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Physiology II > Maternal, Fetal and Neonatal > Flashcards

Maternal, Fetal and Neonatal Flashcards

1
Q

name the 4 phases of the female reproductive cycle and the days they happen

A

follicular phase 0-14
ovulation 14 (14 days before menses)
luteal phase 14-28
menses 0-4

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2
Q

what happens during the follicular phase?

A

FSH recruits 6-12 follicles and one “wins”
big follicle stimulates estrogen
proliferation of uterine tissue
negative feedback from estrogen causes decrease in FSH and LH

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3
Q

what happens during ovulation?

A

High levels of estradiol at end of follicular phase causes pos. feedback on ant. pit and releases FSH and LH(surge)
ovulation happens because of LH surge
estradiol levels decrease after ovulation and mucus becomes more viscous and penetrable

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4
Q

what happens during the luteal phase?

A

corpus leuteum formed and produces estrogen and progesterone**(higher)
progesterone increases uterine secretions
vascularity increases in endometrium
if not fertilized then CL regresses and estrogen and progesterone decrease

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5
Q

what happens during menses?

A

endometrium is slothed bc removal or estrogen and progesterone

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6
Q

what is acrosome

A

cap like structure over top half of sperm head

must be removed for fert.

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7
Q

what causes the acrosome cap to have the reaction?

A

hyaluronic acid

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8
Q

what are the steps to fertilization

A

penetration of cumulus and acrosome rxn start
penetration of zona pellucida
fusion of sperm and egg membrane
IPD/DAG Calcium signalling
enzymes released to harden membrane and stop sperm
mixing DNA and completion of meiotic division

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9
Q

what are the steps for penetration of zona pellucida?

A

ZP3 bind
acrosome rxn complete
ZP2 bind
digestion and swim to egg

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10
Q

how is the fertilized egg transported from the fallopean tube to uterus?

A

fluid current and cilia, progesterone from CL causes tube relaxation

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11
Q

how many days after the fertilization does the blastocyte hatch?

A

3-4 days

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12
Q

when does the blastocyte implant?

A

5-7 days after fert.

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13
Q

what does the blastocyte rely on for nutrition?

A

uterine milk (secretions

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14
Q

describe adhesion

A

trophoblasts around outside of cell adhere to the endometrium

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15
Q

during invasion what two cells types does trophoblasts turn into

A

cytotrophoblasts (inner layer of trophoblast to anchor)

syncytiotrophoblast (multi cytotrophoblast make this)

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16
Q

what forms inside of syncytiotrophoblast during invasion?

A

lacuna- dirests moms blood vessels

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17
Q

what do syncytiotrophoblasts release during invasion?

A

placental hormones

hCG and hCS

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18
Q

describe implantation

A

cytotrophoblasts create chorionic villi that contains fetal capillaries and boarders between that and moms blood

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19
Q

chorionic villi

A

border between moms and fetus blood

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20
Q

pre eclampsia

A

obese, diabetic, old moms

trophoblast cant invade deep and cause growth restriction

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21
Q

placenta accreta

A

attachment goes to muscle layer

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22
Q

when does the fetal heart start to pump blood through capillaries?

A

21 days after fert.

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23
Q

what type of nutrition is critical early on in pregnancy?

A

trophoblastic nutrition (progesterone)

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24
Q

how many weeks after last menstration is the placenta functional?

