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obs and gynae > physiology of pregnancy and lactation > Flashcards

physiology of pregnancy and lactation Flashcards

1
Q

what happens at 3-5 days after fertilisation

A

transport of the blastocyst to the uterus

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2
Q

what happens at 5-8 days after fertilisation

A

blastocyst attaches to the lining of the uterus

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3
Q

what does the blastocyst turn into

A

-inner cells develop into embryo
-outer cells burrow into uterine wall and become placenta

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4
Q

when is the placenta (and fetal heart) functional?

A

5th week of pregnancy

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5
Q

what signals the corpus luteum to continue secreting progesterone

A

hCG

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6
Q

what does the progesterone do in placental development

A

stimulates decidual cells to concentrate glycogen, proteins and lipids

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7
Q

how does the placenta work as an atriovenous shunt

A

-extends villi into uterine wall
-which means nutrients and waste materials can be exchanged between the placenta and uterus
-blood vessels from the embryo devleop in the villi
-there is no direct contact between fetal and maternal blood

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8
Q

what facilitates to supply of oxygen to the fetus by the placenta

A

-fetal Hb
-higher Hb concentration in fetal blood
-Bohr effect (fetal Hb can carry more oxygen in low pCO2 than in high pCO2)

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9
Q

what does hCG do in pregnancy

A

-prevents inovulation of corpus luteum
-development of sex organs in male fetus

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10
Q

when is HCS (human chorionic somatomammotropin)/human placental lactogen produced

A

around week 5 of pregnancy

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11
Q

what does human placental lactogen do

A
  • Growth hormone-like effects - protein tissue formation
  • Decreases insulin sensitivity in mother - more glucose for the fetus
  • Involved in breast development
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12
Q

when do hCG levels drop off

A

fall from 12-14 weeks

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13
Q

side effects of. hCG

A

nausea
vomiting

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14
Q

hCG in an ectopic pregnancy

A

static or slow rising

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15
Q

hCG in a failing pregnancy

A

falling

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16
Q

hCG in an ongoing viable pregnancy

A

doubling or >60% rise

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17
Q

what does progesterone do in pregnancy

A
  • Development of decidual cells
  • Decreases uterus contractility
  • Preparation for lactation
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18
Q

what does estrogen do in pregnancy

A
  • Enlargement of uterus
  • Breast development
  • Relaxation of ligaments
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19
Q

cardiovascular changes in pregnancy

A

-increase in cardiac output
-functional murmurs
-heart sounds
-HR increases
-BP drops during second trimester

20
Q

ECG changes in pregnancy

A

-relative sinus tachycardia
-slight left axis deviation
-inverted or flattened T waves
-Q-wave
-atrial and ventricular ectopic beats more common

21
Q

haematological changes in pregnancy

A
  • Plasma volume increases proportionally with cardiac output
  • Erythropoesis increases, thus Hb is decreased by dilution (decreases blood viscosity)
  • Iron requirements increase significantly - iron supplements needed
22
Q

what do lung function changes happen due to

A

partly due to progesterone increases and partly because of the enlarging uterus interfering with lung function

23
Q

what are the respiratory changes during pregnancy

A

-lower CO2 levels
-O2 consumption increases
-respiratory rate increases

24
Q

urinary system changes in pregnancy

A

-GFR and renal plasma flow increases
-increased reabsorption of ions and water
-slight increase in urine formation

25
Q

coagulation state in pregnancy

A

hypercoaguable state
-reduces risk of haemorrhage during and after delivery
-increased risk of venous thromboembolism

26
Q

average maternal weight gain

A

11kg

27
Q

when is the mother’s anabolic rate

A

1st-20th week
-small nutritional demands of the conceptus

28
Q

when is the mother’s catabolic phase

A

21-40 weeks
-high metabolic demands of the fetus

29
Q

what is insulin resistance caused by in pregnancy

A

HPL, cortisol and growth hormone

30
Q

in what phase does insulin resistance happen

A

catabolic phase

31
Q

nutritional needs in pregnancy

A

-folic acid
-vit D supplements
-high protein diet
-iron supplements
-B vitamins

32
Q

why do mothers take folic acid

A

reduces risk of neural tube defects

33
Q

hormonal changes in parturition

A

-estrogen/progesterone ratio alters
-prostaglandins produced by placenta
-oxytocin released from posterior pituitary

34
Q

what does progesterone do in parturition

A

inhibits contractility

35
Q

what does estrogen do in parturition

A

increases contractility

36
Q

what does oxytocin do in parturition

A

increases contractions and excitability

37
Q

what happens at the onset of labour

A
  • Braxton Hicks contractions increase towards the end of pregnancy
  • Cervical rupening
  • Stretch of the cervix by fetal head increases contractility
  • Cervical stretching also causes further oxytocin release
  • Strong uterine contraction and pain from the birth canal cause neurogenic reflexes from spinal cord that induce intense abdominal muscle contractions
38
Q

how is labour initiated

A
39
Q

what is the first stage of labour

A

cervical dilation
-8-24 hours

40
Q

what is the second stage of labour

A

passage of fetus through birth canal
-few min to 120 mins

41
Q

what is the third stage of labour

A

expulsion of placenta

42
Q

estrogen and progesterone role in inhibiting milk production

A

estrogen - growth of ductile system
progesterone - development of lobule-alveolar system

43
Q

what hormone stimulates milk production

A

prolactin

44
Q

what hormone is responsible for the ‘milk let down reflex’

A

oxytocin

45
Q

feedback loop for milk production and release

A
46
Q

what is the milk let down reflex

A

obs and gynae (21 decks)

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