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Physiology Of Pregnancy Flashcards

1
Q

How long is the Average Human Pregancy?

A

40 weeks - (9 months)

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2
Q

How many trimesters in pregnancy?

A
  • Three Trimesters
    • first (<12 weeks)
    • second (12 weeks to end week 26)
    • third (27 weeks – birth)
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3
Q

When is the First Trimester? (Pregancy)

A

first (<12 weeks)

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4
Q

When is the Second Trimester? (Pregancy)

A

second (12 weeks to end week 26)

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5
Q

When is the Third Trimester? (Pregancy)

A

third (27 weeks – birth)

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6
Q

During Pregnancy, there are many … changes – ie. not … changes - that take place to support the to support the needs of a … …

A
  • During Pregnancy, there are many physiological changes – ie. not pathological changes - that take place to support the to support the needs of a growing fetus
    • Supplying a baby with enough nutrients (O2, glucose, amino acids) for growth, development, production of amniotic fluid
    • Managing increased waste production – eg. CO2, nitrogen compounds
    • Change in hormones to support pregnancy and prepare
    • for delivery
    • Anatomical changes to accommodate the growing fetus and
    • preparing for labour
    • Manage the stresses of delivery and potential haemorrhage
    • Postnatal Recovery and Breastfeeding
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7
Q

Physiological Changes During Pregnancy:

  • Supplying a baby with enough … (O2, glucose, amino acids) for growth, development, production of … fluid
  • Managing increased … production – eg. CO2, nitrogen compounds
  • Change in … to support pregnancy and prepare
  • for delivery
  • … changes to accommodate the growing fetus and
  • preparing for labour
  • Manage the … of delivery and potential …
  • … Recovery and B…
A
  • Supplying a baby with enough nutrients (O2, glucose, amino acids) for growth, development, production of amniotic fluid
  • Managing increased waste production – eg. CO2, nitrogen compounds
  • Change in hormones to support pregnancy and prepare
  • for delivery
  • Anatomical changes to accommodate the growing fetus and
  • preparing for labour
  • Manage the stresses of delivery and potential haemorrhage
  • Postnatal Recovery and Breastfeeding
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8
Q

Which systems undergo some form of change during Pregnancy?

A
  • All of them!!
    • Endocrine
    • Cardiovascular
    • Respiratory
    • Haematocological
    • Musculoskeletal/Dermatological
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9
Q

Endocrine Changes During Pregnancy

  • 3 MAIN HORMONES INVOLVED IN PREGNANCY that you need to know about
    • … – dramatic rise in the first days-weeks - released from the corpus luteum initially, then by placenta
    • … - keeps the state of quiescence
    • … – breast growth, areolar enlargement
  • Other hormone changes include …, … and …
A
  • 3 MAIN HORMONES INVOLVED IN PREGNANCY that you need to know about
    • BHCG – dramatic rise in the first days-weeks - released from the corpus luteum initially, then by placenta
    • Pro-gest-erone eg.pro-gestation - keeps the state of quiescence
    • Oestrogen – breast growth, areolar enlargement
  • Other hormone changes include relaxin, inhibin and TSH
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10
Q

BHCG and Pregnancy

  • When is there a dramatic rise?
  • Released by … initially, then by …
A
  • Dramatic rise in the first days-weeks
  • released from the corpus luteum initially, then by placenta
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11
Q

Progesterone and Pregnancy

  • Keeps the state of …
A
  • Keeps the state of quiescence
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12
Q

Oestrogen and Pregnancy

  • Growth of … and enlargement of …
A
  • breast growth, areolar enlargement
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13
Q

HCG & Pregnancy - Clinical Picture

  • Maintains corpus luteum secretion of prog & oest, … as the placental production of progesterone increases
  • … unit forms the basis of pregnancy testing.
  • … unit can mimic LH, FSH, and TSH
  • Large quantities are released in … pregnancy and … pregnancy
  • High levels cause … (hyper…)
A
  • Maintains corpus luteum secretion of prog & oest, decreases as the placental production of progesterone increases
  • beta unit forms the basis of pregnancy testing.
  • Alpha unit can mimic LH, FSH, and TSH
  • Large quantities are released in molar pregnancy and multiple pregnancy
  • High levels cause vomiting (hyperemesis)
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14
Q

