother via the placenta.

Toxic substances can also cross the placenta - what are some examples?

A

Drugs e.g thalidomide, tetracycline, anti-epileptics

Alcohol, nicotine, caffeine…

35
Q

Which hormone prevents the degeneration of the corpus luteum?

A

hCG

Also the hormone used in the pregnancy test

36
Q

Which hormone has important functions re: growth and contributes to gestational diabetes?

A

hCS

human chorionic somatomammotropin

37
Q

Which hormone is produced by the corpus luteum and allows the endometrium to proliferate?

A

Progesterone

38
Q

Which hormone, released by theca cells, allows the uterus to enlarge and the breasts to develop during pregnancy?

A

Oestrogen

which is a group of different hormones

39
Q

Why can hyperthyroidism occur in pregnancy?

A

hCG levels increase in pregnancy

hCG has a very similar structure to TSH; binds to thyroid receptors producing a (mild) effect

> HYPERTHYROIDISM

40
Q

In pregnancy, the oxygen demand of the mother and foetus increase due to the new foetal circulation.

What cardiovascular adaptions does the body make to account for this?

A

Blood volume –> Cardiac output increases

Heart rate increases

Blood pressure decreases

41
Q

What supplement do some pregnant women, and definitely those with multiple pregnancy, require?

A

Iron

42
Q

What is pre-eclampsia?

A

Pregnancy-induced hypertension, proteinuria and oedema

Caused by compression of the spiral arteries during pregnancy

43
Q

What is the triad of signs seen in pre-eclampsia?

A

Hypertension

Proteinuria

Oedema (esp. hands and feet)

44
Q

If untreated, what does pre-eclampsia progress to?

What are the signs and symptoms?

A

Eclampsia

Hypertension, seizures, coma

Lethal to both mother and baby

45
Q

How is pre-eclampsia managed?

A

Regular monitoring of BP, hepatic and renal function, foetal growth

Anti-hypertensive medication - labetalol

Early delivery - 36-38 weeks, can be vaginal or caesarean section

46
Q

How is labetalol administered?

A

IV in hospital

PO otherwise

47
Q

What is the only definitive treatment for (pre)eclampsia?

A

Delivery

48
Q

Pregnant women (gain / lose) weight.

A

gain weight

49
Q

Do pregnant women need to “eat for two”?

A

No

250-300kcal extra per day is sufficient

50
Q

Which hormones increase insulin resistance in pregnant women and may cause gestational diabetes?

A

Human chorionic somatomammotropin (hCS)

Cortisol

GH

51
Q

Which supplement is given to pregnant women to prevent neural tube defects?

A

Folic acid

52
Q

What dose of folic acid is recommended for most pregnant women?

A

400 micrograms

53
Q

What dose of folic acid is recommended for pregnant women at increased risk of delivering babies with neural tube defects?

A

5 milligrams

54
Q

Which vitamin supplement is advised for all pregnant women?

A

Vitamin D

40 micrograms / day

55
Q

Which supplement is advised in some pregnant women, e.g multiple pregnancy, to prevent anaemia?

A

Iron

56
Q

Which specific gland secretes oxytocin?

A

Posterior pituitary gland

57
Q

Which hormone reduces uterine contractility?

A

Progesterone

58
Q

Which hormones increase uterine contractility?

A

Oestrogen

Oxytocin

59
Q

What physical stimulus increases uterine contractility?

What does this mean for multiple pregnancy?

A

Stretching of the uterus

Twins/triplets/multiples take up more space, increasing the chances of early labour

60
Q

What are Braxton Hicks?

When in pregnancy do they begin?

A

Small contractions

2nd trimester

61
Q

Which chemicals are involved in the induction of labour?

A

Prostaglandins

62
Q

Which

a) hormone
b) hormone-like chemical
c) muscle actions

are involved in labour and childbirth?

A

a) Oxytocin

b) Prostaglandins

c) Uterine contractions

63
Q

Which structure follows the baby after birth?

A

Placenta w/ umbilical cord

needs snipped

64
Q

High levels of which hormones inhibit milk production during pregnancy?

A

Oestrogen and progesterone

65
Q

Once childbirth has occurred and the levels of oestrogen and progesterone drop, which hormone can stimulate milk production?

A

Prolactin

66
Q

Which structures produce

a) oestrogen

b) progesterone

c) prolactin

d) oxytocin?

A

a) Theca cells

b) Corpus luteum

c) Anterior pituitary gland

d) Posterior pituitary gland

67
Q

In terms of breastfeeding, which hormones trigger the

a) production
b) ‘let down’

of the milk?

A

a) Prolactin - milk production

b) Oxytocin - milk ‘let-down’

68
Q

Which hormone is responsible for the milk let-down reflex?

What social process is it also responsible for?

A

Oxytocin

Love / bonding

so breastfeeding and birth release floods of oxytocin, encouraging mother-child bonding

69
Q

What is colostrum?

A

First breast milk produced by mammals post birth

High in protein and immunoglobulins

Low in fat (in humans)

70
Q

What is parturition?

A

Childbirth

Reproduction Week 3 2018/19 (8 decks)

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