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Repro > Phys of Pregnancy > Flashcards

Phys of Pregnancy Flashcards

1
Q

What triggers CV adaptation in pregnancy?

A
  1. Changes in the blood volume

2. Decrease in systemic vascular resistance

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2
Q

What CV change occurs with trophoblast invasion?

A

Decrease in systemic vascular resistance

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3
Q

How does BP change during pregnancy?

A

decreases

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4
Q

How does HR change during pregnancy?

A

increases

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5
Q

How do SV and CO change in pregnancy?

A

increase (due to increased blood vol)

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6
Q

How do trophoblasts remodel spiral arteries?

A
  1. endothelial cells and vasc sm muscle cells undergo apoptosis; replaced by endovasc trophoblast cells (in endo- and myometerium)
  2. matrix remodeled by MMP’s
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7
Q

What eventually lines the spiral arteries?

A

EV trophoblasts

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8
Q

What is decidualization?

A

endometrial stromal cells have been transformed into large, pale cells

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9
Q

What infiltrates between decidual cells?

A

invasive trophoblasts

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10
Q

Remodeling of spiral arteries starts at __ weeks and completes at __ weeks

A

4

20

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11
Q

Promotes systemic vascular remodeling, and completes by ~24-28 weeks

A

Progesterone, estrogen

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12
Q

reduced TVR is due to:

A

reduced vasomotor tone and remodelling of resistance‐sized arteries

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13
Q

Balance of angiogenic and anti-angiogenic factors are needed to maintain:

A

proper/lower peripheral vascular tone + resistance (therefore blood flow)

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14
Q

Angiogenic factor which is high in normal pregnancy

A

PIGF

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15
Q

Angiogenic factor which is low in normal pregnancy

A

VEGF

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16
Q

Anti-angiogenic factor which is low in normal pregnancy

A

endoglin

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17
Q

In the 1st trimester, vasodilation (decreased afterload) and relative arterial underfilling activates:

A

further increase CO due to volume retention

inc Na appetite and thirst + renal retention of H2O = increased preload

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18
Q

What causes physiologic anemia of pregnancy, and how do you fix it?

A

Increase in plasma volume is more rapid than increase in RBC vol

iron supplements (bit it will eventually catch up)

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19
Q

What is the consequence of decreased PV in pregnancy?

A

dec fetal growth

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20
Q

Ventricular remodeling during pregnancy results in:

A

increased preload

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21
Q

How is the L ventricle affected by pregnancy?

A

hypertrophy

similar to changes in athletes after exercise

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22
Q

How does pathological ventricular remodeling compare with remodeling in pregnancy?

A

Path: Inc fibroid tissue after MI

Phys: 
   Inc myocyte vol w/o changes in fibrosis    
   Increased elasticity (for inc BV)
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23
Q

What cells are consistent with pathological ventricular remodeling but NOT with remodeling in pregnancy?

A

fibroblasts

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24
Q

Secreted by myocytes in response to atrial wall stretching?

A

ANP and BNP

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25
What is the physiologic response to atrial wall stretching?
dec TPR (via increased cGMP)
26
What is the result of decreased miR-29 in pregnancy?
inc elastogenesis in heart
27
miR-208 functions in:
inhibition of MED13 translation
28
Dec MED13 results in:
decreased metabolism + increased fat stores | = obesity/metabolic syndrome
29
How does pregnancy affect GFR? Why?
increases by ~50% elevations in cardiac output and kidney blood flow
30
How does pregnancy affect creatinine?
decreases by ~0.4
31
What may indicate underlying kidney disease during pregnancy?
creatinine that would be nml for a non-preg person
32
What causes hydronephrosis during pregnancy?
dilatation of the urinary collecting system due to: ureteral compr 2' to enlarging fetus ureteral sm muscle relaxatn (progesterone)
33
Hydronephrosis during pregnancy is more prominent on the (R/L)
R
34
How does pregnancy affect the diaphragm?
elevated as uterus enlarges
35
How does pregnancy affect rib cage?
displaced upward and widens | increases the lower thoracic diameter by 2cm and the thoracic circumference by up to 6cm
36
How does pregnancy affect Chest circumference?
expands 5-7 cm
37
How does pregnancy affect the subcostal angle?
increases (from 68 to 103 degrees)
38
How does pregnancy affect respiratory muscle function?
it doesn't
39
How does pregnancy affect abdominal muscles during respiration?
less tone and less active = respiration more diaphragmatic
40
How does pregnancy affect respiratory dead volume?
increase due relaxation of the musculature of conducting airways
41
How does pregnancy affect respiratory tidal volume?
increases gradually (35-50%) as pregnancy progresses to meet fetal demand for O2
42
How does pregnancy affect TLC?
reduced (4-5%) by the elevation of the diaphragm
43
How does pregnancy affect functional residual capacity + residual volume?
decrease by about 20%
44
What causes 65% increase in alveolar ventilation during pregnancy?
Larger tidal volume and smaller residual volume
45
How does pregnancy affect Inspiratory capacity?
increases 5-10%
46
What protective measure prevents fetus from exposure to excessive levels of CO2? How does it do it?
Maternal hyperventilation deceased PCO2 = Increased CO2 gradient between fetus and mother
47
How does pregnancy affect maternal blood CO2 tension?
decreases, but alveolar O tension unchanged
48
What causes more efficient gas exchange in pregnancy?
decrease in FRC without a change in dead space, thus there is little residual dilution
49
Pregnancy is a state of chronic respiratory ____ with compensatory metabolic ____.
alkalosis | acidosis
50
How do levels change as pregnancy progresses? 1. estrogen/progesterone 2. PRL 3. GH 4. cortisol
1. increases 2. increases 3. decreases because fetal GH has taken over 4. increases
51
How do levels of TNF-alpha and adiponectin change as pregnancy progresses?
around week 25 TNF-alpha increases and adiponection declines
52
What hormonal changes allow maternal fat deposition in 3rd trimester?
insulin and leptin resistance
53
Body fat at birth provides:
energy for brain in between feeds
54
What does placental CRH stimulate?
maternal pituitary and adrenal, leading to increased cortisol production
55
What affect does cortisol overexpsoure have on the developingn fetus?
low birthweight altered HPA axis Long term CNS effects
56
Cortisol is partially metabolized by _____ to cortisone
the placenta
57
Primary barrier for transfer of nutrients from mother to fetus:
syncytiotrophoblast
58
Placental nutrient transport: | Maternal blood pools in the _______ and bathes the ________.
intervillous space | microvillous membrane
59
What portion of the syncytiotrophoblast is oriented toward the fetal circulation?
basal plasma membrane
60
What do transporters expressed in both plasma membranes of the syncytiotrophoblast transfer?
amino acids, glucose (GLUTs), and fatty acids (FATPs)
61
How do FA transfer from mother to fetus?
- -extracellular lipases release FA from maternal lipoproteins - -intracellular binding proteins guide FA within cytosol of syncytiotrophoblast

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