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Human Repro > Lecture 11 > Flashcards

Lecture 11 Flashcards

1
Q

first trimester nutrition

A

histotrophic supplied from uterine secretions by diffusion

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2
Q

second/ third trimester nutrition

A

hemochorial supplied from maternal blood

arises from interstitial implantation

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3
Q

when does foetus develop

A

at physiological hypoxia (lack of o2)

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4
Q

what do glands produce

A

secretions to supply nutritional needs, partially supplied by glucose

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5
Q

histiotroph

A

under influence of progesterone

endometrial glands produce secretions during the first trimester

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6
Q

what does histiotroph secretions contain

A

glucose oligomers
glycoproteins

uterine milk

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7
Q

histiotrophic nutrition

A

endometrial gland secretions cross the chorionic plate into the coelomic cavity

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8
Q

structure before 11 weeks

A

route of diffusion
bottom of decidual gland
build up of trophoblast - multilayer called shell
trophoblast attaches placenta at surface of uterus

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9
Q

villus placenta

A

nutrients are transferred cross tiny capillaries to bigger capillaries

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10
Q

near term ultrasound

A

major changes to uterus vascular supply are required to accommodate and support the foetus and placenta

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11
Q

pregnancy referred to as

A

exercise challenge

demands on cardiovascular system of woman

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12
Q

foetal growth depends on

A

provision of o2 and nutrients from mother

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13
Q

adaptive mechanisms in cardiovascular

A

support growth of foetus whilst preserving maternal health

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14
Q

stimuli for changes in cardio parameters

A

hormonal
metabolic
mechanical

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15
Q

blood volume

A

progressive increase of 35-50%

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16
Q

systemic changes

A

increase in CO
increase in SV
increase in HR

decrease in TPVR

BP stays the same

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17
Q

cardiac output

A

cardiac output increases as weeks increase

change in blood vessels that locally supply uterus

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18
Q

uterine artery

A

bilateral (2)
passes from myo to endo
coiled arteries to spiral arterioles
endo lost in period

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19
Q

cross section of artery

A

smooth muscles
endothelial cells
lumen

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20
Q

number of smooth muscle cells

A

depends on size of artery

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21
Q

Poiseuille’s Law

A

flow related to diameter of artery

as volume flow increases more rapidly, you get a slight increase in radius

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22
Q

relax

A

volume flow increase exponentially

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23
Q

contract

A

volume flow decrease exponentially

24
Q

Right and left uterine artery flow 5-16 weeks

A

increase in volume and velocity

25
Q

uterine artery blood flow increases

A

from 20 weeks to term

26
Q

volume change

A

unilateral

occurs after 16 weeks so there is an increase in velocity

27
Q

increase in blood flow

A

increase in artery size from 20 weeks onwards

28
Q

16 weeks

A

flow rate increases
pressure decreases
diameter increases

29
Q

alteration in vascular function determined by

A

endothelial mediators
constriction
relaxation

30
Q

endothelium-derived vasodilators

A

prostanoids such as prostacyclic
NO
EDHF

communicate by gap junctions

31
Q

20 weeks blood flow

A

increasing blood flow to uterus mainly due to dilation of uterine artery
estrogen increases

32
Q

spiral arteries rhesus monkey

A

interphase between myo and endo
high level of resistance
longer vessel, more resistance

33
Q

implanting placenta

A

interacts with maternal spiral arterioles

34
Q

The interaction with invasive trophoblast

A

initially prevents blood flow

to the developing placenta (first 11 weeks)

35
Q

profound remodelling of the spiral arterioles

A

leads to a
high volume, low pressure blood supply locally to the intervillous space
of the placenta

36
Q

incomplete remodelling

A

pathogenesis

37
Q

week 18-20

A

Trophoblast invasion of the endometrial stroma (decidua)

occurs from immediately after implantation

38
Q

invasive cells called?

A

extravillous trophoblast

39
Q

Secondary villus stage (second week of pregnancy)

A

Cytotrophoblast cells invading the endometrium radiate away from the trophoblastic shell towards a group of glands

40
Q

plug

A

invading cells plug the mouths of endometrial spiral arterioles, preventing blood from accessing the developing intervillous space

41
Q

Blocking

A

by cytotrophoblast plugs

42
Q

Spiral artery remodelling

A

effected by maternal leukocytes
(uNK cells and macrophages)
in collaboration with trophoblast cells derived from the placenta

43
Q

CD45+ cells

A

maternal white blood cells in the wall of a spiral artery during remodelling

These are macrophages and specialised uterine NK cells

44
Q

remodelling process

A

internal elastic lamina and the medial SMC are removed progressively, first by uNK cells and then by invasive trophoblast

45
Q

Loss of the internal elastic lamina and the medial SMC

A

high flow, low resistance channels that lack vasomotor control

46
Q

Loss of vascular smooth muscle

A

renders the arterial supply to the placenta insensitive to maternal vasoconstriction and ensures that blood is delivered to the intervillous space at low pressure

47
Q

Loss of the vascular elastic lamina

A

This ensures loss of elastic recoil, and irreversible expansion of the arterial channel

48
Q

Leukocyte

A

extracellular matrix interactions

VSMC interactions

49
Q

Trophoblast

A

extracellular matrix interactions

VSMC interactions

50
Q

Cellular interactions during vascular remodelling

A

highly regulated, slow process which rebuilds the arteriole wall that lacks the smooth muscle walls

51
Q

Pre-11 weeks

A

blood does not flow in the intervillous space
of the placenta

fetus and placenta are highly hypoxic at this time

52
Q

Pre-11 weeks vascular supply

A

remodelling to avoid exposing the placenta to shear stresses associated with arterial blood pressure

53
Q

From 11 weeks

A

plugs are displaced and the intervillous space becomes a shunt: oxygenated maternal blood passes through at low pressure

54
Q

Trophoblast continues to invade up to

A

18 weeks

reaches arterial segments in the inner third of the myometrium

55
Q

Functions of trophoblast

A 
Transport 
Immunological barrier 
Secretion/endocrine 
Anchorage
Plugging of arteriolar openings
Migration and vascular remodelling
56
Q

Uterine Artery Doppler

A

Ultrasound data reinforces that changes to blood flow to the uterus
continue after trophoblast invasion has ceased at ~20 weeks.

That is, the remodelling of the spiral arteries is not causative – it protects
the placenta from damage.

Human Repro (11 decks)

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