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Year 2 - RDA LCRS 2 > Introduction > Flashcards

Introduction Flashcards

1
Q

Pregnancy is divided into 3 trimesters

A

-

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2
Q

What are some maternal changes that can occur with pregnancy?

A
  • Increased weight [3rd]
  • Increased blood volume [2nd & later]
  • Increased blood clotting tendency [2nd & later]
  • Decreased blood pressure [2nd]
  • Altered brain function [1st & later]
  • Altered hormones [1st & later]
  • Altered appetite (quantity and quality) [1st & later] – GI imbalance
  • Altered fluid balance [2nd & later]
  • Altered emotional state [1st & later]
  • Altered joints [3rd]
  • Altered immune system [1st & later]
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3
Q

main risk to maternal health = linked to

A

delivery

note: at early stage of pregnancy, low risk to mother

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4
Q

what is meant by conceptus?

A

everything resulting from the fertilised egg (baby, placenta, fetal membranes, umbilical cord)

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5
Q

NOTE: progesterone levels remain high during delivery –> but falls sharply AFTER delivery

A

-

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6
Q

When do we start counting pregnancy?

A
  • from first day of last menstrual period
  • -> because we dont know when ovulation is
  • -> normal pregnancy = 38 - 42 weeks gestational age
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7
Q

what is a cotyledon?

what is the significance of a cotyledon?

A

functional subunits of the placenta

  • -> contains placental villus (which branches out)
  • -> gives large SA
  • (to absorb nutrients from maternal blood to fetal blood)
  • to remove waste productions (deoxygenated blood / urea etc. from fetal blood)

umbilical artery –> baby to mother
umbilical vein –> placenta to baby

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8
Q

What are significant features of the placenta?

A
  • highly branched structure –> provides a large surface area (~11m2).
  • effective for transport of molecules between maternal and fetal circulations.
  • Anchors the placenta (and hence the baby) for 9 months.
  • Intimate contact between maternal and placenta tissues – interesting immunology!
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9
Q

What are the placental functions?

A

Functions:
Separation
–> separates blood of mother + fetus

Exchange
–> of nutrients and waste products

Biosynthesis
–>

Immunoregulation
–> so that mother’s immune system doesn’t reject the fetus

Connection
–> provide physical connection between mother and fetus

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10
Q

Describe the development of the placenta?

A

Starts as a layer of single cells in the blastocyst

  • which then proliferate + differentiate
  • to form a simple branched structure that expands iteratively
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11
Q

Describe the development of the placenta?

A

Starts as a layer of single cells in the blastocyst

  • which then proliferate + differentiate
  • to form a simple branched structure that expands iteratively
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12
Q

contact between fetal and maternal tissues

A
  • spiral artery = blocked by cytotrophoblast shell
  • if cytotrophoblast cells break down –> fetus = exposed to high pressure maternal blood –> may cause miscarriage (due to unstable anchoring)
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13
Q

What is the significance of cytotrophoblast shells + spinal arteries during fetal development?

A
  • Cytotrophoblast shell limits blood (oxygen) supply to embryo during early development
  • Remodelling of spiral arteries –> allows high volume blood supply in trimesters 2 and 3, when infant growth is greatest.
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14
Q

Placental mal-development (4 things)

A

Miscarriage (late first trimester)
Miscarriage (second trimester)
Pre-eclampsia (early delivery)
Fetal growth restriction (small infant)

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15
Q

define labour

A
  • uterus is undergoing regular fundally dominant contractions
  • and cervix is undergoing ripening and effacement
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16
Q

Describe tof process of labour - dependent of gestational stage.

A
  • Cervical ripening and effacement (increasing)
  • Co-ordinated myometrial contractions (increasing)
  • Rupture of fetal membranes
  • Delivery of infant
  • Delivery of placenta
  • Contraction of uterus
17
Q

What are the 3 labour stages and how long do they last ?

