Maternal/Fetal Flashcards
1
Q
prepregnancy E2 function
A
thickens endometrium
2
Q
pre-pregnancy progesterone function
A
promotes gestation
3
Q
1st trimester hormones
A
CL: incr E2/P
placental: incr HCG
4
Q
when does HCG peak
A
at end of 1st tri
5
Q
2nd tri hormones
A
CL: tapers off E2/P
placenta: incr E2/P
6
Q
when dose the placenta take over E2 and progesterone production
A
2nd tri
7
Q
3rd tri hormones
A
placenta controls
rate of E2 > rate of progest
8
Q
maternal changes: blood
A
incr BV by 30%
incr fibrinogen
electrolytes remain balanced
9
Q
how much does BV increase by during pregnancy
A
30%
10
Q
when is BV the highest
A
24 weeks
11
Q
Hct levels ____ during pregnancy. Why?
A
decrease due to dilution
plasma increases more than RBC increase
12
Q
what triggers increase in BV
A
RAAS + E2 triggers ADH
13
Q
maternal changes: CV
A
incr CO by 30%
decr MAP
supine hypotension syndrome
14
Q
why does maternal CO increase?
A
incr BV = incr preload
15
Q
why does maternal MAP decrease?
A
shear force on endothelial cells activates ENOS
incr NO
decr TPR (25%)
Vasodilation
16
Q
supine hypotension syndrome
A
occulsion of IVC
- decr venous return
- decr preload
- decr CO
- incr parasympathetics
17
Q
supine hypotension causes maternal _____ and fetal ______
A
maternal hypotension
fetal bradycardia
18
Q
maternal changes: pulmonary
A
incr MV (40%)
dect ERV (40%)
19
Q
what ventilation values increase in maternal?
A
incr TV
incr IV
incr IRV
20
Q
what ventilation values decrese in pregnancy?
A
decr ERV
decr RV
decr FRC
21
Q
what ventilation values dont change in preg?
A
VC
TLC
22
Q
what does progesterone do to RR
A
progesterone incr CO2 sensitivity = incr RR
23
Q
what does increased metabolic rate do to MV?
A
incr metabolic rate will incr CO2 = incr RR and incr TV
24
Q
why does ERV decrease in pregnancy
A
diaphragm moves up 4 cm
- decr RV
- decr FRC
25
maternal changes: renal
incr renal flow
incr GFR
decr renal flow in 3rd tri
cr levels lower
26
what causes incr renal flow in pregnancy
incr aldosterone
incr cortisol
27
what causes incr GFR in pregnancy
NO promotes vasodilation
relaxin relaxes blood vessels
== promotes incr BF
28
why does renal flow decr in 3rd tri
ang2 vasoconstricts
- decr BF
- incr glomerulus pressure
29
normal preg Cr levels
0.5-0.6 mg/dL
30
preeclampsia Cr levels
1 mg/dLw
31
why are cr levels lower in pregnancy?
urination of Cr
32
what mechanism protects maternal bone health?
decr PTH
incr calcitriol
incr calcitonin
== promotes bone deposition
33
what causes incr blood glucose in pregnancy?
HCS release from placenta is diabetogenic
34
what causes gestational diabetes
too much HCS
or
high sensitivity to HCS
35
what does maternal IR do?
incr lipolysis
- sends glucose to fetus
36
why does maternal T4 increase in preg?
fetus is dependent
37
what mechanism increases maternal T4
Type 3 deiodinase from placental converts maternal T3 to T4
38
increased E2 cause what thyroid hormone to increase
incr E2 = incr TBH
== incr TRH = incr TSH = incr T4
39
is TSH increased or decreased in first tri?
decreased bc incre HCG binds TSHR
40
is TSH increased or decreased in 2nd tri?
increased bc HCG declines
41
what causes cretinism
low thyroid in fetus
42
cretinism SE
decr bone turnover
decr neural development
43
what hormone acts like TSH in pregnancy?
HCG binds TSH receptors causing TSH like effects
44
as HCG increases what happens to TSH
TSH decreases
45
when does the baby stop depending on mom for iodine?
once it is born
46
what triggers trophoblastic nutrition?
progesterone released by the corpus luteum
47
trophoblast
undifferentiated cell layer on outside of mammalian blastula
48
what initiates trophoblastic differentiation
ICF
TGF
EGF
49
what do trophoblasts differentiate into
cytotrophoblasts
syncytiotrophoblasts
50
cytotrophoblasts
inner layer of trophoblast that help achor to uterine wall
51
syncytiotrophoblast
extend outward into blood and glands
52
which cells secrete proteolytic enzymes to break down endometrial cells and blood vessels?
