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Su: Phys 2 > Maternal/Fetal > Flashcards

Maternal/Fetal Flashcards

1
Q

prepregnancy E2 function

A

thickens endometrium

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2
Q

pre-pregnancy progesterone function

A

promotes gestation

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3
Q

1st trimester hormones

A

CL: incr E2/P
placental: incr HCG

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4
Q

when does HCG peak

A

at end of 1st tri

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5
Q

2nd tri hormones

A

CL: tapers off E2/P
placenta: incr E2/P

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6
Q

when dose the placenta take over E2 and progesterone production

A

2nd tri

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7
Q

3rd tri hormones

A

placenta controls
rate of E2 > rate of progest

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8
Q

maternal changes: blood

A

incr BV by 30%
incr fibrinogen
electrolytes remain balanced

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9
Q

how much does BV increase by during pregnancy

A

30%

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10
Q

when is BV the highest

A

24 weeks

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11
Q

Hct levels ____ during pregnancy. Why?

A

decrease due to dilution
plasma increases more than RBC increase

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12
Q

what triggers increase in BV

A

RAAS + E2 triggers ADH

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13
Q

maternal changes: CV

A

incr CO by 30%
decr MAP
supine hypotension syndrome

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14
Q

why does maternal CO increase?

A

incr BV = incr preload

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15
Q

why does maternal MAP decrease?

A

shear force on endothelial cells activates ENOS

incr NO
decr TPR (25%)
Vasodilation

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16
Q

supine hypotension syndrome

A

occulsion of IVC
- decr venous return
- decr preload
- decr CO
- incr parasympathetics

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17
Q

supine hypotension causes maternal _____ and fetal ______

A

maternal hypotension
fetal bradycardia

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18
Q

maternal changes: pulmonary

A

incr MV (40%)
dect ERV (40%)

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19
Q

what ventilation values increase in maternal?

A

incr TV
incr IV
incr IRV

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20
Q

what ventilation values decrese in pregnancy?

A

decr ERV
decr RV
decr FRC

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21
Q

what ventilation values dont change in preg?

A

VC
TLC

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22
Q

what does progesterone do to RR

A

progesterone incr CO2 sensitivity = incr RR

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23
Q

what does increased metabolic rate do to MV?

A

incr metabolic rate will incr CO2 = incr RR and incr TV

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24
Q

why does ERV decrease in pregnancy

A

diaphragm moves up 4 cm
- decr RV
- decr FRC

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25
Q

maternal changes: renal

A

incr renal flow
incr GFR
decr renal flow in 3rd tri
cr levels lower

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26
Q

what causes incr renal flow in pregnancy

A

incr aldosterone
incr cortisol

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27
Q

what causes incr GFR in pregnancy

A

NO promotes vasodilation
relaxin relaxes blood vessels

== promotes incr BF

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28
Q

why does renal flow decr in 3rd tri

A

ang2 vasoconstricts
- decr BF
- incr glomerulus pressure

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29
Q

normal preg Cr levels

A

0.5-0.6 mg/dL

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30
Q

preeclampsia Cr levels

A

1 mg/dLw

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31
Q

why are cr levels lower in pregnancy?

A

urination of Cr

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32
Q

what mechanism protects maternal bone health?

A

decr PTH
incr calcitriol
incr calcitonin

== promotes bone deposition

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33
Q

what causes incr blood glucose in pregnancy?

A

HCS release from placenta is diabetogenic

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34
Q

what causes gestational diabetes

A

too much HCS
or
high sensitivity to HCS

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35
Q

what does maternal IR do?

A

incr lipolysis
- sends glucose to fetus

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36
Q

why does maternal T4 increase in preg?

A

fetus is dependent

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37
Q

what mechanism increases maternal T4

A

Type 3 deiodinase from placental converts maternal T3 to T4

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38
Q

increased E2 cause what thyroid hormone to increase

A

incr E2 = incr TBH
== incr TRH = incr TSH = incr T4

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39
Q

is TSH increased or decreased in first tri?

