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Physiological Adaptation To Pregnancy Flashcards

1
Q

ENDOCRINE SYSTEM

What early pregnancy changes occur to the endocrine system due to trophoblastic cells?

A

Trophoblastic cells start to secrete HCG

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2
Q

ENDOCRINE SYSTEM

What is the purpose of hCG?

A

It maintains the corpus luteum

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3
Q

ENDOCRINE SYSTEM

What produces progesterone? What does progesterone do?

A

The corpus luteum secreted progesterone which nourishes the blastocyst and regulate the uterus (endometrium)

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4
Q

ENDOCRINE SYSTEM

When does the placenta take over progesterone production and why?

A

The placenta takes over progesterone production at 8-12 weeks because the corpus luteum degenerates

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5
Q

ENDOCRINE SYSTEM

Why would a pregnancy test show positive?

A

hCG hormone produced by syncytiotrophoblast diffuses into blood stream via villi into lacunae and is excreted into urine 2 weeks after fertilisation

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6
Q

ENDOCRINE SYSTEM

What are some symptoms caused by hCG?

A

Nausea/vomiting
Increased appetite and fat composition
Increased thirst and release of ADH
Increased sensitivity to glucose

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7
Q

ENDOCRINE SYSTEM

What does hCG do which prevents body rejection of the placenta?

A

It suppressed maternal lymphocyte response

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8
Q

ENDOCRINE SYSTEM

Bodily changes caused by progesterone

A

Relaxation of smooth muscle
Increased body temperature
Increased respiration
Increased sodium and chloride excretion

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9
Q

ENDOCRINE SYSTEM

Fetoplacental unit

A

A functional compartment responsible for synthesising hormones which maintain a pregnancy

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10
Q

ENDOCRINE SYSTEM

The production and secretion of hormones by the placenta requires the use of what?

A

Enzymes in the maternal and fetal circulation

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11
Q

ENDOCRINE SYSTEM

What is the relationship between the level of hCG to the level of hPL?

A

As hCG level falls, hPL rises

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12
Q

ENDOCRINE SYSTEM

What functions does hPL have?

A

It stimulates growth of fetal and maternal tissues
It protects the fetus from rejection
It has a diabetogenic effect (reduces glucose uptake from maternal cells so more is available for fetal use)

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13
Q

ENDOCRINE SYSTEM

Relaxin is produced by what

A

Corpus luteum and then the placenta when corpus luteum degenerates

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14
Q

ENDOCRINE SYSTEM

Relaxin function

A

Softens elastic ligaments which allows growth of uterus into abdomen

Maintains uterine quiescence by suppressing oxytocin release which affects gap junction permeability

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15
Q

ENDOCRINE SYsTEM

What hormone allows growth of the uterus and how?

A

Relaxin allows his by softening elastic ligaments

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16
Q

ENDOCRINE SYSTEM

What may be a cause of lower back pain in pregnancy?

A

Stretching of ligaments for the growth of the uterus. This is due to relaxin hormone softening elastic ligaments

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17
Q

ENDOCRINE SYSTEM

What hormone maintains uterine quiescence and how?

A

Relaxin suppresses oxytocin release by affecting the gap junction permeability. This prevents the uterus from contracting

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18
Q

ENDOCRINE SYSTEM

Which adrenal and pituitary hormones increase in pregnancy?

A

Cortisol
Prolactin
Melanocyte

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19
Q

ENDOCRINE SYSTEM

What may an increase in melanocyte hormone cause in pregnancy? (In severe cases)

A

Hyperpigmentation - tanning more deeply or chloasma (skin discolouration)

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20
Q

ENDOCRINE SYSTEM

What thyroid hormones increase during pregnancy?

A

T3
T4
Together these hormones regulate body’s temperature, metabolism and heart rate

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21
Q

ENDOCRINE SYSTEM

What does an increase in T3 and T4 in pregnancy cause?

A

A mimic of hyperthyroidism- increased temp, increased appetite, fatigue and increased metabolic rate

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22
Q

ENDOCRINE SYSTEM

What is an unpleasant side effect of the increased level of T4 in pregnancy?

A

Nausea and vomiting

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23
Q

REPRODUCTIVE STSTEM

Changes to the uterus in pregnancy

A 
Blood supply increases
Remodelling of spiral arteries causes decrease in blood resistance
Lower blood pressure
Uterine hyperplasia
Uterine hypertrophy
Defining of the 3 myometrium layers
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24
Q

REPRODUCTIVE SYSTEM

What changes occur as a result of the remodelling of spiral arteries?

