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S & F 4 Test 2 > McCumbee - Maternal Adaptations To Pregnancy > Flashcards

McCumbee - Maternal Adaptations To Pregnancy Flashcards

1
Q

Due to their structural similarity, HcG uses -____ receptors to exert its biological actions

A

LH

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2
Q

HcG is more extensively glycosylated than LH and, therefore, has +++______

A

A longer half life

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3
Q

HcG levels rise fast and can be detected ___-__ days after implantation .

(Secreted by syncytiotrophoblast cells

A

1 to 2

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4
Q

What are the principle actions of HcG?

A

Prevent luteolysis of the corpus luteum

Promote progesterone production

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5
Q

In pregnant women, progesterone is synthesized by both the ______ and the ________

A

Corpus luteum

Placenta

(Only placenta after 8 weeks)

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6
Q

How many weeks of pregnancy until the placenta takes over as the primary source of progesterone?

A

8 weeks

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7
Q

___________ released by the corpus luteum during the secretory phase of the endometrial cycle stimulates the production and storage of nutrients that sustain the embryo prior to formation of a functional placenta

A

Progesterone

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8
Q

High concentrations of _________ suppress the maternal immune system’s response to the developing embryo

A

Progesterone

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9
Q

________ is a major circulating estrogen during pregnancy

A

Estriol

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10
Q

For estrogen synthesis by the placenta, the _____________ of the fetus secretes DHEA-S which is acted on by a sulfatase in the syncytiotrophoblast and then used for estrogen synthesis.

A

“Fetal zone of the adrenal cortex”

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11
Q

The ________ expresses the enzyme to convert DHEA-S to 16alpha-OH-DHEA-S

A

Fetal liver

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12
Q

What does chorionic somatomammotropin (hCS/ placental lactogen) do ?

A

In the mother it stimulates lipolysis and antagonizes insulin, causing an increase in glucose levels. This keeps adequate glucose flows to the fetus

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13
Q

In the 3rd trimester of pregnancy, _____% of cardiac output goes to the uterus!

A

15-20

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14
Q

There is a ________ in peripheral resistance during pregnancy

A

Decrease.

The uterine arterioles become and maintain a dilated state throughout pregnancy. This acts as a shunt, decreasing peripheral resistance.

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15
Q

There is a ______ in cardiac output during pregnancy

A

Increase

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16
Q

______ are responsible for decreased vascular resistance in the uterus

A

Estrogens

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17
Q

How do estrogens cause a decrease in vascular resistance in the uterine arterioles (and an overall decrease in peripheral vascular resistance)?

A

Estrogens decrease the responsiveness of the vessels to vasoconstrictors (NE and angiotensin II)

Estrogens induce local production of vasodilators (NO and prostacyclin [PGI2)

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18
Q

A sustained reduction in placental perfusion can result in ?

A

Intrauterine growth restriction (IUGR)

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19
Q

Cardiac output increases markedly during the ____ trimester and remains elevated throughout pregnancy

A

1st

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20
Q

Humoral factors indicated in the decreased peripheral resistance seen in pregnancy: (x3)

A

Estrogen

Progesterone

Relaxin

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21
Q

The increased cardiac output associated with pregnancy is due to an increase in _______ and ________

A

Stroke volume

Heart rate

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22
Q

Compliance of the heart and aorta is _____ by estrogen and progesterone

A

Increased

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23
Q

The resting heart rate increases about ____ to ____ BPM during course of pregnancy

A

10 to 20

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24
Q

In the 3rd trimester, cardiac output is higher when the mother is in a ________ position than in a supine position

A

Lateral recumbent

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25
Q

At the end of pregnancy, blood volume increases by about ___-____ percent

A

40 to 50 %

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26
Q

Plasma volume levels increase _____ than red blood cell mass during pregnancy

A

More

Leads to anemia of pregnancy

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27
Q

Erythropoietin levels _____ during pregnancy

A

Increase

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28
Q

Prolactin (PRL) and human placental lactogen (hPL) ______ the effect of erythropoietin on erythropoeisis

A

Enhance

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29
Q

It takes about ____ weeks for blood volume to return to normal after pregnancy

A

8

30
Q

Blood pressures ______ thru the middle of the 2nd trimester of pregnancy

A

Decline

Even though there is a 50% increase in total blood volume

31
Q

Pulse pressure _____ during pregnancy

A

Widens

Due to a greater drop in DBP than SBP because of the decreased vascular resistance

32
Q

Concentration of albumin in blood ______ during pregnancy

A

Decreases

33
Q

Concentration of fibrinogen, some clotting factors and certain binding globulins _______ during pregnancy

A

Increases

34
Q

Estrogens _______ the synthesis of thyroxine-binding globulin, corticosteroid-binding globulin and sex-steroid-binding globulin

A

Stimulates

35
Q

What is the phsyiological significance of increased fibrinogen and some clotting factors that is produced during pregnancy?

