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Repro Pt.2 > Normal Pregnancy > Flashcards

Normal Pregnancy Flashcards

1
Q

The first trimester is from _ to _

A

The first trimester is from LMP to week 12

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2
Q

2nd trimester is week _ to _

A

2nd trimester is weeks 13-27

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3
Q

3rd trimester is weeks _

A

3rd trimester is weeks 28-40

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4
Q

Early term, full term, late term, postterm

A

Early term: 37-38
Full term: 39-40
Late term: 41-42
Postterm: 42 +

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5
Q

The embryonic period is from weeks _ to _

A

The embryonic period is from weeks 3-8

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6
Q

The fetal period is from weeks _ until _

A

The fetal period is from week 9- delivery

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7
Q

Placenta forms at week _ and takes over _ production

A

Placenta forms at week 10 and takes over progesterone production

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8
Q

The embryo is most susceptible to toxic exposures during _

A

The embryo is most susceptible to toxic exposures during first trimester

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9
Q

Initial prenatal care visit (in 1st trimester) includes:

A

Initial prenatal care visit (in 1st trimester) includes:
* Review of meds (start folic acid/ prenatal vitamins)
* Blood type and infectious disease screening
* Genetic screening

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10
Q

Spontaneous abortion most commonly occurs during weeks _

A

Spontaneous abortion most commonly occurs during weeks 6-8
* Most of the time will be due to genetic errors

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11
Q

The leading cause of maternal mortality in the 1st trimester is _

A

The leading cause of maternal mortality in the 1st trimester is ectopic pregnancy

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12
Q

Methotrexate MOA

A

Methotrexate: inhibits dihydrofolate reductase –> inhibits purine synthesis –> inhibits DNA/RNA synthesis

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13
Q

The fetus reaches viability around weeks _

A

The fetus reaches viability around weeks 22-24 (second trimester)

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14
Q

What are the highlights of the second trimester?

A
  • Fetus reaches viability
  • Uterus expands into abdomen
  • Fetal movements quicken ~20 weeks
  • Anatomy scan
  • Gestational diabetes screening
  • RhD-negative eval
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15
Q

Lung maturity of the fetus is reached at week _

A

Lung maturity of the fetus is reached at week 36
* Surfactant reduces the surface tension of alveoli

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16
Q

What are the highlights of the 3rd trimester?

A
  • Lungs mature
  • Group B strep screening
  • Monitor for intrauterine growth restriction
  • Monitor blood pressure
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17
Q

Pregnancy is associated with a _ in peripheral vascular resistance

A

Pregnancy is associated with a decrease in peripheral vascular resistance
* This is due to increase in progesterone, estradiol, relaxin

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18
Q

Pregnancy is associated with a _ in plasma volume

A

Pregnancy is associated with a increase in plasma volume
* Kidney is retaining water/solutes
* We see 10-20% increase in plasma volume + RBCs

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19
Q

Anemia of pregnancy can be explained by _

A

Anemia of pregnancy can be explained by serum > RBC mass
* Hematocrit 15-20% below non-pregnant individual

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20
Q

Pregnancy is associated with _ in cardiac output

A

Pregnancy is associated with increase in cardiac output
* Cardiac output will peak in 3rd trimester
* Heart increases in size 112%

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21
Q

What causes cardiac output to increase during pregnancy?

A

Increase in stroke volume + heart rate

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22
Q

Stroke volume _ in pregnancy

A

Stroke volume increases in pregnacy
* Increase of blood volume
* Decrease of PVR

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23
Q

What happens to MAP during pregnancy?

A

MAP decreases through 30 weeks of pregnancy and then increases prior to/ during labor

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24
Q

Pregnancy is associated with _ in respiratory rate

A

Pregnancy is associated with no change in respiratory rate

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25
Q

Minute volume can _ during pregnancy

A

Minute volume can increase during pregnancy
* Increased tidal volume
* Slightly increased chest diameter

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26
Q

Pregnancy is associated with respiratory (alkalosis/acidosis)

A

Pregnancy is associated with respiratory alkalosis
* Increased ventilation –> decreased CO2 in blood
* Compensatory increase of renal bicarb excretion

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27
Q

We might expect a slightly (acidic/basic) pH in a pregnant woman

A

We might expect a slightly basic pH in a pregnant woman

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28
Q

GI effects of pregnancy:

A

GI effects of pregnancy:
* Acid reflux/GERD
* Constipation
* Nausea/vomiting

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29
Q

Pregnancy can cause constipation due to _

A

Pregnancy can cause constipation due to slowed GI motility and compression of rectum by uterus

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30
Q

Pregnancy is assocaited with _ GFR

A

Pregnancy is assocaited with increased GFR
* Due to increased blood volume

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31
Q

Urinary tract changes expected in pregnancy include:

A

Urinary tract changes expected in pregnancy include:
* Ureteral dilation/ hydroureter
* Dilation of pelves and calyces
* Increased kidney size

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32
Q

(Maternal/ Fetal) side of the placenta

A

Fetal side

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33
Q

(Maternal/ Fetal) side of the placenta

A

Maternal side

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34
Q

Label the parts of the diagram

A
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35
Q

What is the role of the placenta?

