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ENDO I exam 2 > Montemayor-pregnancy and parturition > Flashcards

Montemayor-pregnancy and parturition Flashcards

1
Q

What day does fertilization usually occur

A

day after ovulation

average day 16

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2
Q

When does implantation occur after ovulation

A

6 or 7 days later

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3
Q

how long is pregnancy from last menstrual cycle

“gestational period”

A

40 weeks

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4
Q

how long is pregnancy from ovulation

“embryonic”

A

38 weeks

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5
Q

What is detected in pregnancy test

A

beta hCG

detected 24 hrs after implantation

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6
Q

What are the 4 types of estrogens

A

estradiol, estrone, estriol

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7
Q

What are the major hormones of pregnancy

A

hCG, progesterone, estrogens, human placental lactogen/human chorionic somatomammotropin

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8
Q

What hormones play a role in the 1st trimester

A

hCG savs corpus luteum to stimulate luteal estrogen and progesterone production
placenta takes over hormone synthesis

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9
Q

What time frame does the placenta take over hormone synthesis from corpus luteum

A

8 weeks “luteal placental shift”

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10
Q

What hormones play a role in the 2nd trimester

A

maternal progesterone and estrogen levels rise

maternal placental fetal unit takes over production

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11
Q

What produces hCG

A

syncytiotrophoblasts

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12
Q

when does hCG peak

A

around 10 weeks to make sure that the luteal placental shift occurs

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13
Q

Structurally hCG is similar to what other hormones? so which R can it bind

A

LH, FSH and TSH

binds LH R with high affinity

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14
Q

what is the primary action of hCG

A

stimulate LH R on corpus luteum
prevents degradation
maintains high luteal-derived progesterone before placenta takes over

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15
Q

what are the other effects of hCG

A

can cross react with TSH R and cause hyperthyroidism
stimulates fetal leydig cells to produce testosterone
stimulates fetal adrenal cortex

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16
Q

When does the P production increase

A

switch from corpus luteum to placenta

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17
Q

What hormone is needed to maintain pregnancy and why

A

P because inhibits myometrial contractions. (sm muscle inhibitor)

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18
Q

Can progesterone be used as indicator of healthy fetus

A

no, independent

just tells how well the placenta is functioning

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19
Q

What other substances are needed to make progesterone

A

CYP11A1 and 3beta hydroxysteroid dehydrogenase to convert cholesterol derivative to progesterone

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20
Q

What are the action sof progesterone in pregnancy

A

dec uterine motility/contractions
increase secretory activity necessary for nourishment, growth, and implantation of embryo
increase fat deposition early in pregnancy(stimulate appetite, diver energy stores from sugar to fat)

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21
Q

Where are estrogens made during pregnancy

A

placenta after luteal switch

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22
Q

Can estrogen during pregnancy be maintained by mother alone

A

no need 19 C androgen DHEA-S from fetus (adrenal gland)

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23
Q

What estrogens is the fetus placental unit responsible for

A

estradiol-17Beta
estrone
estriol(major)

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24
Q

Can estrogen be used as an indicator for fetal health

A

yes, estriol is used as measurement

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25
Q

What are the actions of estrogens in pregnancy

A 
increase uteroplacental blood flow
increase uterine sm mm hypertrophy
increase LDL R expression
increase PG
increase oxytocin R
increase mammary gland growth
increase prolactin

required for parturition

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26
Q

how do E:P levels change throughout pregnancy

A

low E:P to high E:P

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27
Q

What produces human placental lactogen

A

syncytiotrophoblasts in placenta

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28
Q

What is human placental lactogen a direct proportion to

A

placental growth (weight)

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29
Q

What is the main role of hPL

A

increase glucose availability for fetus
inhibits maternal glucose uptake
lypolytic action–> shift maternal energy use to FFA

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30
Q

What are the other roles of hPL and what is it responsible clinically in pregnant mother

A

antagonize insulin action “diabetogenicity of pregnancy”

stimulates mammary gland development

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31
Q

With a functioning placenta, can fetal health decline? nonfucntioning?

A

functioning, fetus can still decline

non-functioning, always detrimental

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32
Q

What do syncytiotrophoblasts produce

A

steroid and protein hormones

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33
Q

What are the functions of placenta

A

maintain pregnant state of uterus
stimulate lobuloalveolar growth and function of breasts
adapt aspects of maternal metabolism and physic to support fetus
regulate aspects of fetal development
regulate timing and progression of parturition

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34
Q

What are the limitations of the placenta

A

cannot make enough cholesterol
lack enzymes for estrone and estradiol production
lacks enzyme for estriol production

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35
Q

What does the mother contribute to placenta for adequate hormone production

A

LDL cholesterol

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36
Q

What does the fetus contribute to placenta for adequate hormone production

A

the enzymes to make estrone, estradiol and estriol

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37
Q

What enzyme does the placenta have for produce estrogens

A

the aromatase to convert DHEA to estradiol

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38
Q

What changes in the pituitary in the mother during pregnancy

A

increase prolactin
increase pituitary size
dec LH and FSH
ADH secretion threshold is augmented

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39
Q

What happens to the lactotrophs during pregnancy? what causes this?