A

Can help prevent postpartum hemorrhage

Also puts pregnant women at greater risk for thrombosis

36
Q

Renal changes seen in pregnancy

A

Size

Renal blood flow

GFR —> decreased serum creatinine, urea, and uric acid, increased urinary protein excretion, increase glucose filtration and decreased ability to reuptake causes glycosuria.

37
Q

Under basal conditions, the Na concentrations of plasma in pregnant women is _____ than that of non-pregnant women

A

Lower

38
Q

Estrogen _______ angiotensinogen synthesis

A

Stimulates

Responsible for increased plasma angiotensinogen during pregnancy

39
Q

Estrogen and progesterone ______ renin synthesis

A

Stimulate

40
Q

In pregnancy, there is a net _____ in residual volume (20%) in lungs

A

Decrease

41
Q

In pregnancy there is a _______ in pulmonary resistance

A

Decrease

Due to relaxation of smooth muscle in the airways

42
Q

The increased alveolar ventilation that is seen in early pregnancy and carried on throughout is due to?

A

A 30-40% increase in tidal volume

43
Q

Rate of respiration changes in pregnancy, T/F?

A

False

Rate of respiration does NOT change during pregnancy, increased alveolar ventilation is due to increased tidal volume

44
Q

Alveolar PCO2 ______ throughout pregnancy

A

Decreases

B/c the increase of the rate of alveolar ventilation is greater than the increase in metabolic rate

45
Q

__________ increases alveolar ventilation by increasing the sensitivity of the central chemoreceptors to CO2

A

Progesterone

46
Q

Progesterone ______ ventilatory drive

A

Increases

47
Q

The major pituitary change during pregnancy is the hyperplasia of _____

A

Lactotropes

48
Q

Serum PRL levels _____ during pregnancy

A

Rise

49
Q

Total serum levels of T3 and T4 levels are increased during pregnancy due to _____ induced TBG synthesis. Free t3 and t4 stay same

A

Estrogen

50
Q

There is ______ iodide uptake during pregnancy by the thyroid hormone

A

Increased

51
Q

During the second half of pregnancy, there is an increase in peripheral resistance to the metabolic effects of insulin due to elevated levels of _______ and _______

A

Maternal hPL

Cortisol

52
Q

Gi motility, food absorption, and lower esophageal sphincter tone ________ during pregnancy due to increase in circulating levels of progesterone

A

Decrease

53
Q

Intragastric pressure ______ during pregnancy

A

Increases

This and the fall in lower esophageal sphincter tone cause a predisposition of pregnant women to heartburn

54
Q

What is prolactin’s role in breast development?

A

Lobuloalveolar development of mammary glands during pregnancy

Production and secretion of milk following partuition

55
Q

PRL is unique among pituitary hormones in that its secretion is under tonic inhibition by )_____

A

Dopamine

56
Q

_______ is the most potent postpartum stimulus for PRL release

A

Suckling

57
Q

During pregnancy, lactation is inhibited by ?

A

High levels of progesterone and estrogens

58
Q

Initiation of lactation occurs in response to ?

A

Drop in progesterone levels

Lactation-inducing effects of prolactin

59
Q

______ is the principal hormone for maintaining milk production once it has been initiated

A

PRL

60
Q

PRL acts of _______ to promote milk synthesis

A

Epithelial cells lining alveoli

61
Q

_____ and _____ have a permissive effect on milk production once it has begun

A

Cortisol

Insulin

62
Q

________ acts on the myoepithelial cells surroundin the alveli to promote the ejection of milk

A

Oxytocin

63
Q

______ is primary stimuli for the reflex of milk release.

A

Suckling which releases oxytocin

Psychic stimuli such as crying can also stimulate this release

64
Q

Suckling of the nipple _____ dopamine release

A

Inhibits (allowing secretion of prolactin and the secretion of milk)

65
Q

Lactation ______ ovarian cyclees

A

Suppresses

66
Q

If a mother does not nurse her infant, ovulatory cycles will resume in about ____ to _____ weeks

A

8 to 10

67
Q

What happens if you sever the stalk of the pituitary?

A

Decrease in all pituitary hormones except for prolactin, because prolactin is tonically inhibitted

68
Q

Target tissues for oxytocin (x2)

A

Myoepithelial cells of the breast

Uterine smooth muscle

69
Q

Why is the uterus resistant to oxytocin during the first 2 trimesteres of pregnancy?

A

Because the uterus produces oxytocinases which break down oxytocin during this time

70
Q

Oxytocin ______ labor

A

Does NOT induce

71
Q

Uterine sensitivity to oxytocin increases immediately before and during contractions because?

A

There is an increase in uterine oxytocin receptor content

72
Q

Oxytocin is used clinically to ? X3

A

Induce labor

Enhance contractions

Decease postpartum bleeding

S & F 4 Test 2 (15 decks)

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