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Obstetrics + Gynaecology > Physiology 2 > Flashcards

Physiology 2 Flashcards

1
Q

Which endocrine changes occur during the pregnancy?

A

Increase in oestrogen (from placenta) + progesterone (from corpus luteum + later from placenta)
Increase in thyroid binding globulin (TBG)
Increase in anti-insulin hormones:
- human placental lactogen
- prolactin
- cortisol
Increase in lipolysis as alternative energy source

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2
Q

What is the result of an increase in TBG during pregnancy?

A

More T3 + T4 bind to TBG
–> more TSH released from anterior pituitary
Therefore, free T3 and T4 levels remain the same but TOTAL T3 + T4 levels rise

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3
Q

Why do the changes in TBG in pregnancy occur?

A

Thyroxin is essential for the foetus’ neural development

–> ensures constant supply to foetus in early pregnancy

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4
Q

What do the anti-insulin hormones do in pregnancy?

A

Increase insulin resistance + reduce peripheral uptake of glucose
–> ensures constant supply of glucose for foetus

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5
Q

What is the risk of increased lipolysis during pregnancy?

A

Increased risk of ketoacidosis

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6
Q

Which cardiovascular adaptations occur during pregnancy?

A

Progesterone –> decreased SVR –> decrease in diastolic BP during first + second trimesters
In response, CO increases by about 30-50%

Total blood volume increases due to activation of RAAS

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7
Q

Which respiratory adaptations occur during pregnancy?

A

Increase in total volume + ventilation rate to match increased oxygen demand

Hyperventilation is common and can cause respiratory alkalosis

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8
Q

Which changes in the urinary system occur during pregnancy?

A

Increase in CO –> increase in renal plasma flow –> increase in GRF by about 50-60%
(urea + creatinine will be lower)

Relaxation of ureter + bladder –> increased risk of UTIs

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9
Q

Which haematological changes occur during pregnancy?

A

Increased risk of VTE due to:

  • increase in fibrinogen + clotting factors
  • decrease in fibrinolysis
  • stasis of blood + venodilation

Plasma volume increase –> physiological dilutional anaemia

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10
Q

How can an increased risk of VTE be treated in pregnancy?

A

LMWH

NOT warfarin - teratogenic

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11
Q

What is the most common site of ectopic implantation?

A

Ampulla of the fallopian tube

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12
Q

What are Braxton Hicks contractions?

A

Irregular, involuntary contractions of the uterine smooth muscle that occur during the third trimester
(not part of labour)

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13
Q

Which 2 things need to happen for labour to commence?

A

Cervical ripening

Myometrial excitability

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14
Q

When is a women typically considered to be in labour?

A

When regular, painful contractions lead to effacement and dilatation of the cervix

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15
Q

What is cervical ripening?

A

Softening of the cervix that occurs before labour

- without this, the cervix cannot dilate

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16
Q

Which substance is particularly important for cervical ripening?

A

Prostaglandins

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17
Q

Which hormonal change is responsible for myometrial excitability?

A

Decrease in progesterone in relation to oestrogen

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18
Q

Which chemical is responsible for initiating uterine contractions?

A

Oxytocin (from posterior pituitary)

19
Q

What are the stages of labour?

A

First stage (latent + active phase)
Second stage (passive + active stage)
Delivery
Third stage

20
Q

When is a women considered to be in the first stage of labour?

A

From the beginning of labour until the cervix is fully dilated (10cm)

21
Q

How regular are contractions in the first stage of labour?

A

Every 2-3 minutes

22
Q

What happens during the latent phase of the first stage of labour?

A

Slow cervical dilatation over several hours until reaches 4 cm

23
Q

What happens during the active phase of the first stage of labour?

A

Faster rate of cervical dilatation up to 10cm

  • 1cm/hr in nulliparous women
  • 2cm/hr in multiparous women
24
Q

When is a women considered to be in the second stage of labour?

A

From full dilatation of the cervix until the foetus has been expelled

25
Q

What happens during the second stage of labour?

A

Passive stage:
- until the head reaches the pelvic floor
- rotation + flexion of the head
Active stage:
- pressure of head on pelvic floor –> urge to push
- woman pushes in conjunction with her contractions to expel foetus

26
Q

Which two hormones make contractions more forceful and frequent during the second stage of labour?

A

Prostaglandins (increase force)

Oxytocin (increases frequency)

27
Q

How long should the active second stage last?

A

40 minutes in nulliparous women
20 minutes in multiparous women
- if it takes > 1 hour, spontaneous delivery becomes unlikely

28
Q

How does the foetal hand position assist with delivery?

A

Once head reaches perineum –> extends

Following delivery of the head –> rotates 90 degrees to help delivery of shoulders

29
Q

How are the shoulders delivered?

A

Anterior shoulder first, coming under the pubic symphysis

Then posterior should

30
Q

When is a woman considered to be in the third stage of labour?

A

Following delivery of the foetus until the placenta has been delivered

31
Q

How long does the their stage typically last?

A

About 15 minutes

32
Q

How much blood loss in normal in the third stage of labour?

A

Up to 500ml

33
Q

How is bleeding normally controlled during the third stage of labour?

A

Contraction of the uterus constricts blood vessels
Pressure is exerted on placental site by walls of contracting uterus
Normal blood clotting mechanism

34
Q

What are the three main methods of artificially inducing labour?

A

Vaginal prostaglandins
Amniotomy
Membrane sweep

35
Q

What are the complications of artificial induction of labour?

A

Failure of induction
Uterine hyperstimulation
Increased rate of further interventions (compared to spontaneous labour)

36
Q

What is colostrum?

A

Breast milk produced immediately after birth

  • less water soluble vitamins, fat and sugar than mature milk
  • more proteins (esp Ig) and fat soluble vitamins
37
Q

Which hormone regulates breast milk production?

A

Prolactin (from anterior pituitary)

38
Q

Which hormone controls prolactin secretion?

A

Dopamine (from hypothalamus) INHIBITS prolactin

Also stimulated by suckling

39
Q

Where does the inguinal ligament lie?

A

Between the ASIS and the pubic tubercle

40
Q

In what position should the foetal head enter the pelvic cavity and why?

A

Facing either to the left or to the right

  • at pelvic inlet, transverse diameter is wider than AP diameter
  • occipitofrontal diameter is longer than the biparietal diameter of the foetal skull
41
Q

What is the ‘station’ referring to?

A

Distance of the foetal head from the ischial spines

  • negative number means the head is superior to the spines
  • positive number means the head is inferior to the spines
42
Q

When descending through the pelvis cavity, what position should the foetal head be in?

A

Flexed (chin on chest)

and rotating

43
Q

In what position should the foetal head pass through the pelvic outlet?

A

Ideally occipitoanterior (OA)

44
Q

What position should the foetal head be in during delivery?

A

Extension

Obstetrics + Gynaecology (22 decks)

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