A

decreased bc incre HCG binds TSHR

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40
Q

is TSH increased or decreased in 2nd tri?

A

increased bc HCG declines

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41
Q

what causes cretinism

A

low thyroid in fetus

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42
Q

cretinism SE

A

decr bone turnover
decr neural development

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43
Q

what hormone acts like TSH in pregnancy?

A

HCG binds TSH receptors causing TSH like effects

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44
Q

as HCG increases what happens to TSH

A

TSH decreases

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45
Q

when does the baby stop depending on mom for iodine?

A

once it is born

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46
Q

what triggers trophoblastic nutrition?

A

progesterone released by the corpus luteum

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47
Q

trophoblast

A

undifferentiated cell layer on outside of mammalian blastula

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48
Q

what initiates trophoblastic differentiation

A

ICF
TGF
EGF

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49
Q

what do trophoblasts differentiate into

A

cytotrophoblasts
syncytiotrophoblasts

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50
Q

cytotrophoblasts

A

inner layer of trophoblast that help achor to uterine wall

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51
Q

syncytiotrophoblast

A

extend outward into blood and glands

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52
Q

which cells secrete proteolytic enzymes to break down endometrial cells and blood vessels?

A

cytotrophoblasts
and
syncytiotrophoblasts

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53
Q

which cells form lacuna

A

syncytiotrophoblasts

54
Q

which cells digest moms blood

A

syncytiotrophoblats

55
Q

which cells produce placental hormones

A

syncytiotrophoblasts

56
Q

which cells make up the chorionic villi

A

cytotrophoblats

57
Q

what does the chorionic vili contain

A

fetal capillary network

58
Q

pre-ecclampsia

A

trophoblats cant invade deep enough into tissues
growth restriction

59
Q

placenta accreta

A

too much invasion into myometrium

60
Q

lacuna

A

empty pools that fill with maternal blood

61
Q

factors that increase transfer of drugs across placenta

A

low molecular weight
lipid soluble
non-charge
non-protein bound

62
Q

drugs that cross placenta

A

ethanol
most anticholinergics
antihypertensives
benzos
induction agents
local anesthetics
opioids
vasopressors

63
Q

which drugs dont cross the placenta

A

muscle relaxants
heparin
insulin

64
Q

braxton hicks contractions

A

evidence of sm muscles preparing for labor

65
Q

what allows estrogen to induce contractions

A

the withdrawal of progesterone

66
Q

when is the E2:P ration high

A

3rd trimester

67
Q

when is the E2:P ratio low

A

1st tri
2nd tri

68
Q

E2 _______ gap junctions

A

increases

69
Q

E2 ______ Oxytocin receptors

A

increases

70
Q

E2 _____ PG receptors

A

increases

71
Q

what hormones dictate smooth muscle state during 1/2 trimesters

A

progesterone
NO

72
Q

what hormones dictacte sm muscle during last 6-8 weeks

A

incr E:P ratio
prostaglandins

73
Q

what effects happen during myometrial activations

A

incr oxy receptors
incr gap junctions
incr uterine excitation
braxton hicks
cervical ripening

74
Q

when does oxytocin and prostaglandin increase

A

during stimulation of the furgeson reflex

75
Q

what decreases postpartum bleeding

A

oxytocin
prostaglandins
remain high after delivery

76
Q

what stimulates uterine contraction

A

PG and OT activation of IP3/DAG

77
Q

what inhibits uterine contraction

A

b agonist (cAMP)
NO (cGMP)

