Normal Pregnancy Flashcards
1
Q
The first trimester is from _ to _
A
The first trimester is from LMP to week 12
2
Q
2nd trimester is week _ to _
A
2nd trimester is weeks 13-27
3
Q
3rd trimester is weeks _
A
3rd trimester is weeks 28-40
4
Q
Early term, full term, late term, postterm
A
Early term: 37-38
Full term: 39-40
Late term: 41-42
Postterm: 42 +
5
Q
The embryonic period is from weeks _ to _
A
The embryonic period is from weeks 3-8
6
Q
The fetal period is from weeks _ until _
A
The fetal period is from week 9- delivery
7
Q
Placenta forms at week _ and takes over _ production
A
Placenta forms at week 10 and takes over progesterone production
8
Q
The embryo is most susceptible to toxic exposures during _
A
The embryo is most susceptible to toxic exposures during first trimester
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
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
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
12
Q
Methotrexate MOA
A
Methotrexate: inhibits dihydrofolate reductase –> inhibits purine synthesis –> inhibits DNA/RNA synthesis
13
Q
The fetus reaches viability around weeks _
A
The fetus reaches viability around weeks 22-24 (second trimester)
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
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
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
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
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
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
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%
21
Q
What causes cardiac output to increase during pregnancy?
A
Increase in stroke volume + heart rate
22
Q
Stroke volume _ in pregnancy
A
Stroke volume increases in pregnacy
* Increase of blood volume
* Decrease of PVR
23
Q
What happens to MAP during pregnancy?
A
MAP decreases through 30 weeks of pregnancy and then increases prior to/ during labor
24
Q
Pregnancy is associated with _ in respiratory rate
A
Pregnancy is associated with no change in respiratory rate
25
Minute volume can _ during pregnancy
Minute volume can **increase** during pregnancy
* Increased tidal volume
* Slightly increased chest diameter
26
Pregnancy is associated with respiratory (alkalosis/acidosis)
Pregnancy is associated with **respiratory alkalosis**
* Increased ventilation --> decreased CO2 in blood
* Compensatory increase of renal bicarb excretion
27
We might expect a slightly (acidic/basic) pH in a pregnant woman
We might expect a slightly **basic** pH in a pregnant woman
28
GI effects of pregnancy:
GI effects of pregnancy:
* **Acid reflux/GERD**
* **Constipation**
* **Nausea/vomiting**
29
Pregnancy can cause constipation due to _
Pregnancy can cause constipation due to **slowed GI motility and compression of rectum by uterus**
30
Pregnancy is assocaited with _ GFR
Pregnancy is assocaited with ***increased*** GFR
* Due to increased blood volume
31
Urinary tract changes expected in pregnancy include:
Urinary tract changes expected in pregnancy include:
* **Ureteral dilation/ hydroureter**
* **Dilation of pelves and calyces**
* **Increased kidney size**
32
(Maternal/ Fetal) side of the placenta
Fetal side
33
(Maternal/ Fetal) side of the placenta
Maternal side
34
Label the parts of the diagram
35
What is the role of the placenta?
* Support fetus during pregnancy
* Transfer oxygen and nutrients
* Release CO2 and fetal waste
36
The _ is the endometrium of the pregnant uterus
The **decidua** is the endometrium of the pregnant uterus
37
The _ is the innermost lining of the membranous sac of enclosing the embryo
The **amnion** is the innermost lining of the membranous sac of enclosing the embryo
38
The _ is the outermost lining of the membranous sac enclosing the embryo
The **chorion** is the outermost lining of the membranous sac enclosing the embryo
39
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
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
_ is the outer cell layer of the blastocyst which has an inner cytotrophoblast layer and an outer syncytiotrophoblast layer
**Trophoblast** is the outer cell layer of the blastocyst which has an inner cytotrophoblast layer and an outer syncytiotrophoblast layer
41
Cytotrophoblast is the inner layer which produces _
Cytotrophoblast is the inner layer which produces **enzymes for syncytiotrophoblast function**
42
Syncytiotrophoblast is the outer layer of the placenta which does ??