A

Lower arterial resistance
Increased blood flow
Lower blood pressure
Increased blood supply

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25
REPRODUCTIVE SYSTEM Term for the development of new fibres- driven by oestrogen
Uterine hyperplasia
26
REPRODUCTIVE SYSTEM Term for the Increase in length and thickness of fibres (driven by oestrogen)
Hypertrophy
27
REPRODUCTIVE SYSTEM Uterine Isthmus
Inferior-posterior part of the uterus (cervical end)
28
REPRODUCTIVE SYSTEM How does the uterine isthmus grow in pregnancy?
A non pregnant isthmus is 7mm. In early pregnancy is increases to 25mm. Between 32-34 weeks the isthmus forms to lower uterine segment
29
REPRODUCTIVE SYSTEM What hormones maintain uterine quiescence?
Progesterone Relaxin (suppresses oxytocin) Nitric oxide Prostaglandin
30
REPRODUCTIVE SYSTEM What are Braxton hicks contractions?
Painless contractions which do not dilate the cervix. They assist in circulation of blood to the placenta. They are irregular, weak and unsynchronised
31
REPRODUCTIVE SYSTEM What changes to the cervix during pregnancy?
Increased blood supply (caused by oestrogen) softens the cervix Collagen fibres become less tightly bound and water content increases Cervical mucosa proliferates and secretes mucus to protect from infection
32
REPRODUCTIVE SYSTEM Vaginal changes in pregnancy
Increased blood flow (osianders signs) lilac colour of vagina and cervix (jacquemiers sign) Increased discharge Oestrogen causes hypertrophy of muscle layer- increased capacity and elasticity
33
CARDIOVASCULAR SYSTEM Changes to cardiac output in pregnancy
Cardiac output increases due to increased heart rate Blood volume also increases Oestrogen causes hypertrophy of cardiac muscle
34
CARDIOVASCULAR SYSTEM Changes to blood pressure in pregnancy
Systolic pressure has very little jangle in pregnancy Diastolic pressure is lower in the first trimester due to decreased resistance to flow Postural hypertension
35
CARDIOVASCULAR SYSTEM Symptoms of high blood pressure changes in pregnancy
Oedema of lower extremities Diuresis Varicose veins of legs and vulva Haemorrhoids
36
CARDIOVASCULAR SYSTEM What causes oedema in pregnancy?
Blood pressure
37
CARDIOVASCULAR SYSTEM Diuresis
Excess production of urine, can be as a result of raised blood pressure
38
CARDIOVASCULAR SYSTEM Oedema
Fluid retention in extremities due to progesterone which affects tone of blood vessels- increasing likelihood of leaking fluid and gravid uterus impeding flow
39
CARDIOVASCULAR SYSTEM What can cause varicose veins and haemorrhoids in pregnancy?
Gravid uterus puts pressure on blood vessels causing dilation of vessels. Progesterone relaxes the walls of veins so that they relax more which can allow them to swell
40
CARDIOVASCULAR SYSTEM Why should you avoid lying on your back in pregnancy?
Gravid uterus can compress on aorta and inferior vena cava causing reduced output and drop in blood pressure
41
CARDIOVASCULAR SYSTEM How does oestrogen affect blood flow?
It increases blood flow to all tissues
42
CARDIOVASCULAR SYSTEM How does progesterone affect blood flow?
It decreases venous tone, decreasing blood pressure
43
CARDIOVASCULAR SYSTEM Why does blood flow to breasts increase in early pregnancy?
To help milk production
44
CARDIOVASCULAR SYSTEM Why does blood flow to skin increase in pregnancy?
To expedite heat loss
45
CARDIOVASCULAR SYSTEM What haematological changes occur in pregnancy?
Plasma volume increases by 40-50% Red blood cell mass increases Haemodilution- less blood cells in proportion to blood volume Increase in fibrinogen and other clotting factors
46
CARDIOVASCULAR SYSTEM Name one benefit and one risk to having an increase in fibrinogen and other clotting factors in pregnancy?
Benefit- protection against placental separation and sudden blood loss Risk-thromboembolism (blood clot)
47
CARDIOVASCULAR SYSTEM How is iron count affected in pregnancy?
It decreases- especially at 16-22 weeks. It is advised not to let it go below 110 in second and third trimester
48
RESPIRATORY SYSTEM Changes to respiratory system in pregnancy
Increased oxygen consumption Diaphragm displaces upwards Increased flaring of the lower ribs increased chest circumference
49
RESPIRATORY SYSTEM Why is progesterone a respiratory stimulant?
Progesterone lowers the sensitivity of chemoreceptors for carbon dioxide
50
RESPIRATORY SYSTEM How is the tidal volume affected in pregnancy?
