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Repro and Sexual Health > Physiology of pregnancy and lactation > Flashcards

Physiology of pregnancy and lactation Flashcards

1
Q

Describe the changes seen as the ovum progresses from the ampulla to implantation?

A

Polar bodies form
Cleavage
Morula formed
Blastocyst

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2
Q

What is the difference between the inner cell mass and trophoblast?

A

Inner cell mass; destined to become foetus

Trophoblast; accomplishes implantation and develops into foetal portions of placenta

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3
Q

What occurs day 3-8 in fertilisation?

A

3-5; transport of blastocyst into uterus

5-8; blastocyst attaches to lining of uterus

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4
Q

How does the blastocyst implant on the endometrial wall?

A

When the free-floating blastocyst adheres to endometrial lining, cords of trophoblastic cells begin to penetrate the endometrium
Advancing cord of trophoblastic cells tunnel deeper into endometrium, carving out a hole for the blastocyst.
Boundaries between cells in advancing trophoblastic tissue disintegrate

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5
Q

When is the implantation completed?

A

Day 12

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6
Q

From what cells is the placental derived from?

A

Trophoblast

Decidual

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7
Q

What will trophoblast cells differentiate into?

A

Multinucleate cells (syncytiotrophoblasts) which invade the decidua and break down capillaries to form cavities filled with maternal blood

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8
Q

How does the placenta get a vascular supply?

A

Developing embryo sends capillaries into the syncytiotrophoblast projections to form placental villi

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9
Q

What does each villus contain?

A

Foetal capillaries separated from maternal blood by a thin layer of tissue

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10
Q

When is the placental and foetal heart functional?

A

Week 5

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11
Q

How does the embryo gain nutrition from the placenta?

A

Invasion of trophoblastic cells into the decidua

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12
Q

What will hCG stimulate?

A

Corpus luteum to continue to secrete progesterone

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13
Q

What is the function of progesterone in early pregnancy?

A

Stimulates decidual cells to concentrate glycogen, proteins and lipids

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14
Q

What occurs in terms of vasculature as the placenta develops?

A

It extends hair like projections into the uterine wall

Increasing contact area between uterus and placenta allowing for more nutrients to be exchanged

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15
Q

Where do blood vessels from the embryo develop?

A

In villi

A thin membrane separates the embryo’s blood in villi from mother’s blood in the intervillous space

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16
Q

Is there direct contact between maternal and foetal blood?

A

No; circulation within intervillous space acts partly as an arteriovenous shunt

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17
Q

What is the role of the placenta in oxygen transport?

A

Plays the role of foetal lungs

Supplies oxygen, removes carbon dioxide

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18
Q

How does maternal oxygen diffuse into foetal circulation?

A

The partial pressure of oxygen in mother is higher that foetus

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19
Q

How can carbon dioxide be removed from foetus?

A

Partial pressure is elevated in foetal blood to allow for a reversed gradient

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20
Q

Through which structure is foetal oxygenated blood returned to the foetus?

A

Umbilical vein

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21
Q

Through which structure is maternal oxygen poor blood returned?

A

Uterine vein

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22
Q

What 3 factors facilitate foetal oxygen supply?

A

Foetal Hb; increased ability to carry oxygen
Higher Hb; concentration in foetal blood is more than 50% of adults
Bohr effects; foetal Hb can carry more oxygen in low pCO2 than in high pCO2

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23
Q

What is the function of hCG?

A

Prevents involution of corpus luteum (stimulates progesterone, oestrogen)
Effect on testes of male foetus; development of sex organs

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24
Q

When is hPL produced?

A

Week 5 of pregnancy

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25
Q

What is the function of hPL?

A

Growth hormone like effect; protein tissue formation
Decreases insulin sensitivity in mother; more glucose for foetus
Involved in breast development

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26
Q

Which hormones are responsible for the development of gestational diabetes in women?

A

Human placental Lactogen
Cortisol
Growth hormone

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27
Q

What is the function of progesterone in pregnancy?

A

Development of decidual cells
Decreases uterine contractility
Preparation for lactation

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28
Q

What is the function of oestrogen in pregnancy?

