Exam 2- lecture 1 Flashcards by ashley hart

define fertilization

fusion of 2 haploid gametes to produce a diploid zygote with 35 chromosomes

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where does fertilization occur?

ampulla of uterine tube

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how long does it take the zygote to reach the uterus?

3-5 days

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fertilized egg aka

zygote

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what transports the zygote from fallopian tube to uterus?

ciliated cells & peristaltic movements

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what is a zygote known as when it reaches the uterus?

blastocyst

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how long does it take the blastocyst to implant?

1-2 days

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uterine milk

nutrition from the endometrial secretions before implantation

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after contacting uterine endometrium, blastocyst becomes surrounded by a layer of

trophoblasts

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trophoblasts erode

the endometrium & the blastocys burrows in (implants)

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after implantation, the trophoblasts develop into

the placenta

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when is it considered an embryo

weeks 2-8

after week 8 it is a fetus

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functions of trophoblasts

digest decidual cells & release their nutrients
secrete hCG until placenta takes over
form chorionic villi

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progesterone plays an important role in converting endometrial cells into

decidual cells

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maternal circulation & fetal circulation are

separated by endothelial cells of maternal sinuses & chorionic villi
they do NOT mix

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chorionic villi carries

fetal blood

- surrounded by sinuses containing maternal blood

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umbilical arteries carry

DEOXYGENATED blood from the fetus to placenta

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umbilical vein carries

OXYGENATED blood back to the fetus

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maternal blood flow

uterine arteries->maternal sinuses-> uterine veins

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fetal blood flow

2 umbilical arteries->capillaries of the villi-> 1 umbilical vein into the fetus

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solute transfer between maternal & fetal circulation occurs

across the placenta

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the fetal and maternal circulatory systems are separated by

the placental trophoblasts & fetal capillary wall

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hormones synthesized by the placenta

hCG, estrogen, progesterone, human chorionic somatomammotropin, relaxin
released into maternal circulation

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when does hCG production begin?

within a few days of implantation

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role of hCG

stimulates corpus luteum to continue to make progesterone during early stages of prego

hCG is a functional analog of

how much does estrogen increase during prego?

30 fold increase

primary effects of estrogen on mother

- growth of uterus, breast, ductal tissue, enlargement of external genitalia, relaxes pelvic ligaments, increase blood flow to uterus

how much does progesterone increase during prego

10 fold

function of progesterone in prego

- causes decidual cells to develop in uterine endometrium - prevents contractions & sloughing - prepare breasts for lactation

labor & parturition are driven by

oxytocin & increased oxytocin receptors in uterus

positive feedback look of oxytocin

baby descends, contracting the cervix-> oxytocin release-> contraction-> push baby further down-> stretch cervix more-> more oxytocin released

Hyperemesis gravidarum (HEG)

condition that is" N/V on steroids"; so severe that she can lose ~5% of pre-prego weight; Ketosis; Sometimes requires hospitalization, needs medical intervention

gestational diabetes (GDM)

by inducing some insulin resistance, able to allow more glucose for fetus

gestational HTN

>140/90

preeclampsia

HTN with proteinuia

exclampsia

preeclampsia with seizures

preeclampsia arises from

abnormal placentation- imperfect vascular exchange, fetal hypoxia & release of inflammatory mediators from placenta to maternal circulation

preeclampsia leads to

HELLP: hemolysis elevated liver enzymes low platelet count

eclampsia treatment

emergency c-section | magnesium sulfate may be needed to control seizures during labor

gestational transient thyrotoxicosis

increased free T4, may be asymptomatic or present with vomiting usually resolves later in prego when hCG <

hCG is structurally similar to:

TSH & can stimulate thyroid

post partum throiditis

increased TH secretion usually resolves spontaneously beta-blockers provide symptomatic relief

thromboembolism

occurs 5-10X more in prego

prego creates a

hypercoagulable state

anticoagulant therapy in prego

UFH or LMWH | NOT warfarin

when do neural tube defects occur?

days 20-28 of prego

folic acid and B12 play an important role in

neural tube development

most common forms of neural tube defects

anencephaly & spina bifida

anencephaly

when a major portion of the babies brain is missing or fails to develop-> death

spina bifida

vertebrae covering spinal cord are not fully fused | -can be surgically corrected

maternal physiologic changes

- blood volume, cardiac output & GFR increase 30-50% - < [] of renally cleared drugs(diluted & excreted faster) - > body fat-> > Vd of fat-soluble drugs - < plasma albumin-> gastric pH

drugs pass through the placenta by

diffusion

factors increasing drug transfer across placenta

- MW protein binding (>albumin on fetal side, so get trapped there) - neutral & basic drugs (fetal pH is more acidic)

prolactin promotes

production of milk

oxytocin promotes

ejection of milk by increasing contractions of mammary myoepithelial cells

during prego, milk production is suppressed by

estrogen & progesterone

slight amount of milk formed during prego is called

colostrum

colostrum contents

NO fat | high in antibodies9IgA), macrophages & lymphocytes- passive immunity

feedback between nursing & prolactin

positive feedback

how much milk is produced /day

1.5L/day | containing lactose, calcium phosphate, acidic, protein & fast, mostly iron free

why do parathyroid glands increase in siz

due to maternal loss of calcium-> decalcification of maternal bones

igG is transported

transplacentally

first 3 days postpartum

leaky paracellular route, little active secretion of milk fluid

by day 7

prolactin causes alveolar epithelial cells to proloferate & fill in gaps

drugs penetrate milk more during

colostral period due to leak barrier

medications enter breast milk if

- highly lipid soluble - reach high maternal [] - MW<500 - LOW protein bindin - long half-life - weak bases (milk pH+6.8-7)

mastitis

inflammation of the breast | - tenderness, redness, warmth, flu-like symptoms

most common cause of mastitis

staph aureus

treat mastitis

antibiotics if infection or NSAIDs