A

10-12 weeks

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25
what organs does the placenta act as for the fetus?
gut, lung, kidney, endocrine glans, immune modulator
26
what types of drugs pass the placenta?
low MW lipid soluble non charged non protein bound
27
how can a fetus get away with a low PO2?
"dbl bohr effect" bc it shifts the oxyHb curve to the left, | less PO2 means more saturated than normally would be
28
in a fetus do the veins or arteries have oxygenated blood?
veins have the oxygenated blood
29
what are the functions of hCG?
maintainance of CL and P and E2 production (1st trimester)
30
what does hCG stimulate?
DHEA-S in fetal zone of adrenal gland | testosterone in male fetus
31
what does hCG inhibit?
contractions | moms immune system
32
what allows estrogen to cause contractions?
the removal of progesterone, which is an E2 R antagonist
33
what does hCS do and when is it secreted?
wk5+ by trophoblast breast bone develp. decrease insulin sens. (more glucose to baby) increased fat breakdown
34
what does relaxin do and when is it secreted?
wk0-6 by CL wk6+ trophoblast relaxes buis ligament and cervix increased RPF/GFR
35
what does progesterone receptor antagonism do?
terminate pregnancy
36
what does androgen insensitivity cause?
born XY but female appearance, increased testosterone | may or maynot have breasts
37
what does 5 alpha reductase deficiency cause?
born XY, but female appearance | surprise penis at puberty because of new enzymes
38
what two things trigger birth?
hormone factors: increase E2,oxy and PG; decrease P | mechanical factor: ferguson reflex
39
what are the phases of birth?
0 - quiescence 1 - myometrial actication 2 - stimulation 3- involution
40
what happens in quiescence?
trimesters 1-2 progesterone and NO high decrease in intracell calc = relax
41
what happens in myometrial activation?
last 6-8 wks increases E:P ratio, PG, relaxin, oxy R, gap junc braxton hicks
42
what happens in stimulation?
oxytocin, PG, stretch, uterine contraction
43
what happens in involution
ocytocin, PG decrease post bleed increase uterine repair
44
how much is full dilation?
10cm
45
labor and deliver stages (stimulation phase)
``` dilation stage (6-12 hr) contrac to full dilation expulsion stage (20m-2hr) full dilation to baby out placental phase (15m) baby out to placenta out ```
46
describe ferguson relfex
baby head stretches cervix and positive feedback for oxy and increased contraction at fundus pushes baby down
47
what things would result in decreased contraction?
beta adrenergic, cAMP or NO, if you increase cAMP or cGMP that inhibits contraction
48
what is the APGAR?
10 pt scale of baby check at 1min and 5 min <7 you need to be concerned
49
what does APGAR stand for?
``` appearance (blue?) pulse (>100) grimace (crys and pulls away) activity (active mvmt) respiration (strong cry) 2-1-0 pts ```
50
how does crying/suckling relay information to the CNS?
sensory afferents
51
regulation of lactation summary
stimulated by decrease in E2 and P after birth sensory information inhibits PIH (dopamine) stimulates oxytocin and Prolactin to be released prolactin causes milk secretions oxytocin causes muscle contraction in breast
52
lactational amenorrhea
prolactin inhibition of FSH and LH
53
what is bilirubin?
yellow compound made when the liver is breaking down Hb
54
what do neonates do after birth with their Hb?
they try to replace HbF with HbAdult
55
what are the 4 shunts in fetal circulation?
placenta shunt: umbilical vein to liver ductus venosus: umbilical vein to IVC ductus arteriosus: PA to Aorta foramen ovale: inbetween LA and RA
56
what are the 6 circulatory changes with fetal vs neonate?
1- loss of placental BF (2x increase in SVR) 2- PVR decreases (lung expand and oxygen) 3- disintegration of umbilical cord (umb vein repaced with round ligament; umbilical artery is now iliac artery) 4- closure of ductus venosus (1-3 hr) blood flows to portal vein 5- ductus arteriosus closes at birth 6- foramen ovale closes at birth
57
what types of mothers/birth would you see low surfactant
premature | diabetic
58
fetus vs neonate lungs
fetus- amniotic fluid and movements of breaths | neonate- ENaC pump moves water out of lungs
59
transient tachypnea
abnormal fast breathing starts after 4-6 from birth | oxygen and wait
60
respiratory distress
lack of surfactant | give surfactant and cpap/vent
61
what are the 3 neonatal respiratory triggers
``` sensory (being born) mechanical (birth, squeezes lung) chemical stimulation (cut umbilical = acidosis (increased CO2) ```
62
what are the 3 challenges a neonate faces at birth
hypoxia hypoglycemia hypothermia
63
what things in a neonate cause hypoxia
``` anesthestic depression Hb phenotype nasal breather soft tissue obstruction ETT may be difficult ```
64
why is hypoglycemia a problem in neonates?
limited gluconeogensis | glucose dependent brain
65
what are the threats for hypothermia for neonates?
radiation conduction convection evaporation
66
what are neonates protection from hypothermia?
peripheral vascular resistance sub q fat fetal position non shivering thermogensis

Physiology II (10 decks)

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