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REPD 372 > Module 4: The Physiology of Pregnancy > Flashcards

Module 4: The Physiology of Pregnancy Flashcards

1
Q

Gestational age

A

-calculated from the first day of a woman’s last menstrual period
-refers to the age of pregnancy

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2
Q

Fetal age

A

-estimated from date of conception
-must be approximately 2 weeks less than gestational age

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3
Q

How long is average human pregnancy

A

-38-40 weeks

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4
Q

First trimester time period

A

-from week of conception to 13th week of gestation

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5
Q

First trimester development

A

-organ systems
-mothers body increases blood supply to carry more nutrients and oxygen

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6
Q

First trimester symptoms

A

-fatigue
-morning sickness
-headaches
-constipation

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7
Q

Second trimester time period

A

-week 13 to 26 of gestation

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8
Q

Second trimester development

A

-hair nails and reproductive organs develop
-sex of fetus can be determined
-fetus begins to make movements

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9
Q

Second trimester symptoms

A

-body aches
-dizziness
-swelling of hands and feet

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10
Q

Third trimester time period

A

-from week 27 to birth of baby

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11
Q

Third trimester development

A

-fetus gains weight
-organ systems mature

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12
Q

When does birth usually occur

A

-from week 37-42

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13
Q

Possible positions of baby

A

-cephalic
-breech

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14
Q

Cephalic position

A

-head down

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15
Q

Breech position

A

-bottom down

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16
Q

When is the fetus most vulnerable

A

-weeks 3-10

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17
Q

Teratogens

A

-agents that have the ability to cause birth defects such as radiation, alcohol, and certain prescriptions

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18
Q

When are miscarriages most common

A

-first trimester

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19
Q

Preterm delivery

A

-birth before 37 weeks

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20
Q

Preterm delivery complications

A

-maternal complications
-worsening health outcomes for baby

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21
Q

Full term delivery

A

-37-40 weeks

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22
Q

Late term delivery

A

-in week 41

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23
Q

Post term delivery

A

-beyond 42 weeks

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24
Q

Post term delivery complications

A

-significant risk

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25
Q

Postnatal period

A

-6 week period immediately after pregnancy in which mother undergoes significant physical and psychological changes

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26
Q

Naegeles rule

A

-standard way of calculating delivery date for pregnancy

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27
Q

Naegeles rule 3 steps

A

-determine when the first day of your last menstrual period was
-count back 3 calendar months from date
-add 1 year and 7 days to that date

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28
Q

Embryonic stage

A

-comprises the first 8 weeks of development
-called an embryo
-major morphological stages

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29
Q

Fetal stage

A

-begins after week 8
-called a fetus
-growth and development

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30
Q

How many carnagie stages are there

A

-23

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31
Q

Weeks 0-2

A

-called a zygote
-carnegie stages 1-6
-undergoes cleavage and develops germ layers

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32
Q

Weeks 3-4

A

-called an embryo
-carnegie stages 7-13
-germ layers begin to differentiate
-primordial germ cells form wolffian and mullerian ducts
-primitive heart develops

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33
Q

Week 5

A

-called an embryo
-canegie stages 14-15
-chambers of heart become visible
-limb budding
-cerebral hemispheres become visible

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34
Q

Week 6

A

-called an embryo
-carnegie stages 16-17
-heart and lungs descend into thorax
-heart beats at normal rhythm

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35
Q

Weeks 7-8

A

-called a fetus
-carnegie stages 18-23
-fingers become visible
-bone ossification
-testes begin descent

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36
Q

What size is fetus at week 8

A

-kumquat

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37
Q

What size is fetus at 11 weeks

A

-lemon

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38
Q

What size is fetus at 14 weeks

A

-avocado

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39
Q

What size is fetus at 21 weeks

A

-grapefruit

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40
Q

What size is fetus at 29 weeks

A

-coconut

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41
Q

What size is fetus at 38 weeks

A

-watermelon

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42
Q

What does ultrasound tell us

A

-confirm pregnancy and location
-evaluate placenta and fluid levels
-confirm number of babies
-identify birth defects
-determine gestational age
-determine fetal position
-evaluate fetal growth

