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Reproduction and Sexual Health > physiology of pregnancy > Flashcards

physiology of pregnancy Flashcards

1
Q

HCG released by trophoblast signals the corpus luteum to continue secreting which hormone?

A
  • progesterone
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2
Q

supply of oxygen to fetus is facilitated by the increased ability of fetal haemoglobin to carry oxygen. The concentration of fetal haemoglobin in a healthy fetus is what % more than the haemoglobin conc of adult blood?

A
  • 50% more
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3
Q

cardiac output in pregnancy increases by?

A
  • 40%
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4
Q

regarding maternal respiratory function in pregnancy does vital capacity increase true or false?

A

true

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5
Q

regarding maternal resp function in pregnancy is oxygen consumption increased? true or false?

A
  • true
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6
Q

regarding maternal resp function in pregnancy is progesterone predominantly responsible for resp adaptations in pregnancy true or false?

A

true

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7
Q

regarding maternal resp function in pregnancy is PCO2 reduced? true or false?

A

true

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8
Q

is von willebrand factor increased in pregnancy true or false?

A
  • true it is increased
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9
Q

what is the typical maternal weight gain in pregnancy?

A
  • 11kg
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10
Q

the third stage of labour is defined as?

A
  • delivery of placenta
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11
Q

prolactin stimulates milk production and is released from which part of the brain?

A
  • anterior pituitary
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12
Q

oxytocin is required for release of milk from breast to suckling infant. it is released from which part of the brain?

A
  • posterior pituitary
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13
Q

the fertilised ovum progressively divides and differentiates into what?

A
  • blastocyst
  • moves down from site of fertilisation in upper oviduct to site of implantation in the uterus
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14
Q

at what days does the transport of the blastocyst into the uterus occur?

A
  • 3-5 days
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15
Q

at what days does the blastocyst attach to the lining of the uterus?

A
  • 5-8 days
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16
Q

which part of the blastocyst burrow into the uterine wall and become placenta

A
  • outer cells
  • inner cells develop into the embryo
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17
Q

what does the placenta do?

A
  • produces several hormones to maintain pregnancy
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18
Q

cords of what cells - begin to penetrate the endometrium once the free-floating blastocyst adheres to the endometrial lining?

A
  • trophoblastic cells
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19
Q

placenta is derived from what two tissues?

A
  • trophoblast and decidual tissue
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20
Q

trophoblast cells differentiate into what kind of cells?

A
  • multinucleate cells (syncytiotrophoblasts)
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21
Q

what do multinucleate cells do?

A
  • invade decidua and break down capillaries to form cavities filled w maternal blood
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22
Q

developing embyro sends capillaries into the syncytiotrophoblast projections to form what?

A
  • placental villi
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23
Q

villi contains what?

A
  • fetal capillaries separated from maternal blood by a thin layer of tissue - no direct between fetal and maternal blood
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24
Q

how does 2 way exchange occur between mother and foetus?

A
  • largely down diffusion gradient
  • resp gases, nutrients and metabolites are exchanged here
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25
Q

at what week in pregnancy is placenta and heart functional?

A
  • 5th week of pregnancy
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26
Q

early nutrition of embryo involves invasion of what cells into the decidua?

A
  • trophoblastic cells
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27
Q

HCG signals the corpus luteum to continue secreting what?

A
  • progesterone
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28
Q

what does progesterone stimulate decidual cells to do?

A
  • to concentrate glycogen, proteins and lipids
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29
Q

as placenta develops it extends what kind of projections (villi) into the uterine wall

A
  • hair-like
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30
Q

how does villi work?

A
  • increases contact area between uterus and placenta allowing more nutrients and waste materials to be exchanged
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31
Q

blood vessels from embryo develop in what?

A
  • in the villi
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32
Q

is the mothers blood and embryo’s blood in direct contact true or false?

A
  • false
  • a thin membrane separates the embryos blood in villi from mothers blood in intervillous space
  • circulation within the intervillous space acts partly as a AV shunt
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33
Q

the placenta plays the role of the foetals …..?

A
  • lungs
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34
Q

respiratory function of the placenta makes supply of oxygen and removal of what?

A
  • carbon dioxide
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35
Q

is maternal blood considered oxygen rich blood?

A
  • yes
    and the umbilical blood (mixing of arterial and venous blood - is considered oxygen poor)
  • oxygen diffuses from maternal into foetal circulation system
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36
Q

is carbon dioxide elevated in foetal blood true or false?

A
  • true
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37
Q

how does foetal oxygenated blood return to the fetus?

A
  • via umbilical vein
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38
Q

how does maternal, oxygen-poor blood flow back into circulatory system?

A
  • via uterine veins
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39
Q

what 3 factors facilitate the supply of the fetus w oxygen?

A
  • foetal Hb - increased ability to carry O2
  • higher Hb conc in foetal blood
  • bohr effect - foetal Hb can carry more O2 in low pCO2 than in high pCO2
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40
Q

how does placetal exchange processes occur?