78
Q

APGAR score evaluates

A

effects of anesthesia

79
Q

when are APGAR scores taken

A

1 and 5 mins post birth

80
Q

APGAR

A

appearance
pulse
grimace
activity
respiration

81
Q

what is a major cause of delayed breathing at birth

A

fetal hypoxia

82
Q

what APGAR score requires further evaluation

A

< 7

83
Q

twin risks

A

LOW
di-di
mono-di
mono-mono
mono-mono conjoined
HIGH

84
Q

when is the furguso reflex stronger

A

in multiples
– increased risk of premature birth

85
Q

how long does dilation take

A

6-12 hrs

86
Q

how long does expulsion take

A

20min-2 hrs

87
Q

how long does placental delivery take

A

15 mins

88
Q

what stimulation triggers lactation

A

crying/suckling
affernts

89
Q

what hormones trigger lactation

A

increased prolactin
increased oxytocin

90
Q

what inhibits lactation during pregnancy

A

E2 and progesterone inhibit lactation

91
Q

what causes lactational amenorrhea

A

increased prolactin

92
Q

PIH

A

dopa

93
Q

what inhibits PIH

A

crying afferents

94
Q

inhibiting PIH does what

A

increases prolactin

95
Q

2 goals for fetal blood after delivery

A

replace HbF with HbA
decr HCt

96
Q

do newborns have an overall increase or decrease in Hb

A

increase

97
Q

what increases bilirubin

A

breakdown of fetal RBCs into iron heme into bilirubin

98
Q

4 fetal shunts

A

placenta
ductus venosus
ductus arteriosus
foramen ovale

99
Q

what shunt is in the liver

A

ductus venosus

100
Q

what is the ductus arteriosus

A

shunt from pul artery to aorta

101
Q

what is the foramen ovale

A

shunt from RA to LA

102
Q

why does the LV pump more than the RV

A

hypoxicvasoconstriction

103
Q

ductus venosus closure

A

incr portal vein BF
incr portal vein P

104
Q

ductus arteriosus closure

A

incr aortic P
decr pulm art P
incr PaO2
decr prostaglandins

105
Q

foramen ovale closure

A

decr Pulm art P
decr pulm resistance
decr RA p
incr aortic P
incr LA p

106
Q

type 1 cells

A

gas exchagne

107
Q

type 2 cells

A

surfactant production after 24 weeks

108
Q

ENAC

A

incr Na+
incr H2O

109
Q

what does cutting the umbilical cord do?

A

decr O2
incr CO2

—- stimulates drive to breathe!

110
Q

first breath pressure to fill lung

A

-60 cmH20

111
Q

first exhalation pressure required

A

+40 cmH2O

112
Q

transient tachypnea

A

short rapid breathing 4-6 hrs post-delivery

Type 1 cells impaired

113
Q

treat transient tachypnea

A

give O2
wait 1-2 days

114
Q

respiratory distress syndrome

A

lack of surfactant
premature baby
diabetic mom

115
Q

treat respiratory disress syndrome

A

give surfactant
CPAP/Vent

116
Q

neonatal challenges at birth

A

hypoxia
hypoglycemia
hypothermia

117
Q

what is the biggest risk factors for hypoxia

A

anesthetic depression of resp drive

118
Q

other risk for fetal hypicia

A

pulm fluid retention
airway collapse
nasal breathers

119
Q

when can premanent brain damage happen

A

8-10 mins of hypoxia

120
Q

what causes hypoglycemia in newborn

A

small liver/kidneys
= limited gluconeogenesis

121
Q

newborns have a _______ - dependent metabolism

A

glucose-dependent

122
Q

newborns resting metabolic rate

A

high

123
Q

environmental causes of hypothermia

A

conduction
convection
evaporation
radiation

124
Q

newborn protection against hypothermia

A

peripheral vasoconstrictions
sub q fat
fetal position
non shivering thermogenesis

125
Q

what dose cold stress trigger

A

incr TSH
incr Epi release

126
Q

what converst T4 to T3

A

5’iodinase

127
Q

what does T3 do in brown fat metabolism

A

T3 upregulates UCP H+ channel

128
Q

what opens the UCP channel

A

FFA

129
Q

what happens when UCP channels on mito membrane open?

A

H+ goes into cell
decr ETC H+ gradient
incr heat production

130
Q
A

Su: Phys 2 (12 decks)

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