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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
Q

What is the physiologic response to atrial wall stretching?

A

dec TPR (via increased cGMP)

26
Q

What is the result of decreased miR-29 in pregnancy?

A

inc elastogenesis in heart

27
Q

miR-208 functions in:

A

inhibition of MED13 translation

28
Q

Dec MED13 results in:

A

decreased metabolism + increased fat stores

= obesity/metabolic syndrome

29
Q

How does pregnancy affect GFR? Why?

A

increases by ~50%

elevations in cardiac output and kidney blood flow

30
Q

How does pregnancy affect creatinine?

A

decreases by ~0.4

31
Q

What may indicate underlying kidney disease during pregnancy?

A

creatinine that would be nml for a non-preg person

32
Q

What causes hydronephrosis during pregnancy?

A

dilatation of the urinary collecting system due to:
ureteral compr 2’ to enlarging fetus
ureteral sm muscle relaxatn (progesterone)

33
Q

Hydronephrosis during pregnancy is more prominent on the (R/L)

A

R

34
Q

How does pregnancy affect the diaphragm?

A

elevated as uterus enlarges

35
Q

How does pregnancy affect rib cage?

A

displaced upward and widens

increases the lower thoracic diameter by 2cm and the thoracic circumference by up to 6cm

36
Q

How does pregnancy affect Chest circumference?

A

expands 5-7 cm

37
Q

How does pregnancy affect the subcostal angle?

A

increases (from 68 to 103 degrees)

38
Q

How does pregnancy affect respiratory muscle function?

A

it doesn’t

39
Q

How does pregnancy affect abdominal muscles during respiration?

A

less tone and less active = respiration more diaphragmatic

40
Q

How does pregnancy affect respiratory dead volume?

A

increase due relaxation of the musculature of conducting airways

41
Q

How does pregnancy affect respiratory tidal volume?

A

increases gradually (35-50%) as pregnancy progresses to meet fetal demand for O2

42
Q

How does pregnancy affect TLC?

A

reduced (4-5%) by the elevation of the diaphragm

43
Q

How does pregnancy affect functional residual capacity + residual volume?

A

decrease by about 20%

44
Q

What causes 65% increase in alveolar ventilation during pregnancy?

A

Larger tidal volume and smaller residual volume

45
Q

How does pregnancy affect Inspiratory capacity?

A

increases 5-10%

46
Q

What protective measure prevents fetus from exposure to excessive levels of CO2? How does it do it?

A

Maternal hyperventilation

deceased PCO2 = Increased CO2 gradient between fetus and mother

47
Q

How does pregnancy affect maternal blood CO2 tension?

A

decreases, but alveolar O tension unchanged

48
Q

What causes more efficient gas exchange in pregnancy?

A

decrease in FRC without a change in dead space, thus there is little residual dilution

49
Q

Pregnancy is a state of chronic respiratory ____ with compensatory metabolic ____.

A

alkalosis

acidosis

50
Q

How do levels change as pregnancy progresses?

  1. estrogen/progesterone
  2. PRL
  3. GH
  4. cortisol
A
  1. increases
  2. increases
  3. decreases because fetal GH has taken over
  4. increases
51
Q

How do levels of TNF-alpha and adiponectin change as pregnancy progresses?

A

around week 25 TNF-alpha increases and adiponection declines

52
Q

What hormonal changes allow maternal fat deposition in 3rd trimester?

A

insulin and leptin resistance

53
Q

Body fat at birth provides:

A

energy for brain in between feeds

54
Q

What does placental CRH stimulate?

A

maternal pituitary and adrenal, leading to increased cortisol production

55
Q

What affect does cortisol overexpsoure have on the developingn fetus?

A

low birthweight
altered HPA axis
Long term CNS effects

56
Q

Cortisol is partially metabolized by _____ to cortisone

A

the placenta

57
Q

Primary barrier for transfer of nutrients from mother to fetus:

A

syncytiotrophoblast

58
Q

Placental nutrient transport:

Maternal blood pools in the _______ and bathes the ________.

A

intervillous space

microvillous membrane

59
Q

What portion of the syncytiotrophoblast is oriented toward the fetal circulation?

A

basal plasma membrane

60
Q

What do transporters expressed in both plasma membranes of the syncytiotrophoblast transfer?

A

amino acids, glucose (GLUTs), and fatty acids (FATPs)

61
Q

How do FA transfer from mother to fetus?

A
  • -extracellular lipases release FA from maternal lipoproteins
  • -intracellular binding proteins guide FA within cytosol of syncytiotrophoblast

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