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HD > Hormonal Changes and The Maternal Adaptation to Pregnancy > Flashcards

Hormonal Changes and The Maternal Adaptation to Pregnancy Flashcards

1
Q

what is the average weight gain of a mother during gestation

A

1.5-4.5

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2
Q

what components of the pregnant mother contribute to weight gain

A

blood, fetus, amniotic fluid, adipose tissue, placenta, breast,extracellular water

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3
Q

when is most weight gained during pregnancy

A

after week 20

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4
Q

what happens to plasma volume during pregnancy

A

increases the more children you have the more the plasma increases

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5
Q

what hormone causes increases rbc synthesis in mother during pregnancy

A

erythropoietin

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6
Q

why does a mother with increased rbc during pregnancy appear anemic

A

number increases but apparent anaemia

due to dilution of hb

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7
Q

what happens to Haematocrit value

A

drops from 40 to 32 percent ratio of rbc to total blood volume

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8
Q

why does intracellular dpg increase by approx 30% during pregnancy

A

DPG (2-3 diphosphoglycerate) facilitates
offload of O2
release to fetus
by stabilising tense state

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9
Q

outline fatty acid transport in blood

A 
Lipoprotein lipase
releases non-esterified
fatty acids ((NEFAS)
from the
trigyclerides in
lipoproteins (LP).
NEFAS are then transported
across the trophoblast cells
by fatty acids transport
proteins (FATP)
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10
Q

why are women advised to take folic acid supplements early on

A

folate supplements in
early pregnancy reduce
neural tube defects and The essential role of Folate and Vitamin B12
in DNA Synthesis

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11
Q

what are the three main hormones to bear in mind from the placenta

A

hcg, progesterone and estrogen

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12
Q

what happens to estrogen conc as pregnancy progresses

A

it keeps rising and rising

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13
Q

what does estrogen at high conc do to anterior pituitary

A

inhibits fsh and lh preventing ovulation

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14
Q

Stimulate synthesis of liver fatty acids and

cholesterol which hormone during pregnancy is responsible

A

estrogen, fat stored and needed for energy throughout pregnancy and when baby is born for breast feeding

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15
Q

how does estrogen effect uterus for maternal adaptations during pregnancy

A
  • Growth of uterus

* ‘Priming’ of uterus for labour

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16
Q

what does estrogen do to raas

A

Stimulates Renin-Angiotensin- Aldosterone axis

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17
Q

how does estrogen effect heart during pregnancy

A

causes cardiac adaptation to aid higher bp and blood volume

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18
Q

how does estrogen affect blood glucose

A

Weak anti-insulin activity

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19
Q

what does estrogen do to the cervix

A

cervical ripening

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20
Q

list the effects of estrogen

A

• Stimulate synthesis of liver fatty acids and
cholesterol
• Cardiovascular adaptation to pregnancy
• Growth of uterus
• ‘Priming’ of uterus for labour
• Weak anti-insulin activity (via enhanced cortisol)
• Onset of labour-relative rise v fall in progesterone?
• Cervical Ripening
• Stimulates Renin-Angiotensin- Aldosterone axis

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21
Q

what does progesterone do to facilitate implantation

A

Prepares and maintains the endometrium to allow

implantation

22
Q

after day approx day 60 where does progesterone get produced

A

placenta

23
Q

why is progesterone important in delivering child

A

Plays a role in parturition, just does play a role don’t question

24
Q

why is progesterone important to fetus

A

underveloped so Serves as a substrate for fetal adrenal gland
production of glucocorticoids and mineralocorticoids

25
Q

how does progesterone affect maternal immmune response during gestation

A

May have a role in suppressing the maternal
immunologic response to fetal antigens thereby
preventing preventing maternal rejection of the
trophoblast