Progesterone & Pregnancy - Clinical Picture

  • Progesterone relaxes … … – everywhere!
  • Maintains uterine … by … uterine electrical activity
  • Constipation, … reflux, supra-… dysfunction
  • … suppressor ( HLA )
  • Lobulo-alveolar development in …
  • Substrate for fetal adrenal corticoid synthesis eg. …
A
  • Progesterone relaxes smooth muscle – everywhere!
  • Maintains uterine quiescence by decreasing uterine electrical activity
  • Constipation, gastric reflux, supra-pubic dysfunction
  • Immune suppressor ( HLA )
  • Lobulo-alveolar development in breasts
  • Substrate for fetal adrenal corticoid synthesis eg cortisol
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15
Q

Oestrogen & Pregnancy - Clinical Picture

  • Growth of the …, … changes
  • Development of … system of breasts
  • Stimulation of … synthesis
A
  • Growth of the uterus, cervical changes
  • Development of ductal system of breasts
  • Stimulation of prolactin synthesis
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16
Q

The Placenta as an Endocrine Organ

  • Protein hormones:
    • hCG (human chorionic gonadotrophin) – produced by trophoblast, first detectable 8-9 days, peaks 8-9 weeks.
    • hPL (human placental lactogen) - Similar structure to prolactin and growth hormone. Larger placenta produces … hPL. Alters maternal carbohydrate and lipid … to provide steady state of glucose for fetal requirements
    • hPG (human placental gonadotrophin) induces maternal … resistance to regulate fetal … – this may become a pathological process seen as GDM
      • CRH (corticotropin releasing hormone)
  • Steroids:
    • …
    • … (oestriol)
A
  • Protein hormones:
    • hCG (human chorionic gonadotrophin) – produced by trophoblast, first detectable 8-9 days, peaks 8-9 weeks.
    • hPL (human placental lactogen) - Similar structure to prolactin and growth hormone. Larger placenta produces more hPL. Alters maternal carbohydrate and lipid metabolism to provide steady state of glucose for fetal requirements
    • hPG (human placental gonadotrophin) induces maternal insulin resistance to regulate fetal growth – this may become a pathological process seen as GDM
      • CRH (corticotropin releasing hormone)
  • Steroids:
    • Progesterone
    • Oestrogen (oestriol)
17
Q

During Pregnancy, there is a …% increase in plasma volume

A

During Pregnancy, there is a 40% increase in plasma volume - 2.5L to 3.7L (8-10kg gain)

18
Q

During Pregnancy, there is a …% increase in RBC, leading to …

A

During Pregnancy, there is a 25% increase in RBC, leading to dilutional anaemia

19
Q

During Pregnancy, Plasma colloid osmotic pressure …

A

During Pregnancy, Plasma colloid osmotic pressure falls - shift of fluid into extracellular space

20
Q

During Pregnancy, there is an … in clotting factors - … state

A

During Pregnancy, there is an increase in clotting factors - hypercoaguable state

  • evolutionary balance between thrombosis and haemorrhage
  • Increasine plasma fibrinogen (increased ESR), platelets, factor VIII, and von willebrand factor
21
Q

Cardiovascular System and Pregnancy

  • Increased blood volume has implications on:
    • cardiac output (…) increase or decrease?
    • peripheral resistance (…) increase or decrease?
    • … pressure
  • Heart is working hard reach supply demands of the fetus – increase in heart rate and stroke volume to account for …
    • Remember C.O. = … x …
    • Heart enlarges by ….% (increased venous return)
    • Innocent … murmurs are common (~90%)
    • Beware … murmur – may signify cardio…
A
  • Increased blood volume has implications on:
    • cardiac output (increased)
    • peripheral resistance (decreased)
    • blood pressure (slightly lower)
  • Heart is working hard reach supply demands of the fetus – increase in heart rate and stroke volume to account for increase in cardiac output
    • Remember C.O. = Stroke volume x Heart Rate
    • Heart enlarges by 12% (increased venous return)
    • Innocent systolic murmurs are common (~90%)
    • Beware diastolic murmur – may signify cardiomyopathy
22
Q

During Pregnancy, the heart is working heard to reach supply demands of the fetus. The heart enlarges by …%

A

During Pregnancy, the heart is working heard to reach supply demands of the fetus. The heart enlarges by 12%

23
Q

Innocent … murmurs are common during pregnancy

A

Innocent systolic murmurs are common during pregnancy (approx 90%)

