McCumbee - Maternal Adaptations To Pregnancy

Question 1

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

Answer 1

LH

Question 2

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

Answer 2

A longer half life

Question 3

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

(Secreted by syncytiotrophoblast cells

Answer 3

1 to 2

Question 4

What are the principle actions of HcG?

Answer 4

Prevent luteolysis of the corpus luteum

Promote progesterone production

Question 5

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

Answer 5

Corpus luteum

Placenta

(Only placenta after 8 weeks)

Question 6

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

Answer 6

8 weeks

Question 7

___________ 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

Answer 7

Progesterone

Question 8

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

Answer 8

Progesterone

Question 9

________ is a major circulating estrogen during pregnancy

Answer 9

Estriol

Question 10

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.

Answer 10

“Fetal zone of the adrenal cortex”

Question 11

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

Answer 11

Fetal liver

Question 12

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

Answer 12

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

Question 13

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

Answer 13

15-20

Question 14

There is a ________ in peripheral resistance during pregnancy

Answer 14

Decrease.

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

Question 15

There is a ______ in cardiac output during pregnancy

Answer 15

Increase

Question 16

______ are responsible for decreased vascular resistance in the uterus

Answer 16

Estrogens

Question 17

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

Answer 17

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

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

Question 18

A sustained reduction in placental perfusion can result in ?

Answer 18

Intrauterine growth restriction (IUGR)

Question 19

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

Answer 19

1st

Question 20

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

Answer 20

Estrogen

Progesterone

Relaxin

Question 21

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

Answer 21

Stroke volume

Heart rate

Question 22

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

Answer 22

Increased

Question 23

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

Answer 23

10 to 20

Question 24

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

Answer 24

Lateral recumbent

Question 25

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

Answer 25

40 to 50 %

Question 26

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

Answer 26

More Leads to anemia of pregnancy

Question 27

Erythropoietin levels _____ during pregnancy

Answer 27

Increase

Question 28

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

Answer 28

Enhance

Question 29

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

Answer 29

8

Question 30

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

Answer 30

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

Question 31

Pulse pressure _____ during pregnancy

Answer 31

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

Question 32

Concentration of albumin in blood ______ during pregnancy

Answer 32

Decreases

Question 33

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

Answer 33

Increases

Question 34

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

Answer 34

Stimulates

Question 35

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

Answer 35

Can help prevent postpartum hemorrhage Also puts pregnant women at greater risk for thrombosis

Question 36

Renal changes seen in pregnancy

Answer 36

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.

Question 37

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

Answer 37

Lower

Question 38

Estrogen _______ angiotensinogen synthesis

Answer 38

Stimulates Responsible for increased plasma angiotensinogen during pregnancy

Question 39

Estrogen and progesterone ______ renin synthesis

Answer 39

Stimulate

Question 40

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

Answer 40

Decrease

Question 41

In pregnancy there is a _______ in pulmonary resistance

Answer 41

Decrease Due to relaxation of smooth muscle in the airways

Question 42

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

Answer 42

A 30-40% increase in tidal volume

Question 43

Rate of respiration changes in pregnancy, T/F?

Answer 43

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

Question 44

Alveolar PCO2 ______ throughout pregnancy

Answer 44

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

Question 45

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

Answer 45

Progesterone

Question 46

Progesterone ______ ventilatory drive

Answer 46

Increases

Question 47

The major pituitary change during pregnancy is the hyperplasia of _____

Answer 47

Lactotropes

Question 48

Serum PRL levels _____ during pregnancy

Answer 48

Rise

Question 49

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

Answer 49

Estrogen

Question 50

There is ______ iodide uptake during pregnancy by the thyroid hormone

Answer 50

Increased

Question 51

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 _______

Answer 51

Maternal hPL Cortisol

Question 52

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

Answer 52

Decrease

Question 53

Intragastric pressure ______ during pregnancy

Answer 53

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

Question 54

What is prolactin’s role in breast development?

Answer 54

Lobuloalveolar development of mammary glands during pregnancy Production and secretion of milk following partuition

Question 55

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

Answer 55

Dopamine

Question 56

_______ is the most potent postpartum stimulus for PRL release

Answer 56

Suckling

Question 57

During pregnancy, lactation is inhibited by ?

Answer 57

High levels of progesterone and estrogens

Question 58

Initiation of lactation occurs in response to ?

Answer 58

Drop in progesterone levels Lactation-inducing effects of prolactin

Question 59

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

Answer 59

PRL

Question 60

PRL acts of _______ to promote milk synthesis

Answer 60

Epithelial cells lining alveoli

Question 61

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

Answer 61

Cortisol Insulin

Question 62

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

Answer 62

Oxytocin

Question 63

______ is primary stimuli for the reflex of milk release.

Answer 63

Suckling which releases oxytocin Psychic stimuli such as crying can also stimulate this release

Question 64

Suckling of the nipple _____ dopamine release

Answer 64

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

Question 65

Lactation ______ ovarian cyclees

Answer 65

Suppresses

Question 66

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

Answer 66

8 to 10

Question 67

What happens if you sever the stalk of the pituitary?

Answer 67

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

Question 68

Target tissues for oxytocin (x2)

Answer 68

Myoepithelial cells of the breast Uterine smooth muscle

Question 69

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

Answer 69

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

Question 70

Oxytocin ______ labor

Answer 70

Does NOT induce

Question 71

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

Answer 71

There is an increase in uterine oxytocin receptor content

Question 72

Oxytocin is used clinically to ? X3

Answer 72

Induce labor Enhance contractions Decease postpartum bleeding