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3 Reproduction > Physiology of Pregnancy and Lactation > Flashcards

Physiology of Pregnancy and Lactation Flashcards

1
Q

what happens 3-5 days after fertilisation

A

transport of blastocyst into the uterus

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2
Q

what happens 5-8 days after fertilisation

A

blastocyst attaches to lining of uterus

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3
Q

what does the blastocyst include

A

inner cells (embryoblast) - which become embryo

outer cells - trophoblast cells, become the placenta

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4
Q

what does the placenta do

A

produces hormones to maintain pregnancy

trophoblast cells differentiate into syncytiotrophoblasts which invade decide and break down capillaries to form cavities filled with maternal blood

developing embryos sent capiliaries into the syncytiotrophoblast projections to form placental villi

has 2 ways of exchange - respect gases, nutrients, metabolites between mother and foetus

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5
Q

when is the placenta and foetal heart functional by

A

5th week of pregnancy

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6
Q

what hormone signals the corpus lute to continue to secrete progesterone in pregnancy

A

HCG (human chorionic gonadotrophin)

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7
Q

what does prolonged progesterone secretion by corpus luteum cause in pregnancy

A

stimulates decidual cells to concentrate glycogen, protein and lipids

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8
Q

how does the placenta act as the ‘lungs’ for the foetus

A

gas exchange between oxygen rich maternal blood compared to the foetal circulation

reversible exchange of carbon dioxide from foetus to mother

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9
Q

what 3 factors facilitate the supply of the foetus with oxygen

A
  1. foetal Hb (increased ability to cary O2)
  2. higher Hb concentration
  3. Bohr effect (fetal carries more oxygen in low pCO2 than in high pCO2)
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10
Q

how does the foetus get water

A

increase in water exchange across an osmotic gradient up till the 35th week of pregnancy

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11
Q

how do nutrients and electrolytes cross the placenta

A

can only cross from mother to foetus

glucose passes via simplified transport to the foetus

free diffusion of fatty acids across the placenta

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12
Q

what are teratogens

A

drugs that cross the placenta and effect the foetus, eg.

tetracycline, carbamazepine, thalidomide

alcohol, nicotine, heroin, coccaine, caffeine

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13
Q

what does HCG do

A

prevents break down of corpus luteum

effects the testes of male foetus- development of sex organs

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14
Q

what does HPL (human placental lactogen)

A

produced from week 5

growth hormone like effects

decreases insulin sensitivity

involved in breast development

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15
Q

what does progesterone do in pregnancy

A

development of decimal cells

decrease of uterus contractility

preparation for lactation

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16
Q

what does oestrogen’s do in pregnancy

A

enlargement of uterus

breast development

relaxation of ligaments

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17
Q

how should HCG increase in early pregnancy

A

serum levels should double every 48 hours in a singleton early pregnancy

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18
Q

what changes can you monitor via HCG levels

A

ectopic pregnancy - static or slow rising

failing pregnancy - falling

ongoing viable pregnancy - doubling or >60% rise

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19
Q

side effects of increased HCG

A

nausea
vomiting

high levels can occur in:
multiple pregnancy
molar pregnancy

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20
Q

when does HCG start to go down again in normal pregnancy

A

12-14 weeks

woman starts feeling better - less morning sickness

21
Q

how much does the mothers cardiac output increase in pregnancy

A

30-50%

22
Q

when does cardiac output decrease in pregnancy

A

last 8 weeks

foetus compressing vena caca

23
Q

what normal changes can be seen in pregnancy because of raised CO

A

ECG changes
functional murmurs
heart sounds

24
Q

what happens to plasma volume in pregnancy

A

increases proportionally with cardiac output

25
Q

why is Hb decreased in pregnancy

A

increased plasma volume causes increased dilution

26
Q

what happens to iron requirements in pregnancy

A

increases significantly

iron supplements often needed

27
Q

what respiratory changes happen in pregnancy

A

changes occur due to increase progesterone and large uterus decreasing lung function

progesterone lowers CO2 levels

O2 consumption increases to meet metabolic needs to foetus

28
Q

what happens to the urinary system in pregnancy

A

GFR and renal plasma flow increases

increased re-absorption of ions and water due to placental steroids and aldosterone

increase of urine formation

29
Q

how do postural changes in pregnancy cause changes in renal function

A

decreased in up right position

increased in a supine position (lying flat)

increased in a lateral position during sleep (lying on side)

30
Q

what is pre-eclampsia

A

pregnancy induced hypertension and proteinuria

increasing BP since 20th week

kidney function declines, salt and water retention leads to oedema formation

31
Q

who is pre-eclampsia more common in

A 
pre-existing hypertension 
diabetes 
autoimmune disease 
renal disease 
family history of pre-eclampsia 
obesity 
multiple pregnancy
32
Q

what is the average weight gain in pregnancy

A

11kg

33
Q

what is the pregnancy weight gain from

A 
foetus 
placenta 
amniotic fluid 
extracellular fluid 
other tissue - fat 
uterus and breast tissue 
increase in blood
34
Q

how many extra calories a day do you need in pregnancy

A

200

35
Q

what are the 2 phases of metabolism in pregnancy

A

1st-20th week - mothers anabolic phase

  • anabolic metabolism for mother
  • low metabolic needs of foetus

21st-40th week (catabolic phase)

  • high metabolic demands of foetus
  • accelerated starvation of the mother
36
Q

what happens in the mothers anabolic phase

A

Normal or increased sensitivity to insulin

Lower plasmatic glucose level

Lipogenesis, glycogen strokes increase

-growth of breasts, uterus, weight gain

37
Q

what happens in the mothers catabolic phase

A

increase in maternal insulin resistance
increased transport of nutrients through placenta
lipolysis

insulin resistance is caused by human placental lactose, cortisol and growth hormone

38
Q

what nutrients need to be taken in pregnancy

A 
Folic acid - reduces risk of neural tube defects 
Vitamin D supplements 
High protein diet, higher energy uptake 
Iron supplements 
B-vitamin -erythropoesis
39
Q

what happens to the uterus towards the end of pregnancy

A

gets more excitable due to the oestrogen:progesterone ratio falling

oestrogen increases contractility

oxytocin increases contractions

40
Q

what drugs can be used to induce labour

A

vaginal prostaglandins

oxytocin

41
Q

what are Braxton hicks contractions

A

tightening of uterus

increase towards the end of pregnancy

42
Q

what causes positive feedback to increase oxytocin release

A

stretch of the cervix by foetal head
increased oxytocin increases uterine contractions
also increases prostaglandin secretion which again increases contractions

43
Q

1st stage of labour

A

cervical dilation

8-24 hours

44
Q

2nd stage of labour

A

passage through birth canal (few mins to 120 mins)

45
Q

what is the 3rd stage of labour

A

expulsion of placenta

46
Q

what hormones are involved in producing lactation

A

prolactin
oxytocin
oestrogen
progesterone

47
Q

what does oestrogen do for lactation

A

growth of ductile system

prevents milk production in pregnancy

48
Q

what does progesterone do for lactation

A

development of lobule-alveolar system

prevents milk production in pregnancy

49
Q

what does prolactin do for lactation

A

stimulates milk production
1-7 days after birth, prolactin induces high milk production

stimulates colostrum (first form of milk produced)

3 Reproduction (49 decks)

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