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EndoRepro Final > PHYS: Pregnancy + Lactation > Flashcards

PHYS: Pregnancy + Lactation Flashcards

1
Q

What is the mature placenta made of?

A
  1. Chorionic villi (functional unit of placenta)
  2. Intervillous space
  3. Decidua basalis
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2
Q

What is the main function of the placenta?

A

Major lifeline between mother + fetus

fetal gut –> nutrients

fetal lung –> exchanging o2/c02

fetal kidney –> regulates fluid volumes + disposing of waste

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3
Q

What is the functional capillary in maternal blood flow?

A

inter-villous space

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4
Q

What reglates maternal blood flow?

A

Blood pressure, uterine pressure, and uterine contractions attenuate arterial inflow

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5
Q

What is unique about the umbilical arteries?

A

They carry deoxygenated blood (like veins)

and blood with high 02 and nutrients feeds the placenta through the single umbilical vein

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6
Q

The diffusion of O2 from the maternal blood into the chorionic villi of the fetus causes PO2 of blood in the intervillous space to fall.

A
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7
Q

How can we ensure that the fetus is getting adequate oxygen?

A

Fetal Hb has a much higher affinity for O2 compared to maternal Hb, so the fetus can extract oxygen easily from the maternal blood.

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8
Q

The synctiotrophoblasts of the placenta produce several steroid + protein hormones. What are their function?

A

Maintain the pregnant state of the uterus

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9
Q

On a graph, what does hCG look like during pregnancy?

A

Increased up to 10 weeks and then drops off

It is the first hormone produced by the synciotrophoblast

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10
Q

What does progesterone on a graph look like during pregnancy?

A

Starts increasing after 10 weeks (hCG quit) to full term

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11
Q

On a graph, what does human placental lactogen look like during pregnancy?

A

Steady increase up to full term

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12
Q

On a graph, what does estradiol look like during pregnancy?

A

Steady increase up to full term

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13
Q

What binds with high affinity to the LH receptor?

A

hCG

Its primary action is to stimulate LH receptorson the corpus luteum during the first 10 weeks to maintain high progesterone production.

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14
Q

Where is hPL produced?

A

syncytiotrophoblast

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15
Q

What is the function of human placental lactogen (hPL)?

A

It has antagonistic action to insulin –> can cause diabetic pregnancy –> increases glucose availablity by inhibiting maternal glucose uptake

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16
Q

What is the function of progesterone during pregnancy?

A

The placenta produces a high amount of progesterone, which is required to maintain a quiet myometrium and a pregnant uterus

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17
Q

What produces estrogen?

A

syncytiotrophoblasts

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18
Q

The syncytiotrophoblast converts DHEAS into what?

A

Estradiol/Estriol/Estrone

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19
Q

What is the major estrogen of pregnancy?

A

Estriol

You can use these levels to assess fetal well-being

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20
Q

What is the CYP17 block and where does it occur?

A

The placenta does not have 17 alpha hydroxylase or 17, 20 desmolase –> so progesterone is increased

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21
Q

What is the purpose of 11 beta HSD type 2?

A

It helps both the mom and fetus regulate levels of cortisol

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22
Q

What enzyme do you need to produce cortisol?

A

3 beta HSD

*cortisol can be a signal for contraction*

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23
Q

What does progesterone stimuate from the uterine glands?

A

It stimulates a secretion that provides nutrients to the embryo (histotrophic nutrition)

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24
Q

What hormone indices the “window or receptivity” in the uterine endometrium?

A

Progesterone

day 20-24 of menstrual cycle

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25
Q

What hormone reuces uterine motility and inhibits propagation of contractions?

A

Progesterone

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26
Q

During pregnancy progesterone and estrogen levels increase or decrease?

A

Increase way beyond what they normally would be!

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27
Q

The corpus luteum is the major source of which hormones?

A

Progesterone and estrogens

(But this is not enough! After a while, the placenta takes over!)

28
Q

Can the placenta synthesize hormones by itself?

A

No! It needs the help of mom + fetus

29
Q

What enzymes does the placenta get from the fetus + mom in order to synthesize estrone/estradiol and estriol

A

estrone/estradiol = 17 alpha hydroxylase + 17,20 lyase (fetal adrenal gland)

estriol = 16 alpha- hydroxylase (fetal liver)

30
Q

How does the fetus avoid exposure to dangerously high levels of hormones?

A

The fetus conjugates the necessary steroid intermediates to sulfate, which greatly reduces their biological activity (ex. DHEA = sulfated while in fetus)

+

The placenta = massive sink for weak androgens –> thus preventing the masculinization of female fetuses!

31
Q

What happens to CO and BV during pregnancy?

A

They increase! (by 40-50%)

32
Q

When should morning sickness end?

A

14-16 weeks

33
Q

What are some of the maternal responses to pregnancy?