A
  • phase 1 = many hours
  • -> when cervical changes occur+ contraction begins
  • phase 2 = hours
  • -> delivery of baby
  • phase 3 = 30 mins
  • -> delivery of the placenta
18
Q

first trimester = week
second trimester = week
third trimester = week

A

first trimester = 13 week
second trimester = 26 week
third trimester = 39 week

19
Q

What initiates labour? during:

a) term
b) preterm

A

What initiates labour? during:

a) term
- -> oestrogens
- -> low progesterone
- -> CRH
- -> Oxytocin
- -> (but not rly sure)

b) preterm
- -> Intrauterine infections
- -> intrauterine bleeding
- -> multiple pregnancy
- -> stress
- -> others

20
Q

During the labour process, what happens to the cervix

A

there is :

Cervical ripening and effacement

  • Change from rigid to flexible structure
  • Remodelling (loss) of extracellular matrix
  • Recruitment of leukocytes (neutrophils)
  • Inflammatory process
  • -> Prostaglandin E2, interleukin-8
  • -> Local (paracrine) change in IL-8
21
Q

During the labour process, what happens to the myometrium?

A

there is:

  • Co-ordinated myometrial contractions
  • Fundal dominance
  • Increased co-ordination of contractions
  • Increased power of contractions

Key mediators

  • -> Prostaglandin F2a (E2) levels increased from fetal membranes
  • -> Oxytocin receptor increased
  • -> Contraction associated proteins
22
Q

During the labour process, what happens to the fetal membranes?

A

there is:

Rupture of fetal membranes

  • Loss of strength due to changes in amnion basement component
  • Inflammatory changes, leukocyte recruitment
  • -> Modest in normal labour, exacerbated in preterm labour
  • Increased levels and activity of MMPs
  • Inflammatory process in fetal membranes
23
Q

NOTE:

Cervix
Prostaglandin E2, interleukin-8, MMPs

Myometrium
Prostaglandin F2a (E2) levels increased from fetal membranes
Oxytocin receptor increased
Contraction associated proteins

Fetal membranes
Inflammatory process in fetal membranes
PGs, interleukins, MMPs

A

-

24
Q

during Labour, many initiators act on NFkB –> causes up regulation of inflammatory genes

  • IL-1B = can further drive NFkB levels
  • Activators of inflammations = linked with preterm labour (e.g intrauterine infection)
A

-

25
Q

Supporting evidence

Almost all pro-labour genes have _____ binding domains in their promoters

Modification of NFkB sites in promoter sequences leads to __________

A

Almost all pro-labour genes have NFkB binding domains in their promoters

Modification of NFkB sites in promoter sequences leads to loss of expression in cells or in expression vectors

26
Q

CRH + PAF = key drivers of labour

–> unregulated inflammatory pathways in fetal membranes

A

-

27
Q

PGE2 has important role in =

A

cervical ripening

28
Q
  • 3 weeks before delivery ____ levels rise
A

CRH increases

29
Q

why is platelet activating factor important in the process of labour?

A

PAF = Part of lung surfactant

  • -> Produced by maturing lung, before birth
  • -> PAF Levels in amniotic fluid increase near term
  • -> Fetal signal of maturity
30
Q

describe the hypothesis for parturition

A
  • lungs mature –> produce PAF
  • placenta = source of CRH –> increases CRH production –> CRH goes to baby –> stimulate pit gland –> increase acth release —> activate adrenal gland –> cortisol produced–> activates lung –> ALSO goes to placenta –> increases CRH levels
  • DHEASE = precursor to oestrogen
31
Q

NOTE

  • Anything that increases CRH may predispose to labour (stress, multiple infants)
  • Anything that increases muscle contraction may predispose to labour (excess stretch of uterus)
  • Anything that activates inflammatory cascades may predispose to labour
  • The above apply to preterm labour (intrauterine infection, bleeding, twins)
A

-

32
Q

What happens if you give Progesterone receptor blockade to a pregnant woman?

A

pregnancy loss

33
Q

during pregnancy –> a lot of progesterone receptors re released –> binds to NFkB –> stops it from initiating proinflammatory action

PR-B mediates the main effects of progesterone via gene expression
PR-A is less able to mediate these effects
Ratio of PR-A : PR-B increases at term

A

???

34
Q

Loss or change in PR may lead to

A

‘functional progesterone withdrawal’

35
Q

What is a key regulator of labour?

A

NFkB

Year 2 - RDA LCRS 2 (8 decks)

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