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Phys and Pharm > Physiology of Pregnancy > Flashcards

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
Q

HCG rises rapidly in _______ pregnancy (doubles every 2-3 days)

A

early

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26
Q

What is a normal length of a pregnancy?

A

37-42 weeks

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27
Q

What is Naegle’s rule?

A

LMP(last menstrual period) +7 days -3 months

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28
Q

Quickening

A

(fetal movement) occurs between 16-20 weeks

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29
Q

Uterine size/fundal height

A

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.

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30
Q

What are the methods to determine the delivery date?

A
  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
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31
Q

What are the reproductive and system changes in pregnancy?

A

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

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32
Q

What are cardiovascular system changes needed for?

A

for organ perfusion & perfusion of fetal-placental unit

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33
Q

There are slight changes in cardiac position and size and up to the _______

A

left

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34
Q

T/F may hear new murmurs in pregnant women

A

True

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35
Q

There is increased cardiac output in pregnant patients and 10-20% goes to the ______________

A

uterus

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36
Q

The Vena cava can be compressed by the fundus after ______ weeks

A

20

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37
Q

Peripheral edema in pregnant patients

A

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

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38
Q

What are Blood volume changes ?

A

Range: 20-100%
Average: 45-50%

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39
Q

What are plasma changes?

A

increase 30-50%
Starts @ 6 weeks and peaks 30-34 weeks
Probably secondary to estrogen & progesterone => sodium and water retention, vasodilation

40
Q

What are RBC changes?

A

Erythropoietin levels start rising end of 1st trimester
After plasma levels rise
Increase 33% with iron supplementation, 18% without

41
Q

What are Hemodilution changes due to?

A

to increased plasma volume
-28-30 weeks, is physiologic & normal

42
Q

What are WBC changes ?

A

WBC rises, 5-12,000 normal
In labor 25-30,000

43
Q

________ state is secondary to estrogen

A

Hypercoagulative

44
Q

What are diaphragm changes ?

A

rises as uterus rises
-More diaphragmatic breathing
-Decreased abdominal tone

45
Q

What occurs with the cartilage in the respiratory system

A

Cartilage softens and ribs flare slightly to allow greater transverse diameter

46
Q

T/F there is increased oxygen consumption, slight increase in rate, and SOB in pregnant women?

A

True

47
Q

Engorgement/edema of which structures in the respiratory system?

A

nasopharynx, larynx, trachea, bronchi

48
Q

Sinus pressure and increased _______ are common

A

rhinorrhea

49
Q

Astham exacerbations may present in ____ of patients

A

1/3

50
Q

Urinary system changes

A

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
Q

What is a major urinary system risk for preterm labor?

A

UTI

52
Q

Increased nutritional needs _______

A

300kcal

53
Q

Nausea and vomiting: “Morning sickness”

A

Seems to correlated with increasing hCG levels, protective?
Hyperemesis gravidarum, persistent vomiting with electrolyte disturbances or significant weight loss

54
Q

Constipation

A

Progesterone slows motility
Increased water absorption
Iron supplementation

55
Q

Oral changes

A

Increase salivation
Estrogen=>hypertrophic & hyperemic gums, bleeding

56
Q

Gastric

A

Dilation & relaxation of sphincter increased risk of reflux
Decreased emptying

57
Q

Bile statis increases risk of ________

A

stones

58
Q

women gain 5-10 pounds of fat because of ____________

A

breast feeding

59
Q

What is the weight and size increase

A

Uterus, baby, placenta
Breasts
Blood volume
Fat stores

60
Q

Insulin resistance

A

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
Q

In pregnancy, there is a slight increase in thyroid size?

A

Rise in T4 with drop in TSH stimulated by hCG
Increased need for thyroid hormone (133% of pre-pregnant state)

62
Q

What are skin changes

A

Melasma: mask of pregnancy
Linea Negra
Stretch marks
Spider veins

63
Q

What are muskuloskeletal changes during pregnancy?

