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Reproduction & Sexual Health > Physiology of Pregnancy > Flashcards

Physiology of Pregnancy Flashcards

1
Q

Where does fertilisation occur?

A

Ampulla

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2
Q

After fertilisation what happens?

A

Fertilised ovum progressively divides and differentiates into a blastocyst as it moves from site of fertilisation in the upper oviduct to the site of implantation in the uterus

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3
Q

At what gestational age is the blastocyst transported to the uterus?

A

3-5 days

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4
Q

What happens to the blastocyst at 5-8 days?

A

Blastocyst attaches to the lining of the uterus and the inner cells develop into an embryo and outer cells burrow into the uterine wall

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5
Q

What do the cells that burrow into the uterine wall become?

A

Placenta

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6
Q

Describe how the placenta forms

A
  1. Cords of trophoblastic cells penetrate into the endometrium
  2. Maternal capillaries respond to form the decidual layer and placental bed
  3. Boundaries between the trophoblastic tissue disintegrate
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7
Q

When is implantation complete?

A

Day 12

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8
Q

Is there any contact between maternal and foetal blood?

A

No - thin layer of tissue

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9
Q

When is the placenta functional?

A

Week 5

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10
Q

What hormone keeps the placenta alive?

A

hCG - signals the corpus luteum to continue secreting progesterone which in turn stimulates decidual cells to concentrate glycogen, proteins and lipids

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11
Q

What increases the contact area of the placenta?

A

Villi

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12
Q

What acts as a shunt in the placenta?

A

Circulation in the intervillous space

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13
Q

State the factors that allow oxygen transportation to the baby

A
  1. Foetal Hb has increased ability to carry oxygen
  2. Higher Hb concentration in foetus (50% more than adults)
  3. Bohr effect
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14
Q

What is the bohr effect?

A

Foetal Hb can carry more oxygen in low pCO2 than high pCO2

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15
Q

State four mechanisms by which nutrients and waste can be exchanged between mum and baby

A

Passive/active transport
Simple diffusion
Osmosis
Simplified transport

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16
Q

What is the main energy source to the foetus?

A

Glucose - simplified transport

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17
Q

Define teratogens

A

Drugs that can cross the placental barrier and are detrimental to the foetus

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18
Q

Name some teratogens

A 
Thalidomide 
Carbamazepine 
Tetracycline 
Alcohol 
Nicotine 
Caffeine
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19
Q

Which ions can only go from mother to child?

A

Iron and calcium

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20
Q

When does water exchange stop increasing?

A

35 weeks

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21
Q

State the purpose of hCG

A

Prevents involution of the corpus luteum in the first 12 weeks of pregnancy (stimulates progesterone and oestrogen)

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22
Q

Describe the normal trend of hCG

A

Levels double every 48 hours

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23
Q

In pathology what happens to hCG

A

Ectopic - static
Failing - falls usually >50%
Molar - extremely high

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24
Q

What are the side effects of hCG?

A

Nausea and vomiting

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25
Q

When does hCG levels start to fall?

A

12-14 weeks

26
Q

State the purpose of HPL

A

Growth hormone like effects - protein tissue formation
Decreases insulin sensitivity (increase glucose to foetus)
Breast development

27
Q

When is HPL produced?

A

From week 5 when the placenta and foetal heart develop

28
Q

Describe the role of progesterone in pregnancy

A

Rises throughout
Development of decidual cells
Decreases uterine contraction
Prepares breast for lactation

29
Q

Describe the role of oestrogen in pregnancy

A

Oestradiol rises throughout pregnancy
Enlargement of uterus
Breast development
Relaxation of ligaments for labour

30
Q

What pathology can hCG/HPL cause in the mum?

A

Hyperthyroidism

31
Q

What pathology can calcium demands cause in the mum?

A

Hyperparathyroidism

32
Q

What pathology can corticotrophin releasing hormone cause in the mum?