A

increase in size and number

estrogen stimulates PRL synthesis and secretion

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40
Q

If the pituitary becomes too big and causes vascular problems what is that called

A

Sheehan’s syndrome

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41
Q

Why does LH and FSH production decrease during pregnancy

A

neg feedback from estrogens and progesterone

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42
Q

What happens to ADH threshold in pregnancy

A

ADH is released at a lower osmolality (lower threshold)
higher ADH levels than usual
increased sensitivity of osmoR

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43
Q

What are the changes to thyroid in pregnancy

A

increase thyroid size

increase total T4 and total T3

44
Q

What is though to cause increase in thyroid size during pregnancy

A

stimulated by hCG

weakly binds TSH R- transitional gestational hyperthyroidism

45
Q

Why are there increased total T4 and T3 in pregnancy but no changes in the Free T4

A

estrogen promotes increased liver production of thyroxine binding globulin

46
Q

What are the adrenal changes during pregnancy

A

increased cortisol, aldosterone

47
Q

Why is there an increase of cortisol during pregnancy

A

estrogens stimulate, increase liver production of cortisol-binding globulin

48
Q

Why is there and increase in free cortisol

A

late in pregnancy, because inactivated to protect fetus by placental 11betadehydrogenase type 2

49
Q

Why does aldosterone increase during pregnancy

A

estrogens stimulate increase liver production of angiotensinogen and renal renin production
increase ang II and aldosterone

50
Q

How come the increased aldosterone does not result in hypernatremia, hypokalemia or hypertension

A

progesterone blunts aldosterone action

competes for mineralocorticoid R

51
Q

What are the CV changes during pregnancy

A

increase blood volume, dec hematocrit
increase CO thru inc HR and SV
decrease TPR, inc vasodilation and vascularity with a dec in hemtocrit
dec MAP or normal

52
Q

Why does MAP relatively stay fairly normal during pregnancy

A

increase CO

decrease TPR

53
Q

Why is there an increased blood volume in pregnancy

A

facilitates fetal perfusion and exchange of nutrients/wastes

protects mom from blood loss during delivery

54
Q

What causes the increase in plasma V in pregnancy

A

increase NaCL retention from aldosterone

increase H2O retention from low ADH threshold

55
Q

Why does hematocrit dec during pregnancy (physiological anemia)
what is overall result

A

increase RBC production rate does not match the plasma expansion
decrease viscosity so decrease TPR

56
Q

What is the effect of decreased TPR on maternal cardiac work

A

minimizes maternal work as CO increases

57
Q

by how much does CO increase during pregnancy

A

30-50% by inc HR and SV

58
Q

Why does SV decrease in late pregnancy

A

SV periodically dec due to compression of the IVC

decrease VR, decrease EDV and decrease SV

59
Q

Where does the additional CO distribute to

A

uterus 15% of CO

increase renal by 40%

60
Q

What systems of the body do not change during pregnancy

A

brain, gut, skeleton

61
Q

Describe the 2 ways there is an overall decrease in TPR in pregnancy

A

low resistance circuit utero/placental circulation from vasculogenesis and angiogenesis
Vasodilation from E and P

62
Q

How does E and P cause vasodilation

A

antagonists to vasopressive action of ANG II

P acts as smooth m relaxant

63
Q

How come there is an increase in venous P in pregnancy

A

compression of IVC from growing uterus

increased venodilation under hormonal influences

64
Q

What causes the decreased capillary colloid osmotic pressure in pregnancy

A

maternal synthesis of plasma proteins does not keep pace with increase in plasma volume

65
Q

What factors contribute to the increase in alveolar ventilation

A

elevation of diaphragm
increased O2 demand and CO2 production
increased sensitivity to CO2

66
Q

What causes an elevated diaphragm in pregnancy

A

increased intra-abdominal P with fetal growth
Progesterone effect of relaxing m and fascia
decrease residual volume and functional residual capacity

67
Q

Why is there an increased sensitivity to CO2 in pregnancy

A

progesterone effect
dec medullary resp center set-point for respiratory response to central chemo R detection of CO2
increased tidal volume and alveolar ventilation
decrease partial pressure of CO2

68
Q

What are all the respiratory changes in pregnancy

A 
dec functional residual capacity
decrease residual volume
increase tidal volume
increase alveolar ventilation
no change in RR
decrease PCO2
69
Q

Can pregnancy cause respiratory alkalosis or acidosis

A

dec PCO2 so respiratory alkalosis

70
Q

What occurs in response to the respiratory alkalosis in pregnancy

A

renal compensation to increase HCO3 excretion

71
Q

Describe the fetal hemoglobin compared to adult

A

has higher affinity for O2 than mom

lower CO2 affinity

72
Q

What are the renal changes in pregnancy

A

increased blood flow, GFR
increases plasma RAAS from Estrogen
increase Na retention from aldosterone
increase H2O retention from dec ADH threshold
decrease serum Na from dec in ADH threshold

