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My Reproduction > Physiology (O) > Flashcards

Physiology (O) Flashcards

1
Q

What does the blastocyst attach to?

A

inner lining of the uterus and the outer cells will become the placenta

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2
Q

When is implantation completed?

A

day 12

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3
Q

What is the placenta made up of?

A

trophoblast and decidual tissue

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4
Q

What is the contact between blood supplies for the foetus and mother?

A

no direct contact due to placental villi which contains fetal capillaries

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5
Q

When are placenta and metal heart functional?

A

w5

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6
Q

What is the early nutrition of the foetus before placenta takes over?

A

invasion of trophoblastic cells in to the decidua

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7
Q

What is the role of decidual cells in response to progesterone?

A

HCG signals corpus luteum to continue making progesterone then decimal cells concentrate glycogen, proteins and lipids

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8
Q

What are the features of fetal haemoglobin?

A
  • higher affinity to O2
  • higher Hb concentration in blood
  • Bohr effect
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9
Q

How does water move from mother to foetus?

A

by osmosis and electrolytes follow the water

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10
Q

What does HCG stimulate?

A

Human Chorionic Gonadotropin stimulates progesterone production

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11
Q

What can HCG monitoring diagnose?

A
  • ectopic (static or slow rising)
  • failing pregnancy (falling)
  • ongoing viable pregnancy (doubling every 48h in early pregnancy)
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12
Q

What adverse effects can HCG cause?

A

N+V

hyperthyroidism

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13
Q

What do high HCG levels suggest after 14w?

A

multiple pregnancy

molar pregnancy

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14
Q

What does HCS/hPL do?

A
  • Human Chorionic Somatomemmotropin
  • produced from week 5 of pregnancy
  • growth hormone effects
  • decreases insulin sensitivity so more glucose for fetus
  • involved in breast development
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15
Q

What is the role of progesterone in pregnancy?

A
  • development of decidual cells
  • decreases uterus contractility
  • preparation for lactation
  • prevents formation of gap junctions
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16
Q

What is the role of estrogens in pregnancy?

A
  • enlargement of the uterus
  • breast development
  • relaxes ligaments for labour
  • uterus contraction
  • promotes prostaglandin production
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17
Q

What changes can CO cause on ECG in pregnancy?

A

increased CO in pregnancy causes ECG changes beginning w6 and peaking w24

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18
Q

What are the physiological cardio changes to obs in pregnancy?

A
  • HR rises to about 90bpm

- BP drops in 2nd trimester but rises back to normal by term

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19
Q

What are the physiological haem changes to obs in pregnancy?

A
  • Plasma volume increases and so does RBC
  • Iron requirements increase so iron supplements are needed
  • Anaemia in 1st trimester is Hb<110 and <105 for 2nd and 3rd trimester
  • hypercoagulable state in pregnancy
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20
Q

What are the physiological resp changes to obs in pregnancy?

A
  • Progesterone signals brain to lower CO2 and O2 consumption increases
  • RR increases
  • tidal volume increases
  • pCO2 decreases slightly so pH goes up
  • PaO2 goes up
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21
Q

What can make the physiological changes to obs in pregnancy larger?

A

multiple pregnancies

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22
Q

What are the physiological renal changes to obs in pregnancy?

A
  • GFR increases and increased reabsorption of ions and water

- Urea, creatinine, albumin and ALT are lower in pregnancy

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23
Q

What are the important nutritional requirements in pregnancy?

A
  • average weight gain in pregnancy is 11kg
  • 200 calories more needed per day in last trimester
  • folic acid should be taken 400mcg (reduce risk of neural tube defects)
  • vitamin D supplements 10mcg
  • high protein diet
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24
Q

What is parturition?

A

labour and birth of baby

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25
Q

What occurs in the body just before pregnancy?

A
  • progesterone levels fall
  • prostaglandins are released to ripen cervix
  • oxytocin increases contractions
  • Braxton hicks become more frequent
  • estrogen from ovaries induces oxytocin receptors on uterus
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26
Q

What is given to induce labour?

A

prostaglandins then oxytocin

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27
Q

What are the stages of labour?