A

Enlargement of uterus
Breast development
Relaxation of ligaments

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29
Q

What should happen to hCG levels in pregnancy?

A

Should double every 48 hours in a singleton early pregnancy

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30
Q

For what conditions can hCG be used to diagnose/ monitor?

A

Ectopic; static or slow rising
Failing pregnancy; falling
Ongoing viable pregnancy; doubling or > 60% rise

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31
Q

What are the side effects of rising hCG in pregnancy?

A

Nausea
Vomiting
HYPEREMESIS GRAVIDARUM

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32
Q

When are high levels of hCG common?

A

Multiple pregnancy

Molar pregnancy

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33
Q

When should hCG levels peak and fall?

A

Peak; 8-12 weeks

Fall from 12-14 weeks then plateau

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34
Q

What is the role of CRH in pregnancy?

A

Increased ACTH
Increased aldosterone and cortisol
Hypertension and oedema + insulin resistance

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35
Q

What is the sequelae of increased hCG in pregnancy?

A

Hyperemesis gravidarum

Hyperthyroidism

36
Q

What is the sequelae of increased calcium demands in pregnancy/?

A

Hyperparathyroidism

37
Q

Does CO change in pregnancy?

A

Increased due to demands of uteroplacental circulation

38
Q

How will CO change as the pregnancy progresses?

A

30-50% above normal from 6-24wks
Decreases in last 8 weeks
Increases by 30% in labour

39
Q

What is the resultant effect of increased CO in pregnancy?

A

Placental circulation
Increased metabolism
Skin; thermoregulation
Renal circulation

40
Q

Will HR increase in pregnancy?

A

Yes; up to 90/min to increase CO

41
Q

What occurs with BP in pregnancy?

A

Drops during 2nd trim (uteroplacental circulation expands and peripheral resistance decreases)
With multiple pregnancies, CO increases more, BP drops more

42
Q

What are the haematological changes assoc with pregnancy?

A

Plasma volume increases proportionally with CO
Erythropoiesis increases by 25%
Hb is decreased by dilution (decreasing blood viscosity)
Iron requirements increase (6-7mg/day in 2nd trim)

43
Q

Which hormone results in the resp changes seen in pregnancy?

A

Progesterone increases and enlarging uterus

44
Q

What is the role of progesterone in resp changes in pregnancy?

A

Signals brain to lower co2 levels (increases co2 sensitivity in resp centres )

45
Q

What are the 3 factors that change respiration in pregnancy?

A

Progesterone action on brainstem
O2 consumption increases (20% above normal)
Growing uterus

46
Q

What are the mechanisms the body will adapt to lower co2 levels in pregnancy?

A

RR increases
Tidal and minute volume increases (50%)
pCO2 decreases slightly
Vital capacity and pO2 don’t change

47
Q

Will GFR and renal plasma flow increase in pregnancy?

A

Yes; both increase up to 30-50% with a peak at 16-24 weeks

48
Q

What is the resultant effect of increased GFR and renal plasma flow in pregnancy?

A

Increased re-absorption of ions and water
Placental steroids
Aldosterone
Increased urine formation

49
Q

What effect does posture have on renal function in pregnancy?

A

Upright position; decreased
Supine; increased
Lateral position in sleep; increased alot

50
Q

What is preeclampsia?

A

Pregnancy induced hypertension and proteinuria

51
Q

At what week can preeclampsia be diagnosed?

A

20th week

52
Q

What happens to renal function in pre-eclampsia?

A

Declines; salt and water retention (oedema esp hands and face)
Renal blood flow and GFR decrease

53
Q

What are risk factors for pre-eclampsia?

A 
Pre-existing hypertx 
Diabetes 
Autoimmune disease (lupus) 
Renal disease 
Family history of preeclampsia
Obesity
Women with multiple gestation
54
Q

What is the single most significant risk for preeclampsia?

A

Previous pre-eclampsia

55
Q

What causes pre-eclampsia?

A

Extensive secretion of placental hormones
Immune response to foetus
Insufficient blood supply to placenta; ischaemia

56
Q

What is eclampsia?