73
Q

What GI changes in pregnancy cause reflux

A

dec in gastric emptying from Progesterone
dec in LES tone from Progesterone
increase intra-abdominal P

74
Q

What Gi changes in pregnancy causes constipation

A

decrease in intestinal motility

75
Q

What are the 3 demanded nutrients in pregnancy

A

protein, iron and folate

76
Q

What is the purpose of increase protein demand in pregnancy

A

supports fetus, placenta, uterus, breasts, blood volume

additional 30 g protein/day

77
Q

What is the purpose of increase iron demand

A

suppor increased maternal Hb, placenta and fetus

60mg/day supp recommended

78
Q

What is the purpose of increase folate demand

A

supports increased RBC production, protects against neural tube defects
400-800 mg/day folic acid supplementation recommended

79
Q

What keeps the uterus from contracting during pregnancy

A

progesterone and relaxin

80
Q

What initiates onset of labor

A

endocrine and paracrine and mechanical factors

81
Q

What keeps labor going

A

positive feedback loops

82
Q

What are the Braxton Hicks Contractions

A

periodic episodes of weak, slow rhythmic contractions
very strong during last hours
become labor contractions

83
Q

What is false labor, and what could cause it

A

contraction begin strong then fade

failure of +feedback loops

84
Q

What is the + feedback loop

A

afferent pain signals from uterine contractions reflexively result in abdominal m contraction

85
Q

How many stages of labor are there

A

4

the first or stage 0 is just quiescent phase

86
Q

Describe stage 1 of labor

A

cervical dilation and effacement
contractions go from 30 min to <10 min apart
lasts average 7-12 hours

87
Q

Describe stage 2 labor

A

Descent and expulsion
active labor, cervix fully dilated to 10 cm
contractions
lasts 20-50 minutes

88
Q

Describe stage 3 labor

A

expulsion of placenta
uterus contracts which limits bleeding because compresses vessels
separation of placenta results in bleeding and clotting
average 15 minutes

89
Q

What endocrine factors are important in parturition

A 
PGs
Estrogens
Oxytocin
Placental Corticotropin releasing hormone
relaxin
90
Q

What are the PGs involved in birth, what do they do

A

PGF2alpha and PGE2
initiate birth because increase before onset of labor
increase uterine smooth m contractility promotes gap junctions
soften, dilate and thin cervix

91
Q

What stimulates synthesis of PGs

A

estrogens, oxytocin

uterine stretch

92
Q

How does estrogen stimulate PG synthesis

A 
Phospholipase A2
PG synthetase (COX)
93
Q

What is used to induce labor in large doses

A

PGs

94
Q

What inhibits labor clinically

A

aspirin, reduces PGF2alpha and PGE2

95
Q

What is the role of estrogen in parturition

A

inc gap juntions
inc oxytocin R expression
inc myometrial sensitivity to oxytocin
inc PH production

96
Q

What is the role of oxytocin in birth

A

maintain labor- distention of cervix
increased 200X R expression during early labor
R activation promotes uterine smooth m contraction
stimulate PGF2alpha synthesis

97
Q

Where is oxytocin released form and what causes it

A

released from posterior pituitary
caused by neurogenic reflex (ferguson), response to stretching of cervix, bursts of oxytocin released during stage 1 and frequency then increases

98
Q

How does oxytocin increase uterine sm m contractions

A

PLC to IP3 to increase intracell Ca that activat calmodulin which inc MLC kinase to Pi regulatory light chain for contraction

99
Q

Why are uterine contractions important after placental delivery

A

to constrict vessels after placental delivery

100
Q

What is the role of corticotropin-releasing hormone CRH

A

sensitizes uterus to PG and oxytocin

stimulate fetal ACTH

101
Q

Why is it important that CRH stimulates fetal ACTH

A

increase fetal adrenal cortisol (+ feedback to CRH)

increase fetoplacental estrogens

102
Q

What is the role of relaxin in parturition

A

soften cervix during labor because does promote myometrial quiescence, but also increases during labor

103
Q

What factors from the fetus are important in birth

A

fetal pituitary oxytocin
fetal PG from placenta
fetal androgens, cortisol

104
Q

What fetal and placental signals prepare for labor

A

CRH from placenta, causing increased fetal ACTH and cortisol and DHEAS and estrogen
CRH promotes contractions by sensitizing uterus to PG and oxytocin

105
Q

What is the role of estrogens in labor

A

stimulate contractions as well

106
Q

What are the mechanical factors to increase uterine contractility

A 
stretch of sm m causes contraction
fetal movement
(twins are born earlier)
contractions increase PG production
ferguson- inc stretch of cervix stimulating more oxytocin

ENDO I exam 2 (11 decks)

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