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HSS4102 > Module 2 > Flashcards

Module 2 Flashcards

1
Q

Can your health before getting pregnant have positive or negative effects on fetal development?

A

YES

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2
Q

What is the periconception period?

A

period preceding, including and immediately following human conception

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3
Q

What is the prenatal period?

A

period between conception and birth

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4
Q

What is the perinatal period?

A

period immediately before and after birth

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5
Q

What is the definition of pregnancy?

A

The state of carrying a developing embryo or fetus within the female body

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6
Q

What is gestation?

A

total duration of pregnancy from fertilization to delivery

from conception = 38 weeks

from first day of last menstrual cycle = 40 weeks

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7
Q

What does the first trimester of pregnancy consists of?

A
  • important developmental milestones (fertilization, pre-embryonic period, embryonic period)
  • development of organs and tissues (organogenesis)

-development and growth of placenta

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8
Q

What is “fertilization” in the first trimester?

A

when sperm and ovum(egg) come to together in the fallopian tube

sperm penetrating the zona pellucida of egg causes the zone to become impermeable to other sperms penetrating it (cortical reaction)

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9
Q

What is the order of fertilization in terms of what body of cells form

A
  1. zygote (2 gametes formed together, 46 chromos)
  2. Morula (solid cluster, has zona pellucida)
  3. blastocyst (dividing cells with central cavity filled with fluid)
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10
Q

When does implantation of blastocyst occur during first trimester?

A

end of week 1

goes into endometrium (uterine lining)

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11
Q

When can pregnancy be clinically detected?

A

following implantation
hCG —> in corpeus luteum

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12
Q

What is Gastrulation in the embryonic period of early development?

A

when embryonic disc differentiates into 3 different germ layers which later on will form specific tissues

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13
Q

what are the 3 germ layers that form during gastrulation?

A
  1. ectoderm (outer)
  2. mesoderm (middle)
  3. endoderm (inner)
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14
Q

Is organogenesis during embryonic period a very critical period of development?

A

YES!

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15
Q

What is organogensis?

A

formation of organs from germ layers following gastrulation

during weeks 4-8

embryo is most sensitive

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16
Q

What does endoderm give rise to>

A

respiratory

thyroid cells

digestive

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17
Q

what does mesoderm give rise to?

A

cardiac msucle
skeletal muscle
tubule cells
RBCs
smooth muscle

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18
Q

what does ectoderm give rise to?

A

skin cells
Nervous system
pigment cells

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19
Q

What is Placentation during the embyronic period of first trimester?

A

formation of the placenta

VITAL ORGAN DURING PREGNANCY

all the maternal-fetal exchange

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20
Q

What happens during 2nd and 3rd trimester of pregnancy?

A

“fetal period”

  • continued growth and differentiation of formed organs

growth in fetal size and length (2nd trimester)

growth in fetal weight (3rd trimester)

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21
Q

What is parturition?

A

process of giving birth to offspring

  • sequential, set of changes within myometrium, decidua and cervix

-occurs gradually over a period of days to weeks

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22
Q

What is labor diagnosed with 2 things?

A
  1. presence of regular clinical contraction increasing in frequency and intensity
  2. progressive cervical effacement and dilation
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23
Q

What are the hormones involved in parturition?

A
  1. progesterone
  2. estrogen
  3. oxytocin
  4. prostaglandins
  5. Corticotropin releasing hormone (CRH)
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24
Q

What are the 5 steps to mechanisms involving parturition?

A
  1. functional progesterone withdrawl
  2. increased estrogen bioavailability
  3. increased response of myometrium to prostoglandins and oxytocin
  4. CRH and HPA axis activation
  5. uterine stretch
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25
Q

What does progesterone do in parturition?

A

-primary hormone

  • sustains uterine quiesence (stillness) throughout pregnancy
  • decreasing this at receptor level leads to initation of uterine contractions
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26
Q

What does estrogen do in parturition?

A

lots of this during pregnancy (hyperestrogenic state)

concentrations increase with gestational age

promotes cervical ripening –> Dilation!!

promotes myometrial changes –> uterine contractility (increases prostogladins, oxytocin, and myometrial gap junctions)

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27
Q

What does oxytocin do in parturition?

A

stimulates uterine contractions

stimulates placenta and decidua to produce prostoglandins

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28
Q

What does progstaglandins do in parturition?

A

stimulate uterine contractions

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29
Q

What does CRH do in parturition?

A

neuropeptide produced by hypothalmus

IMPORTANT TO HPA AXIS!!

stimulates ACTH secretion –> produces adrenal cortisol (GC) –> increases estrogen and prostroglandin

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30
Q

What is uterine stretch cycle ?

