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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
Q

what organs does the placenta act as for the fetus?

A

gut, lung, kidney, endocrine glans, immune modulator

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26
Q

what types of drugs pass the placenta?

A

low MW
lipid soluble
non charged
non protein bound

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27
Q

how can a fetus get away with a low PO2?

A

“dbl bohr effect” bc it shifts the oxyHb curve to the left,

less PO2 means more saturated than normally would be

28
Q

in a fetus do the veins or arteries have oxygenated blood?

A

veins have the oxygenated blood

29
Q

what are the functions of hCG?

A

maintainance of CL and P and E2 production (1st trimester)

30
Q

what does hCG stimulate?

A

DHEA-S in fetal zone of adrenal gland

testosterone in male fetus

31
Q

what does hCG inhibit?

A

contractions

moms immune system

32
Q

what allows estrogen to cause contractions?

A

the removal of progesterone, which is an E2 R antagonist

33
Q

what does hCS do and when is it secreted?

A

wk5+ by trophoblast
breast bone develp.
decrease insulin sens. (more glucose to baby)
increased fat breakdown

34
Q

what does relaxin do and when is it secreted?

A

wk0-6 by CL
wk6+ trophoblast
relaxes buis ligament and cervix
increased RPF/GFR

35
Q

what does progesterone receptor antagonism do?

A

terminate pregnancy

36
Q

what does androgen insensitivity cause?

A

born XY but female appearance, increased testosterone

may or maynot have breasts

37
Q

what does 5 alpha reductase deficiency cause?

A

born XY, but female appearance

surprise penis at puberty because of new enzymes

38
Q

what two things trigger birth?

A

hormone factors: increase E2,oxy and PG; decrease P

mechanical factor: ferguson reflex

39
Q

what are the phases of birth?

A

0 - quiescence
1 - myometrial actication
2 - stimulation
3- involution

40
Q

what happens in quiescence?

A

trimesters 1-2
progesterone and NO high
decrease in intracell calc = relax

41
Q

what happens in myometrial activation?

A

last 6-8 wks
increases E:P ratio, PG, relaxin, oxy R, gap junc
braxton hicks

42
Q

what happens in stimulation?

A

oxytocin, PG, stretch, uterine contraction

43
Q

what happens in involution

A

ocytocin, PG
decrease post bleed
increase uterine repair

44
Q

how much is full dilation?

A

10cm

45
Q

labor and deliver stages (stimulation phase)

A 
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
Q

describe ferguson relfex

A

baby head stretches cervix and positive feedback for oxy and increased contraction at fundus pushes baby down

47
Q

what things would result in decreased contraction?

A

beta adrenergic, cAMP or NO, if you increase cAMP or cGMP that inhibits contraction

48
Q

what is the APGAR?

A

10 pt scale of baby
check at 1min and 5 min
<7 you need to be concerned

49
Q

what does APGAR stand for?

A 
appearance (blue?)
pulse (>100)
grimace (crys and pulls away)
activity (active mvmt)
respiration (strong cry)
2-1-0 pts
50
Q

how does crying/suckling relay information to the CNS?

A

sensory afferents

51
Q

regulation of lactation summary

A

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
Q

lactational amenorrhea

A

prolactin inhibition of FSH and LH

53
Q

what is bilirubin?

A

yellow compound made when the liver is breaking down Hb

54
Q

what do neonates do after birth with their Hb?

A

they try to replace HbF with HbAdult

55
Q

what are the 4 shunts in fetal circulation?

A

placenta shunt: umbilical vein to liver
ductus venosus: umbilical vein to IVC
ductus arteriosus: PA to Aorta
foramen ovale: inbetween LA and RA

56
Q

what are the 6 circulatory changes with fetal vs neonate?

A

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
Q

what types of mothers/birth would you see low surfactant

A

premature

diabetic

58
Q

fetus vs neonate lungs

A

fetus- amniotic fluid and movements of breaths

neonate- ENaC pump moves water out of lungs

59
Q

transient tachypnea

A

abnormal fast breathing starts after 4-6 from birth

oxygen and wait

60
Q

respiratory distress

A

lack of surfactant

give surfactant and cpap/vent

61
Q

what are the 3 neonatal respiratory triggers

A 
sensory (being born)
mechanical (birth, squeezes lung)
chemical stimulation (cut umbilical = acidosis (increased CO2)
62
Q

what are the 3 challenges a neonate faces at birth

A

hypoxia
hypoglycemia
hypothermia

63
Q

what things in a neonate cause hypoxia

A 
anesthestic depression
Hb phenotype
nasal breather
soft tissue obstruction
ETT may be difficult
64
Q

why is hypoglycemia a problem in neonates?

A

limited gluconeogensis

glucose dependent brain

65
Q

what are the threats for hypothermia for neonates?

A

radiation
conduction
convection
evaporation

66
Q

what are neonates protection from hypothermia?

A

peripheral vascular resistance
sub q fat
fetal position
non shivering thermogensis

Physiology II (10 decks)

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