A
  • via classic membranous transport mechanisms
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41
Q

how does water diffuse into placenta?

A
  • along its osmotic gradient
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42
Q

electrolytes follow what substance?

A
  • water
  • iron and Ca2+ can only go FROM mother TO child
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43
Q

glucose passes the placenta via what kind of transport?

A
  • simplified transport
  • high glucose is required in 3rd trimester
  • fetus’ main source of energy
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44
Q

fatty acids diffuse across the placenta how?

A
  • free diffusion
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45
Q

waste products diffusion is based on what?

A
  • concentration gradient
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46
Q

what does HCG do?

A
  • prevents involution of corpus luteum - corpus luteum stimulates progesterone and oestrogen
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47
Q

HCG serum levels increase by how much every 48 hours in a singleton pregnancy?

A
  • levels double
48
Q

in an ectopic pregnancy what does HCG do?

A
  • remains static or it is slow rising
49
Q

in a failing pregnancy the HCG can be seen to?

A
  • start falling
50
Q

ongoing viable pregnancy you will see?

A
  • doubling, or >60% rise
51
Q

what are some side effects of HCG on mother?

A
  • nausea and vomiting
52
Q

when is HCG found to be very high?

A
  • in multiple pregnancies or molar pregnancies
53
Q

what point do levels of HCG begin to fall?

A
  • 12-14 weeks
54
Q

human placental lactogen is produced at what point of pregnancy?

A
  • week 5 of pregnancy
55
Q

what does human placental lactogen do?

A
  • involved in protein tissue formation
  • decreases insulin sensitivity in mother - allow more glucose for foetus
  • also involved in breast development
56
Q

what does progesterone do?

A
  • development of decidual cells
  • decreases uterus contractility
  • preparation for lactation
57
Q

what does oestrogen do?

A
  • allows for enlargement of uterus
  • breast development
  • relaxation of ligaments
58
Q

CRH -> ACTH -> aldosterone and cortisol -> ?

A

aldosterone -> can cause maternal hypertension
cortisol -> can cause inc oedema, insulin resistance -> leading to gestational diabetes

59
Q

drugs can also cross placental barrier, what drugs are considered as teratogens?

A
  • thalidomide, carbamazepine, coumarins, tetracycline
  • alcohol, nicotine, heroine, cocaine, caffeine
  • drugs - excluding alcohol -> 3% of all congenital malformations
60
Q

HCG and HC thyrotropin ->

A
  • can cause hyperthyroidism
61
Q

increasing Ca2+ demands can cause

A
  • hyperparathyroidism
62
Q

why is there an increase in CO during pregnancy?

A
  • due to demands of uteroplacental circulation
63
Q

during labour cardiac output can increase how much?

A
  • 30%
64
Q

increase in CO can result in what kind of changes in heart?

A
  • ECG changes
  • functional murmurs
  • heart sounds
    -> considered all normal changes
65
Q

HR increases up to what to increase CO?

A
  • up to 90min to increase CO
66
Q

blood pressure drops during what semester of pregnancy?

A
  • 2nd trimester
  • this is because uteroplacental circulation expands and peripheral resistance decreases
67
Q

in multiple pregnancies, CO increases more and BP drops more? true or false?

A
  • true
68
Q

how much lower is BP than pre-pregnancy BP?

A
  • 15mmHg
69
Q

BP rises in what trimester reaching pre-pregnancy levels again?

A
  • 3rd trimester
70
Q

does plasma volume increase proportionally w cardiac output true or false?

A
  • true
71
Q

why when erythropoesis increases, Hb decreases?

A
  • it is decreased by dilution (decreases blood viscosity)
72
Q

do iron requirements increase in pregnancy?

A
  • yes
  • as womens blood vol increases 50%, RBCs only increase by around 30%, this leads to a natural haemodilution
  • therefore there is an inc in iron requirements and inadequate iron levels affect huge no of women
  • therefore iron supplementation is required.
73
Q

why does lung function change during pregnancy?

A
  • in response to progesterone
  • also because the enlarging uterus interferes w lung function
74
Q

what does progesterone signal the brain to do regarding respiration?

A
  • signals to brain to lower CO2 levels - inc CO2 sensitivity in resp centres
75
Q

O2 consumption increases to meet metabolic need of fetus, placenta and mother true or false?

A
  • true
76
Q

how does body lower CO2 levels in a pregnant women?

A
  • increasing resp rate
  • increasing tidal and minute volume
  • pCO2 decreasing slightly
  • vital capacity and PO2 don’t change
77
Q

GFR and renal plasma flow increases in pregnancy true or false?

A
  • true
  • up to 30-50% peaking at mid trimester - 16-24 weeks
78
Q

there is an increased re-absorption of ions and water - what is this process driven by?

A
  • placental steroids
  • aldosterone
79
Q

first trimester anaemia in pregnancy as defined as Hb below what level?

A

< 110g/L

80
Q

2nd and 3rd trimester anaemia in pregnancy is defined as?

A
  • Hb <105g/L
81
Q

outwith pregnancy anaemia is defined as Hb between?

A
  • 120-160g/L
82
Q

is there an increase in urine formation?

A
  • slight increase in urine formation
83
Q

how does upright position affect renal function?

A
  • decreases renal function
84
Q

how does supine position affect renal function?

A
  • increases renal function
85
Q

how does lateral position affect renal function?

A
  • significantly increases renal function
  • why in 3rd trimester many women sleep in a lateral position to sleep
86
Q

due to increased plasma vol and inc GFR following ranges differ in pregnancy - study

A

ALT decreases <30U/L (5-55)
Urea <3.5mmol/L (2.5-7.8)
creatinine <50umol/L (44-80)
albumin 20-40g/L (30-50)

87
Q

what changes occur to maternal coagulation?

A
  • in pregnancy womens blood becomes a hypercoagulable state
  • reduces risk of haemorrhage during and after delivery however comes w increased risk of VTE
88
Q

how many extra kcal/day should be ingested by the mother?

A
  • 200 extra kcal/day
    > 30g/day extra protein intake
89
Q

1st-20th week there is a normal or increased sensitivity to insulin? true or false?

A
  • true
89
Q

1st-20th week there is a normal or increased sensitivity to insulin? true or false?

A
  • true
90
Q

21st-40th week there is maternal insulin resistance true or false?

A
  • true
    due to human placental lactogen, cortisol, and growth hormone
91
Q

nutritional requirements in pregnancy?

A
  • folic acid (folate) -> reduces risk of neural tube defects
  • vit D supplements
  • high protein diet, high energy uptake
  • iron supplements may be required
  • B vitamins - erythropoesis
92
Q

what is parturition?

A
  • birth of the baby
  • towards end of pregnancy, uterus becomes progressively more excitable
93
Q

progesterone increases contractility towards end of pregnancy true or false?

A
  • false, oestrogen increases contractility, whilst progesterone inhibits contractility
94
Q

prostaglandins are produced by what structures?

A
  • placenta
  • myometrium
  • decidua
  • membranes
95
Q

oxytocin - released from posterior pituitary gland - does what to uterus?

A
  • increases contractions and excitability
96
Q

mechanical stretch of uterine muscle does what?

A
  • increases contractility
97
Q

does D-dimer decrease during pregnancy?

A
  • no it increases thus why for potential PE in pregnant women, D-dimer is not routinely measured
98
Q

which factor remains unchanged during pregnancy?

A
  • factor II
99
Q

is fibrinogen increased or decreased in pregnancy?

A
  • increased
100
Q

is plasminogen increased or decreased during pregnancy?

A
  • increased
101
Q

is vWF increased or decreased during pregnancy true or false?

A
  • increased
102
Q

is antithrombin increased, decreased, or unchanged during pregnancy?

A
  • unchanged
103
Q

braxton hicks contractions increase toward the end of pregnancy, what are these?

A
  • sometimes known as ‘false’ or ‘practice’ contractions
  • caused by muscles of uterus tightening
  • felt in front of the body
104
Q

what else occurs at onset of labour?

A
  • cervical ripening
  • stretch of cervix by fetal head increases contractility
  • cervical stretching also causes further oxytocin release
  • strong uterine contraction and pain from birth canal can cause neurogenic reflexes from spinal cord -> inducing intense abdominal muscle contractions
105
Q

study physiological changes at onset of labour

A
106
Q

what is 1st stage of labour?

A
  • cervical dilation 8-24 hours
107
Q

what is 2nd stage of labour?

A
  • passage of fetus through birth canal (few mins to 120 mins)
108
Q

what is 3rd stage of labour?

A
  • expulsion of placenta
109
Q

what controls growth of ductile system?

A
  • oestrogen
110
Q

what controls development of lobule-alveolar system?

A
  • progesterone
111
Q

both oestrogen and progesterone inhibit milk production true or false?

A
  • true
    -> at birth there is a sudden drop in these hormones
112
Q

what stimulates milk production?

A
  • prolactin
    -> stead rise in levels of prolactin from week 5 till birth
    -> 1-7 days after birth, prolactin induces high milk production
    -> stimulates colostrum (low vol, no fat)
113
Q

oxytocin is responsible for what process?

A
  • ‘milk let-down’ reflex
114
Q

what stimulates the milk let-down reflex

A
  • stimulated by baby’s suction on nipple
115
Q

what happens after baby has attached to nipple in milk let-down reflex?

A
  • impulses are propogated in spinal cord
  • to higher brain centres
  • causing stimulation of hypothalamic nuclei
  • release of oxytocin from posterior pituitary
  • milk is then ejected at the nipple

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