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Pregnancy Physiology And Fetal Wellbeing > Physiological Adaptation To Pregnancy > Flashcards

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
Q

REPRODUCTIVE SYSTEM

Term for the development of new fibres- driven by oestrogen

A

Uterine hyperplasia

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26
Q

REPRODUCTIVE SYSTEM

Term for the Increase in length and thickness of fibres (driven by oestrogen)

A

Hypertrophy

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27
Q

REPRODUCTIVE SYSTEM

Uterine Isthmus

A

Inferior-posterior part of the uterus (cervical end)

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28
Q

REPRODUCTIVE SYSTEM

How does the uterine isthmus grow in pregnancy?

A

A non pregnant isthmus is 7mm. In early pregnancy is increases to 25mm. Between 32-34 weeks the isthmus forms to lower uterine segment

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29
Q

REPRODUCTIVE SYSTEM

What hormones maintain uterine quiescence?

A

Progesterone
Relaxin (suppresses oxytocin)
Nitric oxide
Prostaglandin

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30
Q

REPRODUCTIVE SYSTEM

What are Braxton hicks contractions?

A

Painless contractions which do not dilate the cervix. They assist in circulation of blood to the placenta.
They are irregular, weak and unsynchronised

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31
Q

REPRODUCTIVE SYSTEM

What changes to the cervix during pregnancy?

A

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

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32
Q

REPRODUCTIVE SYSTEM

Vaginal changes in pregnancy

A

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
Q

CARDIOVASCULAR SYSTEM

Changes to cardiac output in pregnancy

A

Cardiac output increases due to increased heart rate
Blood volume also increases
Oestrogen causes hypertrophy of cardiac muscle

34
Q

CARDIOVASCULAR SYSTEM

Changes to blood pressure in pregnancy

A

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
Q

CARDIOVASCULAR SYSTEM

Symptoms of high blood pressure changes in pregnancy

A

Oedema of lower extremities
Diuresis
Varicose veins of legs and vulva
Haemorrhoids

36
Q

CARDIOVASCULAR SYSTEM

What causes oedema in pregnancy?

A

Blood pressure

37
Q

CARDIOVASCULAR SYSTEM

Diuresis

A

Excess production of urine, can be as a result of raised blood pressure

38
Q

CARDIOVASCULAR SYSTEM

Oedema

A

Fluid retention in extremities due to progesterone which affects tone of blood vessels- increasing likelihood of leaking fluid and gravid uterus impeding flow

39
Q

CARDIOVASCULAR SYSTEM

What can cause varicose veins and haemorrhoids in pregnancy?

A

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
Q

CARDIOVASCULAR SYSTEM

Why should you avoid lying on your back in pregnancy?

A

Gravid uterus can compress on aorta and inferior vena cava causing reduced output and drop in blood pressure

41
Q

CARDIOVASCULAR SYSTEM

How does oestrogen affect blood flow?

A

It increases blood flow to all tissues

42
Q

CARDIOVASCULAR SYSTEM

How does progesterone affect blood flow?

A

It decreases venous tone, decreasing blood pressure

43
Q

CARDIOVASCULAR SYSTEM

Why does blood flow to breasts increase in early pregnancy?

A

To help milk production

44
Q

CARDIOVASCULAR SYSTEM

Why does blood flow to skin increase in pregnancy?

A

To expedite heat loss

45
Q

CARDIOVASCULAR SYSTEM

What haematological changes occur in pregnancy?

A

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
Q

CARDIOVASCULAR SYSTEM

Name one benefit and one risk to having an increase in fibrinogen and other clotting factors in pregnancy?

A

Benefit- protection against placental separation and sudden blood loss

Risk-thromboembolism (blood clot)

47
Q

CARDIOVASCULAR SYSTEM

How is iron count affected in pregnancy?

A

It decreases- especially at 16-22 weeks. It is advised not to let it go below 110 in second and third trimester

48
Q

RESPIRATORY SYSTEM

Changes to respiratory system in pregnancy

A

Increased oxygen consumption
Diaphragm displaces upwards
Increased flaring of the lower ribs increased chest circumference

49
Q

RESPIRATORY SYSTEM

Why is progesterone a respiratory stimulant?

A

Progesterone lowers the sensitivity of chemoreceptors for carbon dioxide

50
Q

RESPIRATORY SYSTEM

How is the tidal volume affected in pregnancy?

