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Reproductive