A

Increase ACTH causes increased aldosterone and cortisol which can cause

  • hypertension
  • oedema
  • insulin resistance (gestational diabetes)
33
Q

What happens to cardiac output in pregnancy?

A

Increases due to demands of uteroplacental circulation

34
Q

In the last 8 weeks of pregnancy what does cardiac output depend on?

A

Body position

35
Q

At what gestational age does increase in cardiac output peak?

A

24 weeks

36
Q

What are the signs of physiological cardiovascular changes in pregnancy?

A

ECG changes
Functional/flow murmurs
Heart sounds

37
Q

What will happen to heart rate during pregnancy?

A

Increases up to 90bpm

38
Q

What happens to blood pressure in pregnancy?

A

Drops in the 2nd trimester as uteroplacental circulation expands and peripheral resistance decreases

39
Q

Why do pregnant women often need iron supplement?

A

Erythropoesis increases as plasma volume increases so Hb is decreased by dilution and iron requirements increase

40
Q

How much iron is required in the second trimester?

A

6-7mg/day

41
Q

State the values for anaemia in first and 2nd/3rd trimester?

A

Outwith pregnancy 120-160g/L
First - <110g/L
Second/third <105g/L

42
Q

What effect does progesterone have on respiration?

A

Signals the brain to lower CO2 and there is an increase in CO2 sensitivity

43
Q

What factors causes lower levels of carbon dioxide?

A

Progesterone
Oxygen consumption increase
Growing uterus

44
Q

Describe the effect of lower carbon dioxide levels

A
  • Increased respiratory rate
  • tidal and minute volume increase
  • pCO2 decreases
  • vital capacity and pO2 do not change
45
Q

What renal changes occur in pregnancy?

A

GFR and renal plasma flow increases
Increased re-absorption of ions and water
Increased urine formation

46
Q

What substance drives the re-absorption of ions and water?

A

Steroids and aldosterone

47
Q

What external factor impacts renal function?

A

Posture - upright reduces, supine increases and lateral lying significantly increases

48
Q

In general how do pregnancy values compare to normal values for renal/liver function?

A

Lower

49
Q

How can pregnancy be describe haematologically?

A

Hypercoaguable state - helps to reduce risk of haemorrhage

50
Q

What contribute to maternal weight gain?

A 
Foetus 
Amniotic fluid 
Uterus 
Breasts 
Plasma volume 
Fat accumulation
51
Q

How many extra calories a day should a pregnant lady eat?

A

200

52
Q

Describe phase 1 of pregnancy metabolism

A

Anabolic Phase week 1-20

Small nutritional demands from the foetus

53
Q

What factors contribute to phase one maternal metabolism?

A

Normal/increased insulin sensitivity
Lower plasma glucose
Increased lipogenesis
Growth of breast and uterus

54
Q

Describe phase 2 of pregnancy metabolism

A

Higher metabolic demand and accelerated starvation of the mother if intake is not regular

55
Q

What factors contribute to phase 2 maternal metabolism

A

Maternal insulin resistance
Increased transport of nutrients through placental membrane
Lipolysis

56
Q

State five nutritional needs of women during pregnancy

A
  • folic acid
  • vitamin D
  • high protein diet
  • iron supplements
  • B vitamins
57
Q

Define lactation

A

Producing and releasing milk

58
Q

How do oestrogen and progesterone impact lactation?

A

Oestrogen - growth of ductile system
Progesterone - development of lobular-alveolar system
Both inhibit lactation so decrease after birth

59
Q

Describe the role of prolactin in lactation

A

Stimulates milk production, steady rise in levels from week 5. 1-7 days after birth prolactin induces high milk production and stimulates colostrum

60
Q

What is the let-down reflex?

A
  1. Receptors in nipple stimulated
  2. Impulses propagated to spinal cord
  3. Stimulation of hypothalamic nuclei
  4. Oxytocin released
  5. Milk ejected
61
Q

What is colostrum?

A

High protein and immunoglobulins but no fat and low in volume

Reproduction & Sexual Health (36 decks)

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