A
  • Support fetus during pregnancy
  • Transfer oxygen and nutrients
  • Release CO2 and fetal waste
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36
Q

The _ is the endometrium of the pregnant uterus

A

The decidua is the endometrium of the pregnant uterus

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37
Q

The _ is the innermost lining of the membranous sac of enclosing the embryo

A

The amnion is the innermost lining of the membranous sac of enclosing the embryo

38
Q

The _ is the outermost lining of the membranous sac enclosing the embryo

A

The chorion is the outermost lining of the membranous sac enclosing the embryo

39
Q

The _ is the placental structure where the nutrient and gas exchange occurs; the core composed of loose mesenchymal and fetal blood vessels and the villus is surfaced by trophoblasts

A

The chorionic villus is the placental structure where the nutrient and gas exchange occurs; the core composed of loose mesenchymal and fetal blood vessels and the villus is surfaced by trophoblasts

40
Q

_ is the outer cell layer of the blastocyst which has an inner cytotrophoblast layer and an outer syncytiotrophoblast layer

A

Trophoblast is the outer cell layer of the blastocyst which has an inner cytotrophoblast layer and an outer syncytiotrophoblast layer

41
Q

Cytotrophoblast is the inner layer which produces _

A

Cytotrophoblast is the inner layer which produces enzymes for syncytiotrophoblast function

42
Q

Syncytiotrophoblast is the outer layer of the placenta which does ??

A

Syncytiotrophoblast is the outer layer of the placenta which envades endometrium/ vasculature and synthesizes hormones

43
Q

During the first 10 weeks of pregnancy, the corpus luteum is making _

A

During the first 10 weeks of pregnancy, the corpus luteum is making progesterone, estrogen, relaxin

44
Q

After 10 weeks, the _ makes progesterone and estrogen and _ makes relaxin

A

After 10 weeks, the syncytiotrophoblast makes progesterone and estrogen and cytotrophoblast makes relaxin

45
Q

The purpose of the human chorionic gonadotropin (hCG) is to _

A

The purpose of the human chorionic gonadotropin (hCG) is to build and maintain placenta
* Secreted early in pregnancy

46
Q

The purpose of the human placental lactogen is _

A

The purpose of the human placental lactogen is to ensure fetal nutrition
* It does alter the metabolism of the pregnant person (increasing glucose levels, increasing lipolysis, decreasing glucose utilization)

47
Q

At term, _ from hypothalamus induces uterine contractions

A

At term, corticotropin-releasing hormone from hypothalamus induces uterine contractions
* Also stimulates prostaglandin production, raises DHEA

48
Q

_ surface proteins are expressed by the trophoblast cells and allow maternal immune cells to be more tolerant to fetal cells

A

HLA-G surface proteins are expressed by the trophoblast cells and allow maternal immune cells to be more tolerant to fetal cells

49
Q

HLA-G cell surface proteins on trophoblast cells interact with _

A

HLA-G cell surface proteins on trophoblast cells interact with maternal NK cells and CD8+ cells to make cells more tolerant to fetal cells

50
Q

_ causes apoptosis of maternal T lymphocytes

A

Fas ligand causes apoptosis of maternal T lymphocytes
* Ligand interacts with receptor and causes apoptosis to occur
* Expressed by trophoblast cells

51
Q

_ diminishes maternal T cell supply of tryptophan to prevent cells from attacking the fetus

A

Placental indoleamine-2,3-Dioxygenase (IDO) diminishes maternal T cell supply of tryptophan to prevent cells from attacking the fetus

52
Q

During the last trimester, maternal _ antibodies pass through the placenta to provide immunity to fetus

A

During the last trimester, maternal IgG antibodies pass through the placenta to provide immunity to fetus
* IgG get taken up by endocytosis and then bind intracellular Fc receptors

53
Q

Explain the GxPxxx system

A

Gravida: number of pregnancies total
Para:
a: number of full term deliveries
b: number of preterm deliveries
c: number of miscarraiges/abortions
d: number of living children

54
Q

Gravid means _

A

Gravid means pregnant

55
Q

Nulligravid means _

A

Nulligravid means never been pregnant

56
Q

Primigravid means _

A

Primigravid means first pregnancy

57
Q

Multigravid means _

A

Multigravid means multiple pregnancies

58
Q

Parturient means _

A

Parturient means patient in labor

59
Q

(4) Stages of labor

A
  1. Early labor and dilation
  2. Expulsion
  3. Placental
  4. Recovery
60
Q

Effacement of the cervix means _

A

Effacement of the cervix means thinning of the cervix
* Cervix must dilate and get very thin
* We do vaginal exams to check for dilation and effacement (can introduce bacteria so limited)

61
Q

_ is the hormone responsible for contraction of the myometrium

A

Oxytocin is the hormone responsible for contraction of the myometrium

62
Q

(3) ways we might assess for membrane rupture:

A

(3) ways we might assess for membrane rupture:
1. Speculum exam (pooling)
2. Fluid pH (litmus paper turns blue from amniotic fluid)
3. Ferning (under the microscope)

63
Q

Normal fetal heart rate during labor is between _ beats/min

A

Normal fetal heart rate during labor is between 110-160 beats/min

64
Q

A fetal acceleration is _

A

A fetal acceleration is heart rate > 15 above baseline for > 15 seconds

65
Q

We want to see _ accelerations during labor

A

We want to see 2x accelerations within 20 minutes during labor

66
Q

Define these positions of the fetus:
Cephalic:
Breech:
Transverse:

A

Define these positions of the fetus:
Cephalic: head down
Breech: butt/legs
Transverse: oblique/sideways

67
Q

What are the normal positions of the fetus during expulsion?

A
68
Q

Name some indications for a C-section:

A

Name some indications for a C-section:
* Abnormal presentation
* Failure to progress in labor
* Fetal distress
* Maternal distress
* Uterine rupture
* Umbilical cord prolapse
* Previous C-section

69
Q

The egg gets fertilized in the _

A

The egg gets fertilized in the ampulla

70
Q

The _ reaction prevents polyspermy

A

The cortical reaction prevents polyspermy

71
Q

Normal pregnancy:
Cardiac output:
Afterload:
Preload:
Stroke volume:
Heart rate

A

Normal pregnancy:
Cardiac output: increased
Afterload: decreased
Preload: increased
Stroke volume: increased
Heart rate increased

72
Q

Normal pregnancy:
Tidal volume:
TLC:
RR:

A

Normal pregnancy:
Tidal volume: increased
TLC: decreased
RR: no change

73
Q

Normal pregnancy:
Plasma volume:
Clotting factors:
Folate:
Iron demand:

A

Normal pregnancy:
Plasma volume: increased
Clotting factors: increased
Folate: increased
Iron demand: increased

74
Q

Normal pregnancy:
Renal plasma flow:
GFR:
Creatinine:

A

Normal pregnancy:
Renal plasma flow: increased
GFR: increased
Creatinine: decreased

75
Q

Normal pregnancy:
LES tone:
GI motility:

A

Normal pregnancy:
LES tone: decreased
GI motility: decreased

76
Q

Lactation is suppressed during pregnancy by _

A

Lactation is suppressed during pregnancy by progesterone

77
Q

Once the placenta is delivered, _ levels drop which allows prolactin levels to increase to prepare for lactation

A

Once the placenta is delivered, progesterone levels drop which allows prolactin levels to increase to prepare for lactation

78
Q

Prolactin is inhibited by progesterone and _

A

Prolactin is inhibited by progesterone and dopamine

79
Q

Suckling at the breast stimulates _ region in the hypothalamus

A

Suckling at the breast stimulates arcuate nucleus region in the hypothalamus –> inhibits dopamine

80
Q

Suckling at the breast increases _ release

A

Suckling at the breast increases oxytocin release

81
Q

Oxytocin is released (in response to suckling) from the _ and _ nuclei

A

Oxytocin is released (in response to suckling) from the supraoptic and paraventricular nuclei

82
Q

Mom will have:
_ renin
_ EPO
levels in pregnancy

A

Mom will have:
high renin
high EPO
levels in pregnancy

Blood gets diverted to placenta which triggers increase in renin –> increase salt/water retention; EPO stimulates RBC mass, though we still see dilutional anemia

83
Q

Peripheral vascular resistance decreases during pregnancy because the placenta is a low resistance system in (series/parallel)

A

Peripheral vascular resistance decreases during pregnancy because the placenta is a low resistance system in parallel

84
Q

The basal plate of the placenta is the _

A

The basal plate of the placenta is the maternal side; placenta contacts the uterine wall and includes decidua basalis

85
Q

The chorionic plate of the placenta is the _

A

The chorionic plate of the placenta is the fetal side; chorion + chorionic vili

86
Q

The _ site is a mix of maternal and fetal components

A

The intervillous space site is a mix of maternal and fetal components

87
Q

Transport across the placenta involves which processes?
O2, CO2:
Glucose:
Amino acids:

A

Transport across the placenta involves which processes?
O2, CO2: diffusion
Glucose: facilitated transport
Amino acids: active transport

88
Q

Fertilization occurs within _ day(s) of ovulation; implantation occurs within _ day(s)

A

Fertilization occurs within 1 day of ovulation; implantation occurs within 6 days

89
Q

One mechanism of preventing mom’s immune system from attacking fetus is that the trophoblast cells do not express _

A

One mechanism of preventing mom’s immune system from attacking fetus is that the trophoblast cells do not express many MHC class I antigens
* Placenta secretions also block immune response

90
Q

Human placental lactogen has the following effects:
_ blood glucose levels
_ lipolysis
_ breakdown of proteins

A

Human placental lactogen has the following effects:
Increases blood glucose levels
Increases lipolysis
Increases breakdown of proteins

Repro Pt.2 (6 decks)

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