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43
Q

Types of placental invasiveness

A

-epitheliochorial
-endotheliochorial
-hemochorial

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44
Q

Epitheliochorial

A

-least invasive
-maternal blood is seperate from fetal tissues by endothelium, connective tissue and epithelium

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45
Q

What organisms have epitheliochorial invasiveness

A

-cows
-pigs
-horses

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46
Q

Endotheliochorial

A

-maternal blood is separated by layer of maternal endothelium and some interstitial tissue

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47
Q

What organisms have endotheliochorial invasiveness

A

-dogs
-cats

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48
Q

Hemochorial

A

-human placenta allows fetal membranes to be bathed directly with maternal blood

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49
Q

What organisms have hemochorial invasiveness

A

-humans
-mice
-rabbits

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50
Q

Primary functions of placenta

A

-nutrient and oxygen exchange
-protection
-hormone production
-excretion
-attachment to uterine wall

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51
Q

Layers of trophoblast

A

-synctiotrophoblast
-cytotrophoblast

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52
Q

Syncytiotrophoblast composition

A

-cytotrophoblast cells that fuse together into a multinucleated continuous cell later known as syncytium

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53
Q

What does syncytiotrophoblast layer go on to form

A

-blood-placental barrier

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54
Q

Blood placental barrier function

A

-help regulate nutrient/gas exchange
-production of placental hormones
-regulating immune response

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55
Q

Cytotrophoblast composition

A

-comprise inner layer of trophoblast cells
-produce proteolytic enzymes to facilitate invasion of decidua

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56
Q

Cytotrophoblast cells function

A

-replensih cells of outer syncytium layer

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57
Q

What are chorionic villi

A

-finger-like projections from cytotrophoblast layer

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58
Q

Primary villus

A

-small and avascular
-cytotrophoblast core surrounded by a layer of syncytium

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59
Q

Secondary villus

A

-composed of extraembryonic mesodermal core and are covered by layer of cytotrophoblast cells and outer syncytiotrophoblast layer

60
Q

Tertiary villus

A

-have extraembryonic mesoderm core with villous capillaries and are covered by a cytotrophoblastic and suncytiotrophoblastic layer

61
Q

Anchoring villi

A

-large tertiary villi that connect cytotrophoblastic shell to chorionic plate

62
Q

Floating villi

A

-branches of anchoring villi

63
Q

Intervillous space

A

-space between villi, between chorionic shell and chorionic plate
-this is where maternal circulation will pool and bathe chorionic villi

64
Q

Chorion

A

-shell and chorionic plate together surround embryo to form this

65
Q

Chorion frondosome

A

-highly villous area
-fetal side of placenta

66
Q

Chorion laeve

A

-any villi on opposite side will atrophy

67
Q

Decidua basalis

A

-side of decidua where chorion frondosome attaches and grows

68
Q

Decidua capsularis

A

-other side of decidua surrounding embryo
-does not interact with chorionic cilli and will later become a smooth layer

69
Q

Amnion

A

-innermost fetal membrane
-contains amniotic fluid
-protects embryo from mechanical stress and impact

70
Q

Yolk sac

A

-small sac on ventral surfce of embryo
-source of primordial germ cells and blood cells

71
Q

Allantois

A

-hollow sac on tail end of yolk sac
-contributes to nutrition and excretion
-helps form umbilical cord

72
Q

Chorion

A

-outermost fetal membrane
-forms the fetal side of placenta (chorion frondosome and laeve)

73
Q

Extraembryonic coelom

A

-space between amnion and chorion

74
Q

Spiral artery remodelling

A

-blood vessels that supply uterus are characterized as having spiral shape
-also the same arteries that will supply placenta and growing fetus
-extravillous trophoblasts will migrate towards maternal arteries and cause major modifications of their walls

75
Q

Extravillous trophoblasts

A

-highly invasive type of cytotrophoblast arising from tips of anchoring villi

76
Q

Spiral artery remodelling in early pregnancy

A

-extravillous trophoblasts proliferate from anchoring villi and invade maternal decidua

77
Q

Spiral artery remodelling end of first trimester

A

-extravillous trophoblasts differentiate into 2 types
-interstitial and endovascular

78
Q

Interstitial extravillous trophoblasts

A

-these cells invade deeper into decidua and surround spiral arteries

79
Q

Endovascular extravillous trophoblasts

A

-penetrate the lumen of the uterine spiral arteries

80
Q

Spiral artery remodelling midgestational period

A

-both types of extravillous trophoblasts are involved in degradation of maternal vascular endothelium
-as a result the spiral arteries become wider, allowing higher volume of blood