26
Q

what does progesterone do during preganncy to breathing and c02

A

• Induces overbreathing and lowering of

maternal CO2

27
Q

how does progesterone maintain pregnancy

A

– Inhibition of uterine contractility

– Prevention of ripening of cervix

28
Q

how does hcg effect corpus luteum

A 
Rescue and maintenance of function of the
corpus luteum (continued progesterone
production
29
Q

why is the corpus luteum and hcg so important in first seven weeks of pregnancy

A

Survival of the pregnancy is dependent on corpus luteum

progesterone until the 7th week of pregnancy

30
Q

what are the biological functions of hcg apart from maintaining corpus luteum

A

• Stimulation of maternal thyroid activity
– hCG binds to the TSH receptors of thyroid cells
– LH-hCG receptor is expressed in the thyroid
– Possibly, hCG stimulates thyroid activity via the LHhCG
receptor and by the TSH receptor

31
Q

where is hpl secreted from

A

placenta syncytiotrophoblast

32
Q

why is Maternal lipolysis important during pregnancy and what hormone causes it

A

HPL, - providing a source of energy for

maternal metabolism and fetal nutrition

33
Q

Describe HPL anti insulin action

A

Anti-insulin or “diabetogenic” action - increase in
maternal insulin - favoring provision of mobilizable
amino acids and fetal protein synthesis as well as
glucose for transport to the fetus

34
Q

describe hpl potent angiogenic action

A

• Potent angiogenic hormone - may play an important

role in the formation of fetal vasculature

35
Q

describe and outline action of leptin during pregnancy

A

secreted by both cytotrophoblast cells and
syncytiotrophoblast; maternal levels are significantly
higher than in non pregnant women and that in the
fetal circulation
• Stimulates placental amino acid/fatty acid transport
• Fetal leptin levels
– correlated positively with fetal birthweight
• Probably plays an important role in fetal development
and growth

36
Q

what happens to TPVR during pregnancy

A

decreases

37
Q

what causes tpvr to fall during gestation

A 
• Increased nitric oxide synthesis
• Increased prostacyclin synthesis
• Relaxin?
• Increased compliance of vessels due to
structural changes
38
Q

what happens to cardiac output during pregnancy

A

increases

39
Q

what causes co to increase

A

increased blood volume due to frank Stirling mechanism

40
Q

what causes blood volume to increase and ultimately co,

A

Oestrogen leads to AII-renin- aldosteroneincrease
• Progesterone leads to aldosterone increase
• Vasodilatory PGs  aldosterone increase
• ‘Shunting’ of blood to uterine circulation stimulates
sympathetic activity leads to renin increase
• Renal Na loss due to increased GFR leads to renin increase
• hCG leads to renin increase

41
Q

where does blood flow in pregnancy significantly increase in

A

skin , kidneys, uterus

42
Q

during pregnancy what can increased blood flow to skin cause in women

A 
Leads to
– increase skin temperature
– increase nail growth
– increase % of hairs actively growing
– disappearance of Raynaud’s syndrome
– nose bleeds, nasal stuffiness, snoring
43
Q

how does pregnancy affect renal function

A

glycosuria (glucose in urine), calciuria(calcium in urine) ,

frequent urination, urine statsis, and plasma conc of urea and creatinine decrease

44
Q

what happens to tidal volume during pregnancy

A

tidal volume increase more gaseous exchange needed to support metabolism and respiration of foetus and mother

45
Q

what happens to residual volume during pregnancy

A

decreases

46
Q

appreciate difference in ribcage of pregnant mother compared to female, due to pressure from uterus and fetus

A

rib cage in pregnancy widens and rises higher, out and squished up more

47
Q

outline the main aspects of Pulmonary function in pregnancy

A

• Tidal volume increases
• Deep breathing stimulated by progesterone
• Respiratory rate unchanged
• Expiratory reserve reduced
• pCO2 decrease , pO2 increase, pH unchanged (HCO3
falls)
• Costal margin and diaphragm altered

48
Q

what happens to smooth muscle tone of GI tract in pregnancy

A

reduced

49
Q

what doe Reduced smooth muscle tone in gi tract during pregnancy leads to

A

decrease cardiac sphincter tone and mobility, increase nutrient absorption ,water reabsorption and gastric refluc

50
Q

what changes occur to induce low grade increase in

coagulability -advantageous at delivery

A

Factors VII, VIII and X increase
– Plasma fibrinogen increase leads to ESR increase
Fibrinolytic activity decreases

HD (18 decks)

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