24
Q

Beware … murmurs during pregnancy - may signify cardiomyopathy

A

Beware diastolic murmurs during pregnancy - may signify cardiomyopathy

25
Q

Peripheral Vascular Resistance - Pregnancy

  • Peripheral vasodilatation (effect of …)
  • Peripheral resistance decreases by …%
  • Combined with … cardiac output, results in slightly … BP
  • Decreased vascular resistance leads to … blood pressure
A
  • Peripheral vasodilatation (effect of progesterone)
  • Peripheral resistance decreases by 35%
  • Combined with increased cardiac output, results in slightly lower BP
  • Decreased vascular resistance leads to lower blood pressure
26
Q

Pregnancy and CVS overview

27
Q

Respiratory System - Non-pregnant

28
Q

Respiratory System and Pregnancy

  • Increased … demands
  • Decrease maternal p… & increase maternal p…
  • Increased availability of O2 to tissues and aids passive diffusion at the …, HbF … oxygen affinity
A
  • Increased oxygen demands!
  • Decrease maternal pCO2 & increase maternal pO2
  • Increased availability of O2 to tissues and aids passive diffusion at the placenta, HbF higher oxygen affinity
29
Q

Respiratory System and Pregnancy

30
Q

Clinical Picture - Pregnancy & Respiratory and Cardiovascular System

  • Splinting of diaphrgm, increased ventilation – sensation of increasing …
  • Raised HR leads to …
  • Lots of cross over with symptoms for … and known hypercoagulable state… leads to lots of investigations…!
  • Excess plasma volume shifts causing … – peripheral
  • Decreased … tolerance
  • Low BP causing … / …
A
  • Splinting of diaphrgm, increased ventilation – sensation of increasing SOB
  • Raised HR leads to palpitations
  • Lots of cross over with symptoms for PE and known hypercoagulable state… leads to lots of investigations…!
  • Excess plasma volume shifts causing oedema – peripheral
  • Decreased exercise tolerance
  • Low BP causing fainting / dizziness
31
Q

Musculo-skeletal / Dermatological Changes in Pregnancy

  • Increased lumbar …
  • Ligamentous … – pelvic girdle pain / pubis dysfunction
  • … marks
  • Changes in skin … - Linea Nigra, melasma, darkened nipples
  • … Tunnel
  • S…
  • Cr..
A
  • Increased lumbar lordosis - Lordosis is the inward curve of the lumbar spine (just above the buttocks)
  • Ligamentous laxity – pelvic girdle pain / pubis dysfunction
  • Stretch marks
  • Changes in skin pigmentation - Linea Nigra, melasma, darkened nipples
  • Carpal Tunnel
  • Sciatica
  • Cramps
32
Q

What is Sciatica?

A

Sciatica is where the sciatic nerve, which runs from your lower back to your feet, is irritated or compressed

33
Q

Breast Changes in Pregnancy

  • oestrogen increases … tissue – enlargement and areolar enlargements and the ductal system
  • Progesterone enlarges breast …
A
  • oestrogen increases adipose tissue – enlargement and areolar enlargements and the ductal system
  • Progesterone enlarges breast lobules
34
Q

Urological Changes in Pregnancy

  • Kidney increases …cm in size during normal pregnancy
  • increased renal flow by …%
  • increased … (BUT tubular reabsorption capacity is unchanged) - decreased glucose reabsorption - glycosuria is common
  • Plasma levels of creatinine and urea … in pregnancy
  • … ureters (progesterone)
  • Increased … (increased urine …)
A
  • Kidney increases 1cm in size during normal pregnancy
  • increased renal flow by 50%
  • increased GFR (BUT tubular reabsorption capacity is unchanged) - decreased glucose reabsorption - glycosuria is common
  • Plasma levels of creatinine and urea decrease in pregnancy
  • Dilated ureters (progesterone)
  • Increased pressure (increased urine frequency)
35
Q

Kidney increases …cm in size during normal pregnancy

A

Kidney increases 1cm in size during normal pregnancy

36
Q

In pregnancy, increased renal flow by …%

A

In pregnancy, increased renal flow by 50%

37
Q

Thyroid Changes in Pregnancy

  • … serum T3 & T4 levels, … in thyroid binding globulin (oestrogen)
  • As only unbound T3 and T4 is active, levels of free T3 and T4 …. or … slightly
A
  • Increased serum T3 & T4 levels, Increase in thyroid binding globulin (oestrogen)
  • As only unbound T3 and T4 is active, levels of free T3 and T4 remain the same or fall slightly
38
Q

Physiological Changes during Pregnancy - System Overview

Year 2 Medicine (162 decks)

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