A

Extreme pre-eclampsia which is lethal without treatment

57
Q

What are the symptoms of eclampsia?

A

Vascular spasm
Extreme hypertension
Chronic seizures
Coma

58
Q

What is the treatment for eclampsia?

A

Vasodilators

C-section

59
Q

What is the average maternal weight gain in pregnancy?

A

11kg; but can be as much as 30kg

60
Q

What makes up the maternal weight gain?

A 
Foetus; 3.5kg 
Extra-embryonic fluid/ tissue; 2 kg 
Uterus; 1kg 
Breast; 1kg
Body fluid; 2.5kg 
Fat accumulation; 1kg
61
Q

How should the diet of a mother change whilst pregnant?

A

200 kcal - 85% foteal metabolism, 15% stored as maternal fat
30g/day protein
End of pregnancy; foetal glucose needs 5mg/kg/min therefore mother requires 2.5mg/kg/min

62
Q

What is the 1st phase of pregnancy?

A

Weeks 1-20; mothers anabolic phase
Anabolic metabolism of mother
Small nutritional demands of conceptus

63
Q

What is the 2nd phase of pregnancy?

A

21-40 weeks esp last trim
High metabolic demands of foetus
Accelerated starvation of mother

64
Q

What occurs in the mothers anabolic phase?

A

Normal or increased sensitivity to insulin
Lower plasmatic glucose level
Lipogenesis, glycogen stores increased
Growth of breasts, uterus, weight gain

65
Q

What occurs in the mothers catabolic phase?

A

Maternal insulin resistance
Increased transport of nutrients through placental membrane
Lipolysis

66
Q

What are the special nutritional needs in pregnancy?

A 
Folic acid; reduces risk of neural tube defects
Vit d; esp in overweight women
High protein diet; higher energy uptake 
Iron supplements 
B vits - erythropoiesis
67
Q

What hormone ratio changes resulting in increased excitability of uterus?

A

Oestrogen: prog

Progesterone inhibits contractility whilst oestrogen increases

68
Q

What is the role of oxytocin in parturition?

A

Increases contraction and excitability

69
Q

What hormones does the foetus produce?

A

Oxytocin
Adrenal gland
Prostaglandins

70
Q

What stimulates uterine contraction?

A

Mechanical stretch of uterine muscles

Stretch of cervix - oxytocin release

71
Q

When will women get braxton Hicks contractions?

A

Near end of pregnancy

72
Q

What acts as a positive feedback mechanism in the onset of labour?

A

Stretch of cervix by foetal head increases contractility

73
Q

What impact will strong uterine contraction have on the spinal cord?

A

Neurogenic reflexes that will induce intense abdominal muscle contractions

74
Q

What is the effect of oestrogen on initiation of labour?

A

Induces oxytocin receptors on the uterus

75
Q

What is the effect of oxytocin in initiation of labour?

A

Stimulates uterus to contact

Stimulates placenta to make prostaglandins

76
Q

What is the effect of prostaglandins on initiation of labour?

A

Stimulates more vigorous contractions of the uterus

77
Q

What is the 1st stage of labour?

A

Cervical dilation (8-24 hours)

78
Q

What is the 2nd stage of labour?

A

Passage through birth canal (few mins to 120 mins)

79
Q

What is the 3rd stage of labour?

A

Expulsion of placenta

80
Q

What effect does oestrogen have on the production and release of milk?

A

Growth of ductile system

81
Q

What effect does progesterone have on the production and release of milk?

A

Development of lobule-alveolar system

82
Q

What effect does E and P have on milk production?

A

Inhibit
At birth; sudden drop in E and P
Oestrogen = growth of ductile system
Progesterone = growth of lobules

83
Q

What effect does prolactin have on the production and release of milk?

A

Stimulates milk production (steady rise in levels from wk 5 to birth)
1-7 days after birth, prolactin induces high milk production
Stimulates colostrum

84
Q

What are the components of colostrum?

A

High protein

High immunoglobulin allowing for foetal immunity

85
Q

Which hormones are involved in the milk let down reflex?

A

Oxytocin

Prolactin

Repro and Sexual Health (77 decks)

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