It increases as pregnant women breathe more deeply
51
RESPIRATORY SYSTEM What can cause persistent cough/deeper voice in pregnancy
Oedema of vocal cords
52
RESPIRATORY SYSTEM What can lead to respiratory infections in pregnancy?
Capillaries in respiratory tract become engorged
53
RENAL SYSTEM Changes to passing of urine in pregnancy
Increased frequency Leakage Nocturia UTIs
54
RENAL SYSTEM Why does urine frequency increase during pregnancy?
Kidneys have more waste to excrete due to increased metabolism
55
RENAL SYSTEM Nocturia
Waking up during the night to wee
56
RENAL SYSTEM Kidney changes in pregnancy
Enlarges by 1cm length and 30% volume Increased blood flow (haemodilution) Increased glomerular filtration rate
57
RENAL SYSTEM What changes to the blood and filtrate occur due to increased glomerular filtration rate?
More sodium, glucose and amino acids in filtrate however sodium is reabsorbed by tubular reabsorption Lower levels serum creatine and urea
58
RENAL SYSTEM What two urine conditions are common in pregnancy?
Glucosuria-doesn’t always indicate GDM | Proteinuria-doesn’t always indicate pre-eclampsia
59
RENAL SYSTEM Changes to ureters and bladder in pregnancy
Elongation to accommodate increased urine volume Increased risk of urine infection (due to more urine) Pressure on bladder due to increased fluid intake Progesterone decreases bladder tone which can affect the sphincters
60
RENAL SYSTEM How does progesterone affect bladder function?
It decreases bladder tone, increasing risk of infection by affecting the sphincters
61
GASTROINTESTINAL SYSTEM Changes to appetite
Increased appetite and thirst at start of pregnancy Hormonally controlled Towards the end of pregnancy appetite and thirst decrease
62
GASTROINTESTINAL SYSTEM Why does appetite decrease towards end of pregnancy?
Capacity for food due to gravid uterus - suggest smaller snacks
63
GASTROINTESTINAL SYSTEM How do hormones affect hunger and thirst in pregnancy?
hCG affects hypothalamus leading to increased thirst | Progesterone stimulates hunger and thirst
64
GASTROINTESTINAL SYSTEM what causes cravings (pica) in pregnancy?
Taste buds become filled in pregnancy
65
GASTROINTESTINAL SYSTEM what may cause vomiting and nausea in pregnancy
Delayed stomach emptying as a result of progesterone reducing tone
66
GASTROINTESTINAL SYSTEM why may your mouth become oedematous in pregnancy?
Increased blood flow due to oestrogen changing consistency of connective tissue
67
GASTROINTESTINAL SYSTEM Changes to the mouth in pregnancy
Becomes more spongy due to increased blood flow Can me oedematous Saliva more acidic
68
GASTROINTESTINAL SYSTEM Changes to the oesophagus and stomach in pregnancy
Heartburn (progesterone affecting tone of oesophageal sphincter) Delayed stomach emptying (due to readuction in tone-progesterone)
69
GASTROINTESTINAL SYSTEM Changes to intestines
Decreased tone Increased absorption of substances (glucose, amino acids, iron etc) Relaxation of smooth muscle in the colon =increased water absorption Increased sodium reabsorption Flatulence
70
GASTROINTESTINAL SYSTEM what can cause constipation in pregnancy
Relaxation in smooth muscle of the colon increases water absorption causing constipation.
71
GASTROINTESTINAL SYSTEM What 2 hormones cause increased sodium and water absorption from the colon
Angiotensin | Aldosterone
72
GASTOINTESTINAL SYSTEM What causes increased flatulence in pregnancy?
Compression of the colon by the uterus
73
SKIN How does skin change in pregnancy?
Pigmentation (increase in MSH) Pruritus (itching) Striae gravidarum (stretch marks)
74
SKIN what causes stretch marks? (Striae gravidarum)
Rapid growth causes collagen fibres to stretch beyond their elastic limit
75
SKELETAL SYSTEM What skeletal changes occur?
Increased absorption of calcium Posture affected due to gravid uterus Progesterone and relaxin affect lumber curve in spine causing lordosis Oestrogen and relaxin affect cartilage composition- softens pelvis for labour Symphysis pubis becomes more flexible
76
What causes carpel tunnel in pregnancy? (Tingling hands)
Nerve compression
77
Why may you snore in pregnancy?
Nasal mucosa becomes hyperaemic and congested- stuffy
78
How do sleep patterns change in pregnancy?
Increased desire to sleep Deep (REM) sleep increases from 25 weeks Sleep disturbed by nocturia

Pregnancy Physiology And Fetal Wellbeing (4 decks)

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