A

increased alveolar ventilation –> increased tidal volume

acid reflux

decreased colonic motility –> constipation

morning sickness

34
Q

How long does the fetus cook?

A

38 weeks after fertilization

or

40 weeks after last period

35
Q

What is the fetal station?

A

Refers to where the presenting part is in the pelvis (the part of the baby that leads the way through the canal, usually head)

36
Q

What is the narrowest part of the pelvis

A

Ischial spines

(when babies head is even with them = 0 station)

37
Q

In partuition (having baby), what is the role of estrogen?

A
  1. Increases the degree of uterine contractility
  2. Stimulates synthesis of oxytocin receptors –> increases the number of oxytocin receptors in the myometrial and decidual tissue of pregnant women
38
Q

What main hormone intiates labor and what stimulates it?

A

Prostaglandins initiate labor and they are stimualted by estrogen and oxytocin

39
Q

What is the role of oxytocic in parturition?

A

It stimulates powerful uterine contractions that sustain labor.

ONLY PROSTAGLANDINS INITIATE LABOR

40
Q

What triggers oxytocin release?

A

The stretch of the cervix (Ferguson reflex)

41
Q

Immediately after the fetus is expelled what happens?

A

Oxytocin (OT) causes the uterus to contract, limiting blood flow and blood loss

42
Q

What is the function of relaxin?

A

Keeps the uterus quiescent during pregnancy

It may soften the cervix during labor

43
Q

What are the false contractions you get before the actual labor?

A

Braxton Hicks contractions

(periodic weak + slow contractions)

They aren’t called labor contractions until they are strong and in the last hours of pregnancy

44
Q

What are the 3 phases of delivery?

A
  1. Dilation + Effacement –> takes 7-12 hrs, makes cervix paper thin
  2. Descent + Expulsion –> Cervix fully dilated (20-50 min)
  3. Expulsion of Placenta
45
Q

What is the timeframe for it to be considered prolonged labor?

A

more than 18-24 hrs

46
Q

What major complication can happen with obstructed labor(when fetus is physically blocked)?

A

The baby could not get enough oxygen and it could result in death

47
Q

When is labor considered preterm?

A

If labor begins before the 37th week

Occurs in 12%

48
Q

What is a possible complication during birth that can lead to bleeding, deteroation of fetal heart rate, abdominal pain?

A

Ruptured uterus (integrity of myometrial wall = breached)

49
Q

What is the main symptom of preclampsia?

A

High Blood Pressure during pregnancy after week 20

affect 5-8% of pregnant women

there can also be signs to damge of another organ like the kidneys

50
Q

What is the pathophys behind preclampsia?

A
51
Q

What is the fundamental secretory unit of the breast?

A

Alvelous

52
Q

What 4 hormones affect the mammary gland during pregnancy + breast feeding?

A
  1. mammogenic –> proliferate alveolar ducts (mammary growth)
  2. lactogenic –> initiation of milk production
  3. galactokinetic –> contracts myoepithelial cells for milk ejection
  4. galactopoietic –> maintains milk production
53
Q

Prolactin is a form of what hormone to maintain milk production?

A

Galactopoietic

54
Q

Oxytocin is a form of what hormone to initiate milk ejection “let down” by stimulating the contraction of the network of myoepithelial cells surrounding the alveoli + ducts of the breast??

A

Galactokinetic

55
Q

What are the 5 major route by which epithelial cells in the alveoli secrete component of milk?

A
  1. Secretory
  2. Transcellular (Temporary immunity)
  3. Lipids
  4. Transcellular (salt + water)
  5. Paracellular (electrolytes)
56
Q

Secretory pathway

A

milk proteins lactalbumin + casein

57
Q

Transcellular endocytosis + exocytosis pathway

A

confers temporary immunity w/ IgA

58
Q

Lipid pathway

A

fats for baby

59
Q

Transcellular pathway + Paracellular pathway

A

salt + water

60
Q

What inhibts prolactin?

A

High progesterone + estrogen (helps to not leak during end of pregnancy)

61
Q

What is colostrum?

A

A yellowish milk like substance secreted the first few days after birth that is filled with immunoglobulins to protect the baby

62
Q

What is the most powerful physiological stimulus for prolactin release?

A

Suckling

63
Q

Suckling causes what to be inhibited, so that the milk can flow?

A

Suckling inhbits dopamine, resulting in prolactin secretion.

64
Q

What are the steps that happen after the stimulus of suckling (or sight/sound of child)?

A

Dopamine = inhibited

Oxtocin + PRL increased

Arcuate + preoptic area of hypothalamus inhibited –> GnRH decreased –> FSH + LH decreased (inhibtis ovarian cycle –> no next immediate pregancy)

65
Q

What antibodies come from placenta? What from breast milk?

A

IgG –> crosses placenta

IgA –> crosses breast milk

EndoRepro Final (14 decks)

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