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Physiology of Pregnancy Flashcards

1
Q

What structures secrete progesterone?

A

placenta, corpus leuteum

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2
Q

Which hormone(s) thickens the endometrial lining in preparation of implantation?

A

estrogen, progesterone

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3
Q

What hormone is measured as part of pregnancy tests?

A

hCG

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4
Q

Mature egg is released and supported by which two structures?

A

corona radiata and mucification

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5
Q

The egg is released into the ________ and caught by ________

A

peritoneal cavity , fimbrae

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6
Q

in the oviduct, the________ goes through meiosis I, leading to secondary oocyte, an inactive ___________

A

oocyte ,polar body

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7
Q

Fertilization = when _______ and _________ meet to form a zygote. This usually happens in the ___________. It is a 24 hr process

A

sperm, ovum, fallopian tube

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8
Q

What is the process of fertilization?

A

sperm produces enzymes to burrow through corona radiata and fuses with the egg’s plasma membrane > sperm head disconnects from flagella > After binding to the corona radiata the sperm reaches the zona pellucida and releases enzymes > Granules inside the secondary oocyte fuse with the plasma membrane of the cell, making the whole matrix hard and impermeable thus preventing fertilization by more than one sperm > Oocyte now undergoes its second meiotic division producing the haploid ovum and releasing a polar body > The sperm nucleus then fuses with the ovum, enabling fusion of their genetic material.

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9
Q

In implantation, the zygote becomes an ______ at day _______ with continued divisions as it travels down fallopian tube.

A

embryo, 5

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10
Q

Implantation in the uterus happens ________ days after _______

A

5-6, fertilization

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11
Q

In implantation, the _____ embeds in the ________. Eventually becomes the site of the placenta. This is the _____________

A

embro, endometrium, maternal system interface

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12
Q

By day _________ of implantations, there are already differentiating into various layers and cell types

A

7

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13
Q

________ is secreted which can be detected by day ______ - _______ (implantation must be successful first)

A

hCG, 6-14

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14
Q

Estrogen is critical in pregnancy and is mostly produced by _________

A

ovaries

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15
Q

What are the roles of estrogen in pregnancy?

A
  1. Growth of ovarian follicles, increase motility of ovarian follicles
  2. Increases amount of uterine muscle & contractile proteins
  3. Increase secretion of angiotensin & thyroid-binding globulin
    ***Salt and water retention
  4. Duct growth in the breast and breast enlargement
  5. Pigment changes in the skin
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16
Q

Progesterone is secreted by the _______ and ________

A

corpus luteum & placenta

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17
Q

Progesterone mostly targets the _____, ____ and _____

A

uterus, breast & brain

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18
Q

What are the functions of progesterone in pregnancy?

A

Smooth muscle relaxer:

  1. Uterus
    Endometrial growth
    Anti-estrogen – decreases excitability
  2. Breast
    Lobules and alveoli development
  3. Brain
    Thought to raise basal body temperature
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19
Q

What is relaxin secreted by?

A

Secreted by corpus luteum

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20
Q

What are the roles of relaxin

A

Secreted by corpus luteum
Softens symphysis pubis
Relaxes pelvic joints
Softens & dilates cervix
Inhibits uterine contractions
May play role in development of mammary glands

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21
Q

What is prolactin stimulated by?

A

anterior pituitary, endometrium, placenta

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22
Q

What are the roles of prolactin?

A

Causes milk secretion from breast that have been primed by estrogen & progesterone
May prevent ovulation
Effected by exercise, surgery & stress
Rises during sleep & pregnancy
Falls after delivery unless breastfeeding initiated
Suckling increases levels

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23
Q

What is HCG secreted by?

A

the placenta

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24
Q

Which hormone is found in pregnancy tests?

