Intro, Anat & Physi of Pregnancy

Question 1

List 2 hormones secreted by the hypothalamus (w/ their effects) & how they r secreted

Answer 1

Follicle Stimulating Hormone (FSH)
- stimulates development of ovarian follicle
Luteinising Hormone (LH)
- further development of ovarian follicles, stimulates ovulation
–> Hypothalamus –> anterior pituitary gland –> Gonadotrophin Releasing Factor (GnRF)

Question 2

List 2 hormones secreted by the ovaries and their effects

Answer 2

Oestrogen
- proliferation of uterine endometrium
Progesterone
- Secretory changes of uterine lining: endometrium proliferation, increase blood supply, thick, viscous cervical secretion

Question 3

When does quickening happen?

Answer 3

week 16-20 of gestation
(primipara 18-20; multipara 16-18)

Question 4

Name the waxy white substance coating skin of newborns

Answer 4

Vernix caseosa

Question 5

What is Lanugo? When does it appear & disappear on a foetus?

Answer 5

very thin & soft foetal hair
appears at week ~12-16; disappears from face at week 28-32, body at week 32-36

Question 6

List the 5 hormones found in placenta

Answer 6

Human Chorionic Gonadotrophin (hCG)
Oestrogen
Progesterone
Relaxin
Human Chorionic somatomammotropin (human placental lactogen)

Question 7

Human chorionic gonadotrophin (hCG) production, effects & remarks

Answer 7

Produced by trophoblast
Maintains corpus luteum to continue producing oestrogen & progesterone
detectable in urine 10 days after conception, rises rapidly during 1st trimester then decline; indicator of pregnancy test

Question 8

Oestrogen production, effects & remarks

Answer 8

Produced by corpus luteum in early pregnancy then by placenta
Stimulates uterine growth, increase blood supply to uterine vessels, development of glands & ductal system in breasts

Question 9

Progesterone production, effects & remarks

Answer 9

first produced by corpus luteum then by placenta
Maintains endometrium & inhibit uterine contractility; stimulate growth of lobes & lobules in breasts; lower smooth muscles & increase fat deposition

Question 10

Human Chorionic somatomammotrophin (human placental lactogen) production, effects

Answer 10

Produced by placenta, acts as insulin antagonist, increases maternal blood glucose level

Question 11

Relaxin Production, effects

Answer 11

Produced by placenta;
inhibits uterine activity, reduces strength of uterine contraction,
softening & relaxing of cervix, connective tissue

Question 12

List out 4 hormones secreted by the pituitary gland (endocrine system)

Answer 12

• growth hormone
• melanocyte-stimulating hormone (skin pigmentation)
• prolactin (milk production)
• oxytoxin (uterine contraction during labour, milk-ejection (letdown reflex)after childbirth

Question 13

2 hormones secreted by the thyroid & adrenal gland (endocrine system)

Answer 13

Thyroid
- hyperplasia & increased vascularity leads to increased secretion of thyroid hormone
–> increases metabolic rate
Adrenal
- corticosteroid production suppresses inflammatory reactions, lowers rejection of fetal protein (foreign body)

Question 14

Where & when is uterus palpable?

Answer 14

Symphysis pubis (~frontal hip bone) starting from week 12

Question 15

Describe changes in muscle fibres of the uterus

Answer 15

Endometrium (inner) - thicken, become decidua
basalis (maternal placenta), capsularis (chorion, surrounding foetus), parietalis
Myometrium - hypertrophy & hyperplasia
inner: circular, middle; interlacing, outer: longitudinal
Perimetrium

Question 16

Describe positive Hegar’s sign

Answer 16

softening & compressibility of lower uterine segment (isthmus)
ps. upper segment: fundus

Question 16

Changes in cervix & vagina during gestation

Answer 16

Cervix
- softening (Goodell’s sign)
- rise in vascularization –> bluish discoloration (Chadwick’s sign)
- formation of mucous plug (operculum)
Vagina
- more vascular, thickened & distensible –> light pink to deep violet (Chadwick’s sign)
- more vaginal secretion (leukorrhea)

Question 16

Changes in breast during gestation

Answer 16

• increase in size, growth of duct & glandular tissue
• areola develops Montgomery tubercles
• nipples more prominent & pigmented
• colostrum production (antibody-rich, yellow fluid)

Question 16

Describe changes in cardiovascular system during gestation

Answer 16

Cardiac output ~4.5 –> 7L/min, increased HR, total blood volume ~50% above prepregnant levels, plasma volume ~50%, red cell mass ~30% –> haemodilution/ physiological aneamia of pregnancy
increased iron demands
increased plasma fibrinogen & clotting factors –> hypercoagulable state leads to risk of venous thrombosis
BP lowers slightly in 2nd trimester, then return to prepregrancy state at 3rd

Question 16

What are irregular, painless contractions that occur intermittently throughout pregnancy?

Answer 16

Braxton Hicks contractions

Question 17

What is supine hypotensive syndrome in women

Answer 17

compression of inferior vena cava by enlarged uterus when women lies in supine position
–> left lateral recumbent position is optimal for cardiac output & uterine perfusion

Question 18

4 changes in respiratory system during gestation

Answer 18

tidal volume increased by 30-40%
O2 consumption increased by 15-20%
diaphragm elevated due to pressure form enlarged uterus –> SOB
Nasal congestion due to increased vascularity –> nosebleeds

Question 19

7 changes in GI system during gestation

Answer 19

• nausea & vomitting (hCG)
• hyperemic, swollen gums, easier bleeding
• inc. salivation (ptyalism)
• Oesophageal reflux & heartburn; low GI motility,relaxation of cardiac sphincter & smooth muscle –> slow gastric emptying; upward displacement of stomach
• constipation (low peristalsis due to more iron supplements & less movement)
• hemorroids (pressure of uterus on veins & constipation)
• prolonged gallbladder emptying (predispose to gallstone formation)

Question 20

5 changes in renal/ urinary system

Answer 20

• increased urinary frequency in 1st & 3rd trimesters
• dilation & kinking of ureters –> urinary stasis
• inc. vesicoureteric reflux
• inc. glomerular flitration rate (GFR) 30-50% but tubular reabsorption remains constant –> glycouria
• inc. risk of UTI

Question 21

changes in musculoskeletal system

Answer 21

Waddling gait
- relaxation of ligaments, muscles & pelvic joints
- increased lumbosacral/ lordotic curve (lordosis)
- forward shifting centre of gravity
- Pelvic girdle & back pain

Question 22

3 changes in integumentary system

Answer 22

1. hyperpigmentation
   - face: chloasma (melasma gravidarum)
   - abd wall: linea nigra & striae gravidarum
   - areolae, nipples, vulva, perineal area
2. vascular spiders (telangiectasias) - small, fiery-red branching spots (dilated blood vessels)
3. Oedema, varicosities of vulva, rectum & legs
   - enlarged uterus caused pressure on pelvic & femoral vessels –> dec. venous return from lower extremities

Question 23

Describe the weight gain during gestation

Answer 23

0.5-2kg in 1st trimester; then
0.4-0.5kg/ week till term

Question 24

Nutrition gains during 1st trimester

Answer 24

folate, vitamin A, iodine

Question 25

Nutrition gains during 2nd & 3rd trimester

Answer 25

folate, vitamin A, iodine
iron, zinc, omega-3 fatty acids, calcium
increased energy & protein demands for the growing fetus

Question 26

What extra nutrition is required for breastfeeding?

Answer 26

extra 500 kcal/ day
sufficient protein, folate, iodine, zinc, vitamin A, DHA