81
Q

Spiral artery remodelling 3rd trimester

A

-blood supply to uterus and placenta has increased by a factor of 10 as a result of the remodelling

82
Q

Types of placental circulation

A

-uteroplacental circulation
-fetoplacental circulation

83
Q

Uteroplacental circulation

A

-maternal blood flows from uterine space into intervillous space, allowing for exchange of oxygen

84
Q

Fetoplacental circulation

A

-fetus attached to placenta directly via umbilical cord
-this allows transport to and from mothers blood without direct mixing

85
Q

What does the umbilical cord have inside

A

-one umbilical vein
-two umbilical arteries

86
Q

Umbilical vein function

A

-carries oxygenated, nutrient rich blood from placenta to fetus

87
Q

Umbilical arteries function

A

-carries deoxygenated, nutrient-depleted blood from the fetus to the placenta

88
Q

Functions of placenta as an immune barrier

A

-prevent maternal immune rejection
-protect fetus from pathogens

89
Q

Preventing maternal immune rejection

A

-the fetus is genetically different than the mother so the barrier maintains separation between maternal and fetal blood to prevent the mothers immune cells from recognizing fetal tissues as a foreign body

90
Q

How do pregnancy tests work

A

-measure the hCG hormone levels in urine

91
Q

When are pregnancy tests most accurate

A

-when taken after the first missed menstrual cycle

92
Q

Sex hormones during trimester 1

A

-hCG must appear by day 10 in order to stop the corpus luteum from degrading

93
Q

Sex hormones during trimester 2

A

-placenta starts producing enough progesterone and estrogen to sustain remainder of pregnancy
-production of hCG decreases and corpus luteum degrades

94
Q

Sex hormones in trimester 3

A

-levels of progesterone and estrogen increase steadily due to production by placenta
-largely responsible for many physiological changes observed during pregnancy

95
Q

Adrenal cortex changes during pregnancy

A

-adrenocorticotropic hormone (ACTH) is involved in stress response so it regulates functions such as appetite suppression and feelings of anxiety

96
Q

Which hormone is responsible for timing of parturition

A

-ACTH

97
Q

Thyroid gland changes during pregnancy

A

-thyroid hormone increases
-therefore increasing maternal metabolic rate to meet demands of fetus

98
Q

Ovary changes during pregnancy

A

-FSH and LH are inhibited during pregnancy
-ovulation therefore does not happen
-can take 2 months to a year after birth to go back to normal

99
Q

Mammary glands changes during pregnancy

A

-mainly stimulates mammary glands to produce milk
-PRL stimulates breasts to grow

100
Q

Cervix changes during pregnancy

A

-softens
-necessary to permit variety of functions such as dilation during delivery etc

101
Q

What is colostrum

A

-the first milk
-appears in alveoli of acinar glands as early as second trimester

102
Q

Uterus changes during pregnancy

A

-endometrial layer goes through decidualization
-uterus is stretched to accomodate fetus etc

103
Q

Circulatory system changes during pregnancy

A

-cardiac output increases by as much as 50% mid pregnancy
-happens as a result of increased heart rate and stroke volume

104
Q

Respiratory system changes during pregnancy

A

-oxygen consumption increases by 20-60% during labour
-around month 6 the fetus begins to exert increasing pressure on mothers diaphragm decreasing lung capacity and increasing minute ventilation

105
Q

Immune system changes during pregnancy

A

-immune response prevents rejection of paternal antigens but therefore makes women more susceptible to infectious diseases

106
Q

Metabolic system changes during pregnancy

A

-in early pregnancy it is anabolic
-in late pregnancy is is catabolic
-insulin resistance develops in early pregnancy to direct most of glucose to fetus
-in late pregnancy, maternal adipose tissue releases fatty acids for use by liver and muscle

