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Reproduction and the growing child > Physiology of pregnancy > Flashcards

Physiology of pregnancy Flashcards

1
Q

Premature delivery is birth prior to X weeks

A

37

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2
Q

Characteristics of first pregnancy trimester?

A
  • Growth and development of the placenta

- Growth/development/establishment of the placenta

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3
Q

Key events (for the foetus) during trimester 1

A
  1. Fertilisation
  2. Implantation
  3. Initial development
  4. Placentation
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4
Q

Side effects of trimester 1 on the mother

A
  1. Weight gain

2. Nausea

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5
Q

Characteristics of trimester 2

A
  • Continued growth and development

- Development of the placenta continues

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6
Q

Key events (for the foetus) during trimester 2

A
  1. Nervous system develops
  2. Hair
  3. Spine straightens
  4. Pain
  5. Proportions change
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7
Q

Side effects of trimester 2 on the mother

A
  1. Placental growth
  2. Uterus rises (characteristic bump)
  3. HYPOvolemia
  4. Cardiac remodelling
  5. Breast remodelling
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8
Q

Characteristics of trimester 3

A
  • Development of the lung system

- Rapid growth of the foetus to the final birth weight

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9
Q

Key events (to the foetus) during trimester 3

A
  1. Growth
  2. Fat deposition
  3. Brain growth
  4. Blood cells
  5. Lung development
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10
Q

Side effects of trimester 3 on the mother

A
  1. Braxton-Hicks
  2. Tiredness
  3. Restricted breathing
  4. Lactation
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11
Q

What is decidualisation?

A

The change in structure of the endometrial lining, particularly the stroma which support the epithelium. Decidualised stroma supports/encourages/tolerates the invasion of trophoblast cells from the embryo
- The endometrium is changed in preparation for/during pregnancy

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12
Q

What can happen when decidualisation does not occur properly?

A

Recurrent implantation/ implantation failure

- This is where women are able to conceive but the embryo does not implant, so pregnancy is lost

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13
Q

After implantation, what happens to the trophectoderm trophoblast cells? (within the uterine lining, after decidualisation has occurred and the epithelium has grown back over the conceptus)

A

They begin to differentiate into 2 types of trophoblast cells:

  1. Outer-side are called SYNCITIAL TROPHOBLAST CELLS
  2. CYTOTROPHOBLAST CELLS: immediately next to the conceptus, they form important parts of the placenta
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14
Q

Explain the idea of histotrophic support and when it happens?
- How do syncitiotrophoblast cells play a role in this?

A
  • Prior to implantation, the embryo was free-living in the uterus, but now it has become implanted.
  • So when the conceptus invades the uterine wall, it can now be supported by the fluid produced into the uterine glands which we call histotrophic nutrition.
  • The embryo is also supported by the destruction of underlying stroma by invading trophoblast (syncitiotrophoblast) cells which liberate nutrients and components to support the developing embryo’s growth!
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15
Q

When can pregnancy be recognised by a pregnancy test?

A

7-9 days AFTER implantation which is around wk 3-4 of pregnancy
- This is when HCG is produced by the uterine wall

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16
Q

Following implantation, HCG is produced by the uterine wall which does what?

A

Acts on the LH receptors within the ovary (corpus luteum) to maintain 17-beta oestradiol and progesterone necessary for assistance and maintenance of pregnancy

17
Q

As HCG and progesterone levels rise, there is an impact on maternal physiology/signs of pregnancy, what are these?

A
  1. Suppressed menstrual cycle, to prevent shedding of the endometrial lining and loss of pregnancy = LATE PERIOD
  2. HCG and progesterone can lead to TENDER and ENLARGED breasts
  3. Fatigue
  4. Urinary frequency
  5. Nausea/vomiting = BIG SYMPTOM
  6. Constipation
18
Q

Give the causes of urinary frequency during pregnancy

A
  1. HCG hormone
    - Increases blood flow to the pelvic area and kidneys
    - Kidneys work more efficiently as you are excreting waste for two (baby included)
  2. Growing foetus puts pressure on the bladder
19
Q

During implantation, we have histotrophic support to begin with, but what happens to this?

A

Cessation of histotrophic support and this is taken over by haemotrophic support from the maternal blood supply = placenta development

20
Q

What are lacunae, how are they formed and what is their role?

A

As the syncitiotrophoblast cells digest the stroma of the uterus, pools of blood form within the syncitiotrophoblast cells that are called lacunae
- They allow the accumulation of nutrients to support growth of the foetus

21
Q

Explain how spiral artery modelling is initiated

A

As the syncitiotrophoblast (multi-nucleated) cells expand, they come into contact with maternal blood vessels that line and feed the wall of the embryo
- These blood vessels are spiralled and the syncitiotrophoblast initiates spiral remodelling where the maternal vasculature is remodelled to support embryonic growth

22
Q

What is meant by spiral artery remodelling?