cytotrophoblasts
and
syncytiotrophoblasts
53
which cells form lacuna
syncytiotrophoblasts
54
which cells digest moms blood
syncytiotrophoblats
55
which cells produce placental hormones
syncytiotrophoblasts
56
which cells make up the chorionic villi
cytotrophoblats
57
what does the chorionic vili contain
fetal capillary network
58
pre-ecclampsia
trophoblats cant invade deep enough into tissues
growth restriction
59
placenta accreta
too much invasion into myometrium
60
lacuna
empty pools that fill with maternal blood
61
factors that increase transfer of drugs across placenta
low molecular weight
lipid soluble
non-charge
non-protein bound
62
drugs that cross placenta
ethanol
most anticholinergics
antihypertensives
benzos
induction agents
local anesthetics
opioids
vasopressors
63
which drugs dont cross the placenta
muscle relaxants
heparin
insulin
64
braxton hicks contractions
evidence of sm muscles preparing for labor
65
what allows estrogen to induce contractions
the withdrawal of progesterone
66
when is the E2:P ration high
3rd trimester
67
when is the E2:P ratio low
1st tri
2nd tri
68
E2 _______ gap junctions
increases
69
E2 ______ Oxytocin receptors
increases
70
E2 _____ PG receptors
increases
71
what hormones dictate smooth muscle state during 1/2 trimesters
progesterone
NO
72
what hormones dictacte sm muscle during last 6-8 weeks
incr E:P ratio
prostaglandins
73
what effects happen during myometrial activations
incr oxy receptors
incr gap junctions
incr uterine excitation
braxton hicks
cervical ripening
74
when does oxytocin and prostaglandin increase
during stimulation of the furgeson reflex
75
what decreases postpartum bleeding
oxytocin
prostaglandins
remain high after delivery
76
what stimulates uterine contraction
PG and OT activation of IP3/DAG
77
what inhibits uterine contraction
b agonist (cAMP)
NO (cGMP)
78
APGAR score evaluates
effects of anesthesia
79
when are APGAR scores taken
1 and 5 mins post birth
80
APGAR
appearance
pulse
grimace
activity
respiration
81
what is a major cause of delayed breathing at birth
fetal hypoxia
82
what APGAR score requires further evaluation
< 7
83
twin risks
LOW
di-di
mono-di
mono-mono
mono-mono conjoined
HIGH
84
when is the furguso reflex stronger
in multiples
-- increased risk of premature birth
85
how long does dilation take
6-12 hrs
86
how long does expulsion take
20min-2 hrs
87
how long does placental delivery take
15 mins
88
what stimulation triggers lactation
crying/suckling
affernts
89
what hormones trigger lactation
increased prolactin
increased oxytocin
90
what inhibits lactation during pregnancy
E2 and progesterone inhibit lactation
91
what causes lactational amenorrhea
increased prolactin
92
PIH
dopa
93
what inhibits PIH
crying afferents
94
inhibiting PIH does what
increases prolactin
95
2 goals for fetal blood after delivery
replace HbF with HbA
decr HCt
96
do newborns have an overall increase or decrease in Hb
increase
97
what increases bilirubin
breakdown of fetal RBCs into iron heme into bilirubin
98
4 fetal shunts
placenta
ductus venosus
ductus arteriosus
foramen ovale
99
what shunt is in the liver
ductus venosus
100
what is the ductus arteriosus
shunt from pul artery to aorta
101
what is the foramen ovale
shunt from RA to LA
102
why does the LV pump more than the RV
hypoxicvasoconstriction
103
ductus venosus closure
incr portal vein BF
incr portal vein P
104
ductus arteriosus closure
incr aortic P
decr pulm art P
incr PaO2
decr prostaglandins
105
foramen ovale closure
decr Pulm art P
decr pulm resistance
decr RA p
incr aortic P
incr LA p
106
type 1 cells
gas exchagne
107
type 2 cells
surfactant production after 24 weeks
108
ENAC
incr Na+
incr H2O
109
what does cutting the umbilical cord do?
decr O2
incr CO2
---- stimulates drive to breathe!
110
first breath pressure to fill lung
-60 cmH20
111
first exhalation pressure required
+40 cmH2O
112
transient tachypnea
short rapid breathing 4-6 hrs post-delivery
Type 1 cells impaired
113
treat transient tachypnea
give O2
wait 1-2 days
114
respiratory distress syndrome
lack of surfactant
premature baby
diabetic mom
115
treat respiratory disress syndrome
give surfactant
CPAP/Vent
116
neonatal challenges at birth
hypoxia
hypoglycemia
hypothermia
117
what is the biggest risk factors for hypoxia
anesthetic depression of resp drive
118
other risk for fetal hypicia
pulm fluid retention
airway collapse
nasal breathers
119
when can premanent brain damage happen
8-10 mins of hypoxia
120
what causes hypoglycemia in newborn
small liver/kidneys
= limited gluconeogenesis
121
newborns have a _______ - dependent metabolism
glucose-dependent
122
newborns resting metabolic rate
high
123
environmental causes of hypothermia
conduction
convection
evaporation
radiation
124
newborn protection against hypothermia
peripheral vasoconstrictions
sub q fat
fetal position
non shivering thermogenesis
125
what dose cold stress trigger
incr TSH
incr Epi release
126
what converst T4 to T3
5'iodinase
127
what does T3 do in brown fat metabolism
T3 upregulates UCP H+ channel
128
what opens the UCP channel
FFA
129
what happens when UCP channels on mito membrane open?
H+ goes into cell
decr ETC H+ gradient
incr heat production
130