A

Back pain
Relaxin
Weight changes

round ligament pain from stretching

64
Q

First stage of labor

A

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
Q

Second stage of labor

A

3 hours
Pushing until delivery of infant

66
Q

Third Stage of labor

A

30-60 min
After delivery of infant until delivery of placenta due to contraction

67
Q

Fourth Stage of labor

A

-Immediate postpartum
-After delivery of placenta for one hour
-Time of great emotional and physiologic adjustment

68
Q

Transition stage of labor

A

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
Q

What are complications of pregnancy?

A

Preeclampsia/eclampsia
Placenta previa
Abruptio placenta
Ectopic pregnancy
Spontaneous abortion

70
Q

Preeclampsia

A

high blood pressure and protein urea and evidence of renal involvement

71
Q

Preeclampsia occurs after ______ weeks of pregnancy

A

20

72
Q

In preeclampsia, BP > _______________ in normotensive woman, on two separate occasions at least ______ hours apart

A

140/90, 6

73
Q

Preeclampsia and proteinuria is (mild, severe) _______ on dipstick, 24 hour collection standard

A

> +1

74
Q

Help syndrome is evidence of preeclampsia and it consists of:

A

H= Hemolysis (anemia)
E= Elevated Liver enzymes (AST and ALT)
L= Low Platelets
P= Peripheral and nonperipheral edema

75
Q

What are preeclampsia risk factors?

A

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
Q

What are the warning signs of progression of preeclampsia

A

Headache
Visual changes
Upper abdominal pain
Oligouria
Worsening proteinuria or hypertension
Hyperreflexia
Non-dependent edema

77
Q

What are complications of preeclampsia?

A

Eclampsia
Stroke

78
Q

What is the cure for preeclampsia?

A

Delivery is the cure, risks higher immediately prior to, during, and immediately after delivery
Balance with fetal maturity

79
Q

What is the medication used for preeclampsia?

A

Magnesium Sulfate
Smooth muscle relaxer
Seizure prophylaxis

80
Q

Placenta previa

A

Low implantation – placenta covers os
Total, partial, marginal

81
Q

Total placenta previa

A

cant dilate cervix bc can tear the placenta

82
Q

Partial placenta previa

A

covering part of the os, dont have vaginal birth

83
Q

Margnial placenta previa

A

very close to cervical os, will have innatural birth

84
Q

What is Abruptio Placenta

A

Premature separation
Usually very painful
Increased uterine tone
General uterine tenderness
Bleeding can be concealed or large

85
Q

What is the associated hypothesis for the etiology of Abruptio Placenta

A

Elevated blood pressure
Trauma
Short cord
Cocaine use
Sudden change in uterine volume
AMA

86
Q

Ectopic Pregnancy

A

Pregnancy outside of the uterus
-Tubal, ovarian, abdominal

87
Q

What is the most common type of ectopic pregnancy?

A

tubal, doesnt make it out of the fallopian tube

88
Q

What are the causes of extopic pregnancy?

A
  1. Mechanical – tubal obstruction (adhesions, sterilization)
  2. Functional – early implantation, slow contractility
89
Q

Which type of ectopic pregnancy is viable ?

A

abdominal

90
Q

What are factors to be aware of for ectopic pregnancy?

A

Amenorrhea
Postive hCG with abnormal rise
Spotting, bleeding
Adnexal or lower abdominal pain
May present in shock

91
Q

What is the incidence of spontanous AB (miscariage)

A

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
Q

What is threatened spontanous AB (miscariage)

A

vaginal bleeding 1st trimester

93
Q

What is Inevitable threatened spontanous AB (miscariage)

A

bleeding with os opening

94
Q

What is Incomplete spontanous AB (miscariage)

A

fetal components remain

95
Q

What is missed Spontaneous AB (miscarriage)

A

fetal development arrested but no bleeding evident

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