A
  1. baby pushes against cervix –> stretch
  2. stretch sends nerve signals to brain
  3. brain stimulates post. pituitary to release oxytocin
  4. oxytocin –> smooth muscle of uterus CONTRACTS

REPEAT! (Continous)

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31
Q

What are the 7 ways we can measure fetal health during pregnancy?

A
  1. maternal weight gain
  2. maternal cardiovascular adaptation
  3. maternal insulin requirement
  4. fetal growth profiles
  5. genetic screening
  6. placental health
  7. uterine, placental, and umbilical blood flow
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32
Q

At time of birth how can they measure neonatal health? (7 ways)

A
  1. gestational age at delivery
  2. mode of delivery
  3. birthweight centile
  4. biometrics
  5. organ function
  6. feeding behaviours
  7. nicu admission
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33
Q

What are the consequences of preterm birth?

A

increased morbidity and adult chronic disease

missed important fetal development milestones in utero and post natal

ex: not many organs fully developed

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34
Q

What is usually the main cause of preterm birth?

A

placental disease/dysfunction

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35
Q

What are the consequences of fetal growth restriction?

A
  • due to IUGR (intrauterine growth hormone) restriction
  • did not reach full growth potential due to compromised intrauterine environment
  • quite small
  • symmetrical –> risk of neurological damage , chromosomal abnormalities (down syndrome)
    -assymetrical –> less fat and smaller abdominal organs —> BRAIN SPARING
36
Q

What is the main cause of fetal growth restriction?

A

compromised intrauterine environment
- abnormal uterine and/or umbilical artery flow

37
Q

What is preclampsia?

A

where mother develops hypertension during pregnancy

can cause fetal and maternal mortality and morbidiity

can lead to eclampsia –> maternal seizures

38
Q

What are the symptoms of preclampsia?

A
  1. new onset of hypertension after 20 weeks gestation
  2. proteinuria (protein in urine)
  3. edema (water retention/swelling)
  4. abnormal liver function (HELLP Syndrome)
39
Q

Is there treatment for preclampisa?

A
  • no
40
Q

What are consequences of preclampsia to fetus?

A

pre-term birth

fetal growth restriciton

both affect developmental programming

can cause CVD and metabolic diseases later in life

41
Q

What is gestational diabetes?

A

when you get diabetes during onset of pregnancy

tends to go away after pregnancy

inability to increase insulin secretion to compensate for pregnancy induced insulin resistance –> hyperglycemia

42
Q

What are the consequences to gestational diabetes

A

short term and long term consequences on fetus (chronic diseases, obesity, T2DM, hyperglycemic, hyperinsulin)

43
Q

What group of hormones is gestational diabetes in relation to

A

placental related hormones

44
Q

What is the placenta?

A

vital organ of pregnancy

formed from both maternal and embryonic tissue

functions as lungs, liver, gut, kidneys, endocrine glands, and defensive barrier

provides oxygen and nutrients to fetus

removes waste products

produces hormones

PROTECTS FETUS

45
Q

What is “decidualization”?

A

trnasformation of secretory endometrium to the decidua (uterine lining in pregnancy)

cells change from mesenchymal to epithelial —> stores glycogen and lipids

46
Q

What are** two structures **that are important in utero-placental circulation?

A
  1. Chorionic villi
  2. spiral arteries
47
Q

What are chorionic villi and what do they do?

A
  • help to maximize surface area contact with the maternal blood for nutrient and gas exchange
  • in placenta
48
Q

What are spiral arteries and what do they do?

A
  • pierce decidual plate and enter intervillious spaces
  • supply nutrients to placenta and fetus
49
Q

why are spiral arteries remodelled by extravillous cytotrophoblast cells?

A
  • replace smooth muscle and endothelium
  • become highly dilated
  • INCREASE flow
  • DECREASE resistance
  • not as spirally as before
50
Q

What is Placenta Previa?

A
  • when the placenta is abnormally placed by either totally covereing or close to internal os
    – sudden, painless vaginal bleeding
  • c section required
51
Q

What are the 3 ways placenta could be placed in placenta previa?

A
  1. low lying
  2. marginal
  3. complete (right over internal os)
52
Q

What are the risk factors to having placenta previa?

A
  • abnormally developed uterus
  • scarring of uterine wall from previous pregnancy
  • large placenta
53
Q

What is Placenta Accreta?

A

abnormal deep attachment of placenta

54
Q

What is placenta increta>

A

placenta penetrates into myometrium

55
Q

What is placenta Percreta?

A

penetrates entire myometrium to uterine serosa

56
Q

What is the risk with Placenta accreta, increta, and percreta?