A

It increases as pregnant women breathe more deeply

51
Q

RESPIRATORY SYSTEM

What can cause persistent cough/deeper voice in pregnancy

A

Oedema of vocal cords

52
Q

RESPIRATORY SYSTEM

What can lead to respiratory infections in pregnancy?

A

Capillaries in respiratory tract become engorged

53
Q

RENAL SYSTEM

Changes to passing of urine in pregnancy

A

Increased frequency
Leakage
Nocturia
UTIs

54
Q

RENAL SYSTEM

Why does urine frequency increase during pregnancy?

A

Kidneys have more waste to excrete due to increased metabolism

55
Q

RENAL SYSTEM

Nocturia

A

Waking up during the night to wee

56
Q

RENAL SYSTEM

Kidney changes in pregnancy

A

Enlarges by 1cm length and 30% volume
Increased blood flow (haemodilution)
Increased glomerular filtration rate

57
Q

RENAL SYSTEM

What changes to the blood and filtrate occur due to increased glomerular filtration rate?

A

More sodium, glucose and amino acids in filtrate however sodium is reabsorbed by tubular reabsorption

Lower levels serum creatine and urea

58
Q

RENAL SYSTEM

What two urine conditions are common in pregnancy?

A

Glucosuria-doesn’t always indicate GDM

Proteinuria-doesn’t always indicate pre-eclampsia

59
Q

RENAL SYSTEM

Changes to ureters and bladder in pregnancy

A

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
Q

RENAL SYSTEM

How does progesterone affect bladder function?

A

It decreases bladder tone, increasing risk of infection by affecting the sphincters

61
Q

GASTROINTESTINAL SYSTEM

Changes to appetite

A

Increased appetite and thirst at start of pregnancy
Hormonally controlled
Towards the end of pregnancy appetite and thirst decrease

62
Q

GASTROINTESTINAL SYSTEM

Why does appetite decrease towards end of pregnancy?

A

Capacity for food due to gravid uterus - suggest smaller snacks

63
Q

GASTROINTESTINAL SYSTEM

How do hormones affect hunger and thirst in pregnancy?

A

hCG affects hypothalamus leading to increased thirst

Progesterone stimulates hunger and thirst

64
Q

GASTROINTESTINAL SYSTEM

what causes cravings (pica) in pregnancy?

A

Taste buds become filled in pregnancy

65
Q

GASTROINTESTINAL SYSTEM

what may cause vomiting and nausea in pregnancy

A

Delayed stomach emptying as a result of progesterone reducing tone

66
Q

GASTROINTESTINAL SYSTEM

why may your mouth become oedematous in pregnancy?

A

Increased blood flow due to oestrogen changing consistency of connective tissue

67
Q

GASTROINTESTINAL SYSTEM

Changes to the mouth in pregnancy

A

Becomes more spongy due to increased blood flow
Can me oedematous
Saliva more acidic

68
Q

GASTROINTESTINAL SYSTEM

Changes to the oesophagus and stomach in pregnancy

A

Heartburn (progesterone affecting tone of oesophageal sphincter)

Delayed stomach emptying (due to readuction in tone-progesterone)

69
Q

GASTROINTESTINAL SYSTEM

Changes to intestines

A

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
Q

GASTROINTESTINAL SYSTEM

what can cause constipation in pregnancy

A

Relaxation in smooth muscle of the colon increases water absorption causing constipation.

71
Q

GASTROINTESTINAL SYSTEM

What 2 hormones cause increased sodium and water absorption from the colon

A

Angiotensin

Aldosterone

72
Q

GASTOINTESTINAL SYSTEM

What causes increased flatulence in pregnancy?

A

Compression of the colon by the uterus

73
Q

SKIN

How does skin change in pregnancy?

A

Pigmentation (increase in MSH)
Pruritus (itching)
Striae gravidarum (stretch marks)

74
Q

SKIN

what causes stretch marks? (Striae gravidarum)

A

Rapid growth causes collagen fibres to stretch beyond their elastic limit

75
Q

SKELETAL SYSTEM

What skeletal changes occur?

A

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
Q

What causes carpel tunnel in pregnancy? (Tingling hands)

A

Nerve compression

77
Q

Why may you snore in pregnancy?

A

Nasal mucosa becomes hyperaemic and congested- stuffy

78
Q

How do sleep patterns change in pregnancy?

A

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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