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Obs & Gynae > Obs Physiology > Flashcards

Obs Physiology Flashcards

1
Q

Role of Human Chorionic Gonadotrophin in pregnancy

A

Prevents corpus luteum degradation so that the CL can produce progestins until the placenta is formed.

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2
Q

Role of Progesterone in pregnancy

A

Source = corpus luteum then placenta.
Prepares endometrium and uterus for implantation by:
1) Proliferation, vascularisation and differentiation of endometrial stroma.
2)Promotes endometrial quiescence.
3) Increase maternal ventilation.
4) Promotes glucose deposition in fat stores.

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3
Q

Role of Oestrogen in pregnancy

A

Source = ovary then placenta.
Facilitates progesterone action by increasing progesterone receptors at endometrium.
Indicator of fetal wellbeing during pregnancy.

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4
Q

IgA in pregnancy

A

Secreted in breast milk

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5
Q

IgE in pregnancy

A

Mast cells, used in anaphylaxis

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6
Q

IgG in pregnancy

A

Only antibody able to cross placenta. Role in Rhesus disease with IgM.
Starts to cross at 16 weeks but majority is acquried in last 4 weeks.

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7
Q

Immunology of pregnancy

A

Increase in both T helper 1 and 2 cells but bias towards Th2. Trophoblast has non-immunogenic interface with mother.

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8
Q

Vascular changes at the uterus in pregnancy

A

Extra-Villus Trophoblast invade and remodel maternal spiral arteries. Invading chords form Primary villi which branch to form Secondary villi and then Free-floating villi. Penetrate to inner third of myometrium via decidua.

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9
Q

Maternal adaptations at the cervix

A

Increased vascularity
Reduction in collagen
Increased mucus secretions via gland hypertrophy

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10
Q

Maternal adaptations of the CV system

A

Increase cardiac output
Increase heart rate
Decrease in total peripheral resistance and decrease in blood pressure.
Increase red cell mass
Blood pressure initially falls and then rises in second half of pregnancy.

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11
Q

Maternal adaptations in the resp system

A

Lower maternal PaCO2 to allow better gas exchange with fetus.

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12
Q

Nutrients in pregnancy

A

Glucose main fatal energy substrate.

Hyperlipidaemia state for mother.

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13
Q

Thyroid function in pregnancy

A

Increases

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14
Q

Glomerular filtration rate in pregnancy

A

Increases

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15
Q

What maternal hormones are suppressed by placenta hormones

A

growth hormone, LH and FSH

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16
Q

How does glucose cross the placenta

A

Facilitated diffusion

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17
Q

Examples of molecules which cross placenta via simple diffusion

A

Ketones, urea.

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18
Q

Examples of molecules which cross placenta via active transport

A

Amino acids, water soluble vitamins.

19
Q

Early pregnancy maternal glucose levels

A

Post-prandial levels are low

20
Q

Late pregnancy maternal glucose levels

A

Post-prandial levels are high

21
Q

Stages of labour

A

First stage = onset of labour to fully dilated cervix (10cm). Includes latent and active phase. Latent = irregular contractions, ‘show’, cervix effaces, to 3cm dilated. Active = dilation over 4cm to fully dilated, regular contractions, engagement of fetus’ presenting part.
Second stage = from full dilation to fetus is delivered. Passive stage until head reaches pelvic floor and desire for mum to push commences, active stage with pushing from mum.
Third stage = from fetal delivery to passing of placenta and membranes.

22
Q

Features of labour onset

A

Painful, regular contractions
‘Show’ of mucus plug.
Cervix dilates (3cm) and effacement
Rupture of membranes can occur but is not defining feature.

23
Q

Braxton Hicks contractions

A

Painless, intermittent catering contractions before labour onset.

24
Q

3 factors which determine progress in labour

A

Passage - bony pelvis and resistance by soft tissue
Power - maternal uterine contraction force
Passenger - fetus

25
Q

Cervical effacement

A

Cervical ripening = thinning of cervix and shortening as muscle fibres retract.
Accompanied by dilation.
Caused by raised COX-2 levels.

26
Q

Stages of fetal descend in labour

A 
Engagement
Descent
Flexion
Internal rotation
External rotation
Restitution
Lateral rotation
27
Q

Types of cephalic presentation

A 
Vertex/crown (normal)
Sinciput (forehead first)
Brow
Face
Chin
28
Q

Types of breech presentation

A

Complete
Footling
Frank

29
Q

Types of vertex presentation

A

According to position of occiput. Left, right or transverse? Anterior or posterior?
Best for fitting through pelvis is occiput-anterior and is mostly commonly left.

30
Q

Endocrinology of labour

A
  • Progesterone synthesis decreases due to corticotropin-releasing hormone. Oestrogen levels also drop.
  • Ferguson’s reflex from stretched myometrium triggers oxytocin release from posterior pituitary gland. Causes smooth muscle contractions.
  • Prostaglandins increase in labour to aid contractions via increasing myocyte contractility, ripen cervix and vasodilator small cervical vessels.
31
Q

Trimesters

A 
1 = 0 until 12+6
2 = 13+0 until 28+6
3 = 28+6 until birth/40
32
Q

Hb in pregnancy

A

Physiological anaemia (low Hb), but increase red cell volume

33
Q

4 functions of the placenta

A

Gas exchange
Endocrine (betahCG, progesterone etc)
Nutrient and waste product exchange
Barrier for infection

34
Q

Non-worrying murmur in pregnancy woman

A

Ejection systolic murmur

35
Q

Length of 3rd stage of labour

A

5-30 mins, over 30 mins increases PPH risk.

36
Q

Rate of dilation in active first stage of labour

A

0.5-1.0 cm/hour. Nulliparous = 1.2cm/hr and multiparous 1.5cm/hr. If active first stage is over 2hrs look for cause.

37
Q

Length of second stage of labour

A

Consider interventions if
>2hrs for a nulliparous woman
>1hr for a multiparous woman

38
Q

What can you use to track labour progress

A

Partogram

39
Q

Pattern of rise and fall of human chorionic gonadotrophin hormone

A

Detectable 8days after conception.
Levels double every 48hrs in the first weeks of pregnancy. Reach peak at 10weeks of 80,000mIU/ml and then fall to 10,000mIU/ml for rest of pregnancy.

40
Q

Role of human placental lactogen hormone in pregnancy?

A

Mobilise glucose from fat reserves.
Increase blood glucose levels.
encourage mammary glands to become milk secreting tissues.

41
Q

Surfactant production by fetus

A

24 weeks

42
Q

When does the fetal heart start beating

A

4-5 weeks

43
Q

Discuss fetal haemoglobin and the changes on the oxygen saturation curve

A

HbF has higher affinity to oxygen than HbA (adult). This allows the oxygen in the mothers blood to transfer down to the fetus’ haemoglobin which has a stronger attraction to the oxygen.
HbA starts to be created at about 32-34 weeks.
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Obs & Gynae (17 decks)

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