A

The spiral arteries that feed the non-pregnant endometrium become more and more constricted, and to a very small overall volume

  • So we end up with a high pressure system that supplies the epithelial cells that line the uterus
  • The blood supply is released into the lacunae where they can nourish the developing conceptus’ cells in a low pressure environment
23
Q

The growth of syncitiotrophoblasts are called…

A

Primary villi

24
Q

Villi of chorionic syncitiotrophoblast penetrate the uterus at wk .. and terminate in the …

A

penetrate the uterus at wk 5 and terminate in the lacunae

- This is the initial vasculature of the placenta and foetal blood vessels

25
Q

Explain how maternal blood does not mix with foetal blood

A

Maternal blood sits in the lacunae which are in contact with the villi of the syncitiotrophoblast, so these are bathed in maternal blood
- REMEMBER THE FOETUS IS SURROUNDED BY INNER CYTOTROPHOBLAST AND OUTER SYNCITIOTROPHOBLAST CELLS

  • Since the syncitiotrophoblast villi are bathed in the maternal blood, this allows exchange of nutrients from the blood supply to the foetal blood supply without any physical exchange of blood, also taking waste away
26
Q

The fully mature placenta takes around … wks to develop, although the general anatomical structures of the villi that terminate in the lacunae are formed at around week …

A

12
4
- Before this point the embryo is developing by means of histotrophs and in a hypoxic environment!

27
Q

The umbilical cord is made of…

A

Wharton’s Jelly

28
Q

When is the umbilical cord fully formed?

A

Wk7

29
Q

Explain how the umbilical cord is formed

A

The developing embryo consists of a trilaminar disc attached to the decidua basalis by the connecting stalk, the primitive umbilical cord

The connecting stalk is a thick stalk of the extraembryonic membrane extending from the caudal end of the embryo to the center of the developing placenta on the decidua basalis.

Between the fourth and eighth weeks, there is an increase in amniotic fluid production, which causes the amniotic cavity to swell and fill the chorionic space. This increase in the amniotic fluid also causes elongation of the connecting stalk, and the yolk sac is compressed down within the connecting stalk to form the omphalomesenteric or vitelline duct

The expansion of the amniotic cavity causes the amnion and the chorion to come into contact, and the extraembryonic mesoderm covering these two layers fuses. As such, the chorionic cavity disappears, leaving the umbilical cord, the composite of the connecting stalk and vitelline duct surrounded by the amnion, floating in the amniotic fluid.

30
Q

What is the role of the umbilical cord?

A
  • Connection between maternal and foetal blood supply coalesces in the umbilical cord
  • Critical for delivering O2, nutrients and hormones to the baby for growth
  • Critical for exchange and removal of waste & CO2, this is delivered from the foetus into the placental vasculature to be discarded by the mother
31
Q

Role of the placenta: as a transporting organ

A
  1. Enables exchange of respiratory gases between mother and foetus
  2. Supplies nutrients, particularly glucose, via GLUT1,3,4,12
  3. VLDLs and chylomicrons are metabolised by lipoprotein lipase from the placenta and fed to the foetus
  4. FFAs fed into the foetus via the placenta
32
Q

Role of the placenta: as an endocrine organ

A
  1. Forms hCG which maintains the corpus luteum
  2. Co-operates with the foetus to produce oestrogens
    - At the end this will have physiological effects such as relaxation of pelvic ligaments and >elasticity of symphysis pubis to enable delivery
  3. Produces progesterone
  4. Produces somato-mammotropin
33
Q

How does oedema develop during pregnancy?

A
  1. Increased blood volume due to increase in placental hormones oestrogen and progesterone
  2. Increased angiogenesis due to rising oestrogen, leads to increased blood volume
  3. Progesterone causes vasodilation and reduced peripheral resistance, causing increased blood volume
  4. Oestrogen causes hepatic AngII expression, causing increased renal aldosterone, leading to increased blood volume
  5. Progesterone also increases aldosterone levels and acts on thirst sensor to increase fluid retention, leading to increased blood volume
34
Q

The HR in pregnancy increases by …%

The size of the heart increases by …%

A

20%

12%

35
Q

The displacement and enlargement of the ureters, alongside decreased bladder tone will lead to?

A
  1. Urinary reflux
  2. Urinary stasis
  3. Urine richer in glucose and AAS
  • All of ^ leads to increased UTI risk
36
Q

Explain the role of progestogen in breast remodelling

A

Causes increased growth of alveoli and lobules

37
Q

Explain the role of oestrogen in breast remodelling

A

Stimulates growth and development of milk ducts

38
Q

Explain the role of human placental lactogen in breast remodelling

A

Mimics prolactin and growth hormone, causing breast, nipple and areola to enlarge

Reproduction and the growing child (22 decks)

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