A

hCG

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25
HCG rises rapidly in _______ pregnancy (doubles every 2-3 days)
early
26
What is a normal length of a pregnancy?
37-42 weeks
27
What is Naegle's rule?
LMP(last menstrual period) +7 days -3 months
28
Quickening
(fetal movement) occurs between 16-20 weeks
29
Uterine size/fundal height
Fundal height- palpating top of fundus(top of uterus) it hits right above pubic symphysis at 12 weeks pregnanct. At 20 weeks it will be in the umbilicus, if woman beyond 20 weeks if take tape measure and put 0 on top of pubic symphysis the number of gestation is the same as the cm. if shes 22 cm above her pubic symphysis she is somewhere between 20-24 gestation. So at 38 weeks she will be above 38.
30
What are the methods to determine the delivery date?
1. LMP: Naegle’s rule – LMP +7 days -3 months 2. Pregnancy test, + several days after implantation, usually 2 days to 1 week after expected menses 3. Quickening (fetal movement): occurs between 16-20 weeks 4. Uterine size/fundal height 5. Ultrasound -1st trimester most accurate
31
What are the reproductive and system changes in pregnancy?
1.Uterine growth & contractility 2. Cervical changes *Softer, friable *Bleeding – always a concern, but differs by trimester --Miscarriage --STD --Previa --Abruption 3. Vagina & perineum – mostly effected by estrogen -Increased vascularity -increased secretions -pH decreases
32
What are cardiovascular system changes needed for?
for organ perfusion & perfusion of fetal-placental unit
33
There are slight changes in cardiac position and size and up to the _______
left
34
T/F may hear new murmurs in pregnant women
True
35
There is increased cardiac output in pregnant patients and 10-20% goes to the ______________
uterus
36
The Vena cava can be compressed by the fundus after ______ weeks
20
37
Peripheral edema in pregnant patients
systemic vascular resistance lower -Uteroplacental circulation low-resistance -Estrogen & progesterone effects on vessel walls & vasodilation from -increased body temperature -Increased pressure on lower extremity vasculature
38
What are Blood volume changes ?
Range: 20-100% Average: 45-50%
39
What are plasma changes?
increase 30-50% Starts @ 6 weeks and peaks 30-34 weeks Probably secondary to estrogen & progesterone => sodium and water retention, vasodilation
40
What are RBC changes?
Erythropoietin levels start rising end of 1st trimester After plasma levels rise Increase 33% with iron supplementation, 18% without
41
What are Hemodilution changes due to?
to increased plasma volume -28-30 weeks, is physiologic & normal
42
What are WBC changes ?
WBC rises, 5-12,000 normal In labor 25-30,000
43
________ state is secondary to estrogen
Hypercoagulative
44
What are diaphragm changes ?
rises as uterus rises -More diaphragmatic breathing -Decreased abdominal tone
45
What occurs with the cartilage in the respiratory system
Cartilage softens and ribs flare slightly to allow greater transverse diameter
46
T/F there is increased oxygen consumption, slight increase in rate, and SOB in pregnant women?
True
47
Engorgement/edema of which structures in the respiratory system?
nasopharynx, larynx, trachea, bronchi
48
Sinus pressure and increased _______ are common
rhinorrhea
49
Astham exacerbations may present in ____ of patients
1/3
50
Urinary system changes
Kidney size increases Ureters dilate Bladder tone decreases Uterus compresses bladder depending on position Urinary frequency, urgency, stress incontinence common 1st trimester 3rd trimester Occult bacteria must be addressed as UTIs can trigger premature labor
51
What is a major urinary system risk for preterm labor?
UTI
52
Increased nutritional needs _______
300kcal
53
Nausea and vomiting: “Morning sickness”
Seems to correlated with increasing hCG levels, protective? Hyperemesis gravidarum, persistent vomiting with electrolyte disturbances or significant weight loss
54
Constipation
Progesterone slows motility Increased water absorption Iron supplementation
55
Oral changes
Increase salivation Estrogen=>hypertrophic & hyperemic gums, bleeding
56
Gastric
Dilation & relaxation of sphincter increased risk of reflux Decreased emptying
57
Bile statis increases risk of ________
stones
58
women gain 5-10 pounds of fat because of ____________
breast feeding
59
What is the weight and size increase
Uterus, baby, placenta Breasts Blood volume Fat stores
60
Insulin resistance