107
Q

Parturition

A

-the process by which childbirth occurs
-labour and delivery

108
Q

Stages of parturition

A

-onset of labour
-active labour
-delivery of placenta
-immediate postpartum

109
Q

Onset of labour

A

-stage preceding labour

110
Q

Phases of onset of labour

A

-latent phase
-active phase

111
Q

Latent phase of onset of labour

A

-mother starts experiencing contractions until dilated to 3 cm

112
Q

Active phase of onset of labour

A

-contractions become more intensive

113
Q

Steps of onset of labour

A
  1. response to fetal head on cervix causes stretching of cervix and uterine walls
  2. in response to stretching, nerve impulses are sent to hypothalamus of brain
  3. hypothalamus signals posterior pituitary to release oxytocin
  4. oxytocin joins circulation and causes smooth muscle contractions of myometrium which increases cervical dilation
114
Q

Onset of labour signs and symptoms

A

-lightening (baby moves down in pelvis and breathing may be easier)
-uterine contractions
-water breaks

115
Q

Active labour

A

-cervix progressively dilates
-ferguson reflex

116
Q

Ferguson reflex

A

-positive feedback cycle
-pressure on cervix releases oxytocin and dilates cervix etc

117
Q

How long may active labour last

A

-8-20 hours

118
Q

Delivery of placenta

A

-shortest stage
-starts immediately after fetal birth
-physician will put pressure on mothers abdomen to help detach placenta from uterus

119
Q

How long may delivery of placenta take

A

–5-30 min

120
Q

Signs of placental separation

A

-firmer uterine fundus
-sudden gush of blood from vagina
-lengthening of umbilical cord
-rise of uterus in abdomen

121
Q

Immediate postpartum

A

-hour or 2 after delivery when tone of uterus is reestablished
-uterine massage often used
-colostrum from mammary glands will provide basic immunity for first few hours

122
Q

What is the puerperium period

A

-postpartum up to 6 weeks after birth

123
Q

Complications of parturition

A

-breech birth

124
Q

Breech birth

A

-happens when baby is delivered bottom first

125
Q

What can practitioner do about breech birth

A

-may change baby into appropriate position before birth
-may perform a c section

126
Q

What will majority of pregnancy complications be attributed to

A

-some kind of disruption to placental function

127
Q

First trimester complications

A

-generally associated with disruptions in process of implantation or early embryo development

128
Q

Miscarriage

A

-loss of embryo before 20th week of gestation
-most often a natural response to presence of abnormality

129
Q

Anembyonic pregnancy

A

-condition where embryo does not develop, leaving only gestational sac

130
Q

Second trimester complications

A

-often result of issues that were initiated in first trimester

131
Q

Who is at higher risk of second trimester complications

A

-women with preexisting conditions such as hypertension or diabetes

132
Q

Preeclampsia

A

-most severe hypertensive disorder of pregnancy
-high blood pressure and excess protein in urine

133
Q

What is the main danger of preeclampsia

A

-can evolve into eclampsia and cause seizures in mother

134
Q

What is preeclampsia associated with

A

-impaired placentation
-uterine artery remodeling is impaired

135
Q

Third trimester complications

A

-any health issues that arose in second trimester can become worsened and lead to ealy delivery

136
Q

Antepartum hemorrhage

A

-bleeding that occurs after the 24th week of gestation but before birth
-medical emergency

137
Q

Placental anatomy abnormalities

A

-abruprtio placenta
-placenta previa

138
Q

Abruptio placenta

A

-premature separation of placenta from uterus

139
Q

Placenta previa

A

-occurs when placenta is partially or totally covering mothers cervix, obstructing birth canal

140
Q

How do fetal complications affect long term health

A

-intrauterine growth restriction
-preterm birth

141
Q

Intrauterine growth restriction

A

-significant reduction in fetal growth
-typically result of placental insufficiency
-has been linked to poorer health outcomes in later adult life

142
Q

Preterm birth

A

-leading cause of neonatal death

143
Q

Effect of preterm birth on development and adult health

A

-preterm infants are exposed to various stressors and environmental conditions
-these stressors can lead to permanent changes in organ system development which may incerase risk of specific disorders

144
Q

Potential explanations for preterm birth worldwide trends

A

-changing pregnancy demographics
-induced preterm births to improve fetal mortality rates
-reporting of medically induced preterm births

145
Q

Maternal and fetal screening benefits

A

-advances in diagnostic and treatment procedures have decreased maternal and neonatal morbidity by increasing early detection of maternal and fetal problems

REPD 372 (6 decks)

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