A

HEMORRHAGING

HYSTERECTOMY

57
Q

What are the 5 different maternal-fetal exchanges?

A
  1. diffusion
  2. facilitated diffusion
  3. osmosis
  4. active transport
  5. vesicular transport
58
Q

What is diffusion?

A
  • non polar molecules and fat soluble molecules
  • flows [high] –> [low]
  • not energy dependent
59
Q

What is facilitated diffusion?

A

facilitated by transport molecules (carrier proteins/transmembrane proteins)

not energy dependent

60
Q

what is osmosis?

A

soluble substances
H2O cannot cross through double lipid layer –> crosses placenta by aquaporines via the osmolar gradient

61
Q

What is active transport?

A

transport AGAINST concentration gradient (low –> high)

energy dependent

amino acids go across placenta this way –> influenced by hormones

62
Q

What is vesicular transport?

A

endocytosis, exocytosis

macromolecules are captured by microvilli and absorbed into cell or excreted from it

ex: immunoglobulins

63
Q

What are the 5 functions of placenta?

A
  1. GI –> continous transporters for nutrients
  2. Endocrine –> different hormones and their roles
  3. Lungs –> oxygen exchange and shunts
  4. Barrier –> steroids, infection, xenobiotics, immunity
  5. kidneys
64
Q

What is the placental function of GI?

A

-placental nutrient supply is major determinant of intrauterine growth

  • nutrient supply via circulatory system and parenteral nutrition, NOT fetal digestive tract
65
Q

What are the 4 essential macronutrients for adequate fetal growth?

A
  1. glucose
  2. amino acids
  3. free fatty acids
  4. cholesterol
66
Q

What does glucose do?

A

primary energy substrate for fetal AND placental growth

uses GLUT1 transporters via facilitated diffusion

67
Q

What do amino acids do?

A

help with development of fetal tissue

68
Q

What do Free fatty acids do?

A

help with brain development and fat accretion (CRITICAL IN FETAL GROWTH)

69
Q

What are the 5 hormones of the endocrine system associated with function of placenta?

A
  1. progesterone (P4)
  2. estrogen
  3. Placental lactogen
  4. placental growth hormone
  5. leptin
70
Q

What is progesterone doing for placenta?

A

to maintain pregnancy

keeps uterine still throughout pregnancy

appetite stimulant

prevents mammary glands from being activated by prolactin before birth

levels fall at one point –> stimulate contractions

71
Q

What does estrogen do in relation to placenta function?

A

for proliferation of endometrial cells

helps with mammary glands for developing and producing milk after birth

causes cervial ripening as concentration increases

cause contractility of uterus

72
Q

What does placental lactogen do in relation to placental function?

A
  • promotes fetal growth
  • role in milk production
  • look at slide 41
73
Q

What does placetal growth hormone do?

A

stimulates glyconeogenesis, lipolyis, and anabolism in maternal organs

PROMOTES FETAL GROWTH

74
Q

What does leptin do?

A

supresses food intake –> triggers us in our brain to believe we are full

when you are pregnant, mom is in leptin resistance

regulates fetal growth

75
Q

How is the placenta equivalent to the lungs?

A

ensures fetal oxygen supply and co2 removal

fetus cant oxygenate its own blood!

deoxygenated blood –> in arteries from fetus to placenta

oxygenated blood –> in veins from placenta to fetus

  • has shunts
76
Q

What are the 3 shunts of the lungs for placental functions?

A
  1. ductus venosus (by pass liver)
  2. formamen ovale (by pass lung)
  3. ductus arteriosus (by pass lung)
77
Q

How does the placenta be a barrier to glucocorticoids?

A

stress hormone

regulates fetal exposure to it across pregnancy

protects from elevated levels of cortisol in maternal circulation

TOO MUCH STRESS COULD BE BAD

78
Q

How is fetus vulnerable to infection via two routes?

A
  1. ascend lower genital tract
  2. from maternal blood to uterus
79
Q

What is an effective barrier of placenta against infection?

A

intact syncutium (outermost layer of trophoblast) for vertical transmission

80
Q

What is a xenobiotic ?

A

chemical substance that is foreign to body \
crosses placenta via faciltated diffusion or active transport

81
Q

How does placenta reduce the transfer of xenobiotics?

A

it just does?

82
Q

is immune system mature at time of birth of fetus?

A

NO

83
Q

how can we counter protect fetus for immunity?

A
  • maternal immune factors being transported via breast milk OR placenta
84
Q

How is placenta like a kidney function?

A

-excretory functions
-removes waste products of fetal metabolism into maternal blood –> excreted by mom

85
Q

Read 3rd lecture from slides

A
86
Q
A

HSS4102 (7 decks)

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