A
  • 1-cervical dilation can take 8-24 hours (first stage is 2-4cm dilation and active stage is 4-10cm dilated)
  • 2-fetus being delivered (don’t want this to exceed 3 hours in nulliparous woman)
  • 3- delivery of placenta (10 mins)
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28
Q

What stimulates milk production?

A
  • prolactin
  • rise in this from w5 to birth
  • colostrum to begin with which is low volume no fat
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29
Q

How is milk produced at the nipple?

A

milk let down reflex is through spinal cord and posterior pituitary so oxytocin causes milk to be ejected at the nipple

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30
Q

What is term?

A

37-42w

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31
Q

What is done at the booking visit?

A
  • assess history including surgical
  • blood tests
  • US done to confirm viability, count pregnancies, detect abnormalities and estimate gestational age
  • test for GDM in those with RF
  • urinalysis
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32
Q

What rule can be used to calculate gestation before scanning is done?

A

Naegele’s rule

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33
Q

What makes a viable pregnancy?

A

fetal heart visible

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34
Q

What is used to calculate date of delivery on scan?

A

crown rump line is length of baby (head circumference can be used later on but is less accurate)

35
Q

What are US scans done in a normal pregnancy?

A
  • booking scan (11-14w)

- anomaly scan (18-21+6w gestation)

36
Q

What is screened for at the anomaly scan?

A
  • cleft lip
  • Edwards’
  • Patau’s
  • anencephaly
  • serious heart defects
  • placenta praevia (or use TVUS)
37
Q

What is included in trisomy screening?

A
  • 21 is Down’s
  • 18 is Edward’s (multiple structural abnormalities, can be lethal or severe)
  • 13 is Patau’s (can be lethal or severe, severe physical abnormalities)
38
Q

What else can be done for Down’s screening in high risk groups?

A

bloods so AFP, hCG, UE3, inhibin A and maternal age

39
Q

What is the next step for high risk seen on trisomy US?

A

non-invasive prenatal testing and then diagnostic tests include amniocentesis (after 15w) or chorionic villus sampling (11w-15w)

40
Q

Why is it important to treat maternal anaemia?

A

increased risk of postpartum haemorrhage so treat iron, folate and B12 deficiency

41
Q

What are rhesus negative women given?

A

Anti D injections at 28w and more if any sensitising event and check baby at birth

42
Q

What blood issue is tested for at 28w?

A

anaemia and red cell antibodies

43
Q

What are the nutritional requirements in pregnancy?

A
  • no change in first 2 trimesters

- 200-300 extra calories in last trimester

44
Q

When should folic acid be taken?

A

3m before pregnancy and until w13 of pregnancy 400mcg

45
Q

What is deficiency of folic acid associated with?

A
  • spina bifida
  • heart or limb defect
  • childhood brain tumors
  • maternal anaemia
46
Q

What is listeriosis?

A
  • causes in utero infection and so miscarriage, stillbirth and death
  • women should only eat ripened soft cheese and drink only pasturised milk
47
Q

What can be done to avoid salmonella in pregnancy?

A

not eating raw or partially cooked eggs and not raw meat

48
Q

How is risk of toxoplasmosis risk reduced?

A

hand washing and washing fruit and vegetables, avoiding cat faeces and wear gloves gardening

49
Q

What can iron deficiency in pregnancy cause?

A

small babies, still birth, preterm labour and postpartum haemorrhage

50
Q

How is GDM manages?

A

usually by diet changes

51
Q

What are the characteristics of the Down syndrome screening test?

A
  • majority of women who screen positive won’t have it
  • most people who don’t won’t
  • PPV is low
  • sensitivity is high
  • specificity is VV high
52
Q

What is raised maternal serum AFP associated with?

A

gastroschisis and spina bifida

53
Q

What is the role of liquor?

A

nurtures and protects the fetus and facilitates movement

54
Q

What is Bishops score in pregnancy?

A 
cervix position
cervix consistency
effacement
dilatation
station in pelvis
55
Q

What are the ideal 3Ps for labour?

A
  • Power- pacemaker at top of the fundus spreads wave of contraction, up to 3-4 in 10 minutes with a max of 45s per contraction and get more frequent, longer and more intense
  • Passage- gynaecoid is the most suitable pelvis
  • Passenger- fetal position is ideally longitudinal lie with cephalic occipito-anterior
56
Q

What are the 7 cardinal movements of labour?

