Implantation, pregnancy, diseases of pregnancy Flashcards
What is decidualization?
trophectoderm (embryo) contacts maternal epi => increased vascular permeability in embryo, edema in ICM, swelling of stromal cells w/ glycogen granules, capillary sprouting/ingrowth
What is the purpose for decidualization?
IMPLANTATION => complete embed the embryo into the decidua 12 days after fertilization
8-12 days after fertilization, what does the blastocyst produce? what is it similar to?
hCG => structurally similar to LH
What is the action of hCG?
acts of ovary to stimulate luteal growth and suppress luteolysis
What is the purpose of the placenta?
exchange of nutrients and waste products between maternal and fetal circulations
When does the placenta begin its action?
5 weeks post-fertilization is developed and functional => not fully mature
what makes up the placenta?
villi from cell columns from chorionic syncytiotrophoblast containing fetal blood vessels
Villi branching and penetrating maternal stroma leads to what?
forming a mass of terminal villi separated from fetal capillaries by thin layer of villi
During pregnancy, what is the purpose for high estrogen and progesterone?
stimulate development of mammary glands for lactation;
prevent milk production
after birth, what happens to estrogen and progesterone levels?
decline to allow for milk production
What is necessary for milk production?
prolactin secretion by anterior pituitary
What inhibits prolactin secretion? how is this altered?
hypothalamic dopamine release inhibits but suckling decreases dopamine release
What hormone is responsible for the ejection of milk?
oxytocin secreted by posterior pituitary
When is oxytocin released?
stretch of myometrial cells; suckling; baby crying
2 diseases of pregnancy induced HTN?
pre-eclampsia;
eclampsia
What is the definition of pre-eclampsia?
HTN; proteinuria; edema
Definition of eclampsia
HTN; proteinuria; edema; SEIZURES
Which pregnancy induced HTN disease is most common and why?
pre-eclampsia most common;
eclampsia is rare due to aggressive management of pre-eclampsia
What are Sx of pre-eclampsia?
headache; blurred vision; mental changes;
facial and extremity edema;
abdominal pain
At what time frame does pre-eclampsia become more common?
after 20 weeks gestation
What are distinguishing lab features of pre-eclampsia and eclampsia?
hemolysis;
elevated LFTs;
low platelets (HELLP syndrome)
What is the best Tx for pregnancy induced HTN?
delivery of fetus if possible
If delivery is not proper Tx for pregnancy induced HTN, what is the next Tx?
manage w/ bed rest, salt restriction, IV MgSO4, anti-hypertensives, diazepam
Define abruptio placentae
placenta detaches prematurely from endometrium
What is the risk in abruptio placentae?
death for fetus;
DIC in mother
Define placenta previa
placenta overlies cervical os
What must be done if placenta previa is Dx?
C-section delivery => prevents hemorrhage from mother/fetus due to tearing of placenta during delivery
Define placenta accreta
placenta implants directly in myometrium rather than endometrium
What must be done if placenta accreta is Dx?
after delivery => hysterectomy to ensure all of placenta was removed
Differentiate polyhydramnios from oligohydramnios
poly=> very large amount of amniotic fluid
oligo=> very small amount of amniotic fluid
What may lead to polyhydramnios?
anencephaly;
esophageal atresia;
duodenal atresia
What may lead to oligohydramnios?
bilateral renal agenesis;
posterior urethral valves (males)
Both prevent urination
What is the most common site for ectopic pregnancy? why?
fallopian tube => pathology prevents egg from reaching uterine cavity
What is the risk of ectopic pregnancy?
potentially fatal hemorrhage to mother
What are common infectious agents that cross the placenta?
TORCHH Toxoplasma; Other (Syphilis, Listeria, B19, Coxsackie B, Polio) Rubella CMV Herpes HIV