Syncytiotrophoblast is the outer layer of the placenta which **envades endometrium/ vasculature and synthesizes hormones**
43
During the first 10 weeks of pregnancy, the corpus luteum is making _
During the first 10 weeks of pregnancy, the corpus luteum is making **progesterone, estrogen, relaxin**
44
After 10 weeks, the _ makes progesterone and estrogen and _ makes relaxin
After 10 weeks, the **syncytiotrophoblast** makes progesterone and estrogen and **cytotrophoblast** makes relaxin
45
The purpose of the human chorionic gonadotropin (hCG) is to _
The purpose of the human chorionic gonadotropin (hCG) is to **build and maintain placenta**
* Secreted early in pregnancy
46
The purpose of the human placental lactogen is _
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
At term, _ from hypothalamus induces uterine contractions
At term, **corticotropin-releasing hormone** from hypothalamus induces uterine contractions
* Also stimulates prostaglandin production, raises DHEA
48
_ surface proteins are expressed by the trophoblast cells and allow maternal immune cells to be more tolerant to fetal cells
**HLA-G** surface proteins are expressed by the trophoblast cells and allow maternal immune cells to be more tolerant to fetal cells
49
HLA-G cell surface proteins on trophoblast cells interact with _
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
_ causes apoptosis of maternal T lymphocytes
**Fas ligand** causes apoptosis of maternal T lymphocytes
* Ligand interacts with receptor and causes apoptosis to occur
* Expressed by trophoblast cells
51
_ diminishes maternal T cell supply of tryptophan to prevent cells from attacking the fetus
**Placental indoleamine-2,3-Dioxygenase (IDO)** diminishes maternal T cell supply of tryptophan to prevent cells from attacking the fetus
52
During the last trimester, maternal _ antibodies pass through the placenta to provide immunity to fetus
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
Explain the GxPxxx system
**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
Gravid means _
Gravid means **pregnant**
55
Nulligravid means _
Nulligravid means **never been pregnant**
56
Primigravid means _
Primigravid means **first pregnancy**
57
Multigravid means _
Multigravid means **multiple pregnancies**
58
Parturient means _
Parturient means **patient in labor**
59
(4) Stages of labor
1. Early labor and dilation
2. Expulsion
3. Placental
4. Recovery
60
Effacement of the cervix means _
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
_ is the hormone responsible for contraction of the myometrium
**Oxytocin** is the hormone responsible for contraction of the myometrium
62
(3) ways we might assess for membrane rupture:
(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
Normal fetal heart rate during labor is between _ beats/min
Normal fetal heart rate during labor is between **110-160 beats/min**
64
A fetal acceleration is _
A fetal acceleration is **heart rate > 15 above baseline for > 15 seconds**
65
We want to see _ accelerations during labor
We want to see **2x accelerations within 20 minutes** during labor
66
Define these positions of the fetus:
Cephalic:
Breech:
Transverse:
Define these positions of the fetus:
**Cephalic**: head down
**Breech**: butt/legs
**Transverse**: oblique/sideways
67
What are the normal positions of the fetus during expulsion?
68
Name some indications for a C-section:
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
The egg gets fertilized in the _
The egg gets fertilized in the **ampulla**
70
The _ reaction prevents polyspermy
The **cortical reaction** prevents polyspermy
71
Normal pregnancy:
Cardiac output:
Afterload:
Preload:
Stroke volume:
Heart rate
Normal pregnancy:
Cardiac output: **increased**
Afterload: **decreased**
Preload: **increased**
Stroke volume: **increased**
Heart rate **increased**
72
Normal pregnancy:
Tidal volume:
TLC:
RR:
Normal pregnancy:
Tidal volume: **increased**
TLC: **decreased**
RR: **no change**
73
Normal pregnancy:
Plasma volume:
Clotting factors:
Folate:
Iron demand:
Normal pregnancy:
Plasma volume: **increased**
Clotting factors: **increased**
Folate: **increased**
Iron demand: **increased**
74
Normal pregnancy:
Renal plasma flow:
GFR:
Creatinine:
Normal pregnancy:
Renal plasma flow: **increased**
GFR: **increased**
Creatinine: **decreased**
75
Normal pregnancy:
LES tone:
GI motility:
Normal pregnancy:
LES tone: **decreased**
GI motility: **decreased**
76
Lactation is suppressed during pregnancy by _
Lactation is suppressed during pregnancy by **progesterone**
77
Once the placenta is delivered, _ levels drop which allows prolactin levels to increase to prepare for lactation
Once the placenta is delivered, **progesterone** levels drop which allows prolactin levels to increase to prepare for lactation
78
Prolactin is inhibited by progesterone and _
Prolactin is inhibited by **progesterone** and **dopamine**
79
Suckling at the breast stimulates _ region in the hypothalamus
Suckling at the breast stimulates **arcuate nucleus** region in the hypothalamus --> inhibits dopamine
80
Suckling at the breast increases _ release
Suckling at the breast increases **oxytocin** release
81
Oxytocin is released (in response to suckling) from the _ and _ nuclei
Oxytocin is released (in response to suckling) from the **supraoptic** and **paraventricular nuclei**
82
Mom will have:
_ renin
_ EPO
levels in pregnancy
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
Peripheral vascular resistance decreases during pregnancy because the placenta is a low resistance system in (series/parallel)
Peripheral vascular resistance decreases during pregnancy because the placenta is a low resistance system in **parallel**
84
The basal plate of the placenta is the _
The basal plate of the placenta is the **maternal side; placenta contacts the uterine wall and includes decidua basalis**
85
The chorionic plate of the placenta is the _
The chorionic plate of the placenta is the **fetal side; chorion + chorionic vili**
86
The _ site is a mix of maternal and fetal components
The **intervillous space** site is a mix of maternal and fetal components
87
Transport across the placenta involves which processes?
O2, CO2:
Glucose:
Amino acids:
Transport across the placenta involves which processes?
O2, CO2: **diffusion**
Glucose: **facilitated transport**
Amino acids: **active transport**
88
Fertilization occurs within _ day(s) of ovulation; implantation occurs within _ day(s)
Fertilization occurs within **1 day** of ovulation; implantation occurs within **6 days**
89
One mechanism of preventing mom's immune system from attacking fetus is that the trophoblast cells do not express _
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
Human placental lactogen has the following effects:
_ blood glucose levels
_ lipolysis
_ breakdown of proteins
Human placental lactogen has the following effects:
**Increases** blood glucose levels
**Increases** lipolysis
**Increases** breakdown of proteins