A
  • engagement (fifths)
  • decent (reduce vaginal exams as much as possible to reduce infection)
  • flexion
  • internal rotation
  • crowning+extension (occiput in contact to the inferior margin at the symphysis pubis, painful for mother and episiotomy can be done)
  • restitution+external rotation
  • expulsion anterior shoulder first
57
Q

When should cord calming occur?

A

a minute after birth when there is cord pulsating so there is higher red cell flow to the fetal organs

58
Q

Why is skin to skin important?

A

immediately after birth for an hour uninterrupted makes babies breastfeed for longer

59
Q

How is active management of the third stage carried out?

A

prophylactic syntometrine

60
Q

What is abnormal postpartum blood loss?

A

over 500mls with greater significance if over 1000mls

61
Q

What is lochia?

A

bleeding in puerperium (6 weeks after) which lasts 10 days starting red and turning watery then yellow

62
Q

What is lactation initiated by?

A

placental expulsion and a decrease in oestrogen and progesterone

63
Q

What does the ductus venous do?

A

carries the blood from the umbilical vein into the inferior vena cava

64
Q

What is the foramen ovale?

A

hole between the atria so the blood passes from the R atrium into the L atrium

65
Q

What does the ductus arteriosus do?

A

connects the descending aorta to the pulmonary bifurcation so in utero the blood flows to the systemic circulation through the aorta as it is low resistance (compared to the lungs)

66
Q

What is the contents of the blood to the head and neck/upper body in the foetus?

A

most oxygenated as it is before the ductus arteriosus

67
Q

What produces surfactant?

A

Type 2 pneumocytes

68
Q

What happens as the baby begins to breathe?

A
  • fluid is reabsorbed
  • reduced prostaglandins
  • pulmonary vascular resistance drops
69
Q

What happens just after birth?

A

-pulmonary vascular resistance drops as baby breathes
-systemic vascular resistance rises when the cord is cut
duct constricts (less prostaglandins, high pO2 and reduced flow through it)
-oxygen tension rises
-foramen ovale closes

70
Q

How do babies stay warm firstly?

A
  • use brown fat laid down between scapula and around internal organs in 3rd trimester by non-shivering thermogenesis
  • peripheral vasoconstriction
71
Q

What does the baby use for nutrition firstly?

A
  • glycogen stores in liver and muscle and this is used after birth as there is a drop in insulin and increase in glucagon
  • babies can also use ketones and lactate to fuel their brains
72
Q

What happens to the babies Bohr curve?

A

increase is 2,3 DPG shift the pp curve to the right

73
Q

What is psychological jaundice?

A
  • occurs due to the breakdown of fetal haemoglobin and the conjugating pathways are immature so there is rise in unconjugated bilirubin
  • lasts less than 2w
74
Q

What can cause failure of cardioresp system in babies?

A
  • cold
  • aspiration pneumonia
  • prematurity
  • resus at birth
  • GBS causing sepsis
75
Q

What can cause babies to become hypoglycaemic?

A
  • unwell or cold (increased energy demands)
  • small (low glycogen stores)
  • maternal diabetes or hyperinsulinism (inappropriate insulin to glucagon ratio)
  • drugs
76
Q

What can qfPCR do in genetics?

A

shows how many chromosomes there are for each number so can show trisomy 21

77
Q

Which genetics tests pick up balanced and imbalanced arrangements?

A
  • chromosome microarray has high resolution but only shows imbalance
  • karyotyping picks up balanced changed arrangements
78
Q

What are mosaics from?

A

denovo mutations not inherited mutations

79
Q

What is an important thing to counsel patients for every test esp genetic?

A

results can be inconclusive

80
Q

What is anticipation in genetics?

A

a disease presents earlier and earlier for each generation of a family

81
Q

What is a compound heterozygote in genetics?

A

when you have two different mutations causing faulty gene on the same gene

82
Q

What is the differential for babies with delayed meconium passage?

A

CF

83
Q

How are smears tested?

A
  • HPV is tested for in the cervical screening and if this is negative then they come back in 5 years
  • If HPV positive, this then goes to cytology

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