May be a protective mechanism to ensure that developing baby gets adequate glucose Role of HPL and hpGH in increasing insulin secretion and insulin resistance not well understood Risk of gestational diabetes, increasing incidence
61
In pregnancy, there is a slight increase in thyroid size?
Rise in T4 with drop in TSH stimulated by hCG Increased need for thyroid hormone (133% of pre-pregnant state)
62
What are skin changes
Melasma: mask of pregnancy Linea Negra Stretch marks Spider veins
63
What are muskuloskeletal changes during pregnancy?
Back pain Relaxin Weight changes round ligament pain from stretching
64
First stage of labor
24 hours or more Start of labor till start of pushing mucus plug has out- cervical plug made of mucus will often times come out at cervix starts to dilate
65
Second stage of labor
3 hours Pushing until delivery of infant
66
Third Stage of labor
30-60 min After delivery of infant until delivery of placenta due to contraction
67
Fourth Stage of labor
-Immediate postpartum -After delivery of placenta for one hour -Time of great emotional and physiologic adjustment
68
Transition stage of labor
end of first stage of labor from 8-10 cm rigors, vomiting and a sense that you are going to die. Very rapid change and hormonal changes
69
What are complications of pregnancy?
Preeclampsia/eclampsia Placenta previa Abruptio placenta Ectopic pregnancy Spontaneous abortion
70
Preeclampsia
high blood pressure and protein urea and evidence of renal involvement
71
Preeclampsia occurs after ______ weeks of pregnancy
20
72
In preeclampsia, BP > _______________ in normotensive woman, on two separate occasions at least ______ hours apart
140/90, 6
73
Preeclampsia and proteinuria is (mild, severe) _______ on dipstick, 24 hour collection standard
>+1
74
Help syndrome is evidence of preeclampsia and it consists of:
H= Hemolysis (anemia) E= Elevated Liver enzymes (AST and ALT) L= Low Platelets P= Peripheral and nonperipheral edema
75
What are preeclampsia risk factors?
Primiparous, especially young or old Multiple pregnancy Chronic hypertension Diabetic Previous history Family history Fetal hydrops (heart failure-volume overload) Trophoblastic disease/ hydatidiform molar pregnancy: preeclampsia, prior to 20 weeks, sperm fertilizes empty egg, cluster of grapes on ultrasound, nonviable
76
What are the warning signs of progression of preeclampsia
Headache Visual changes Upper abdominal pain Oligouria Worsening proteinuria or hypertension Hyperreflexia Non-dependent edema
77
What are complications of preeclampsia?
Eclampsia Stroke
78
What is the cure for preeclampsia?
Delivery is the cure, risks higher immediately prior to, during, and immediately after delivery Balance with fetal maturity
79
What is the medication used for preeclampsia?
Magnesium Sulfate Smooth muscle relaxer Seizure prophylaxis
80
Placenta previa
Low implantation – placenta covers os Total, partial, marginal
81
Total placenta previa
cant dilate cervix bc can tear the placenta
82
Partial placenta previa
covering part of the os, dont have vaginal birth
83
Margnial placenta previa
very close to cervical os, will have innatural birth
84
What is Abruptio Placenta
Premature separation Usually very painful Increased uterine tone General uterine tenderness Bleeding can be concealed or large
85
What is the associated hypothesis for the etiology of Abruptio Placenta
Elevated blood pressure Trauma Short cord Cocaine use Sudden change in uterine volume AMA
86
Ectopic Pregnancy
Pregnancy outside of the uterus -Tubal, ovarian, abdominal
87
What is the most common type of ectopic pregnancy?
tubal, doesnt make it out of the fallopian tube
88
What are the causes of extopic pregnancy?
1. Mechanical – tubal obstruction (adhesions, sterilization) 2. Functional – early implantation, slow contractility
89
Which type of ectopic pregnancy is viable ?
abdominal
90
What are factors to be aware of for ectopic pregnancy?
Amenorrhea Postive hCG with abnormal rise Spotting, bleeding Adnexal or lower abdominal pain May present in shock
91
What is the incidence of spontanous AB (miscariage)
May go unnoticed if before missed period Estimate 45-50% of fertilized ova 10-15% of recognized pregnancies 30% of all first pregnancies Generally 25% or 1 in 4
92
What is threatened spontanous AB (miscariage)
vaginal bleeding 1st trimester
93
What is Inevitable threatened spontanous AB (miscariage)
bleeding with os opening
94
What is Incomplete spontanous AB (miscariage)
fetal components remain
95
What is missed Spontaneous AB (miscarriage)
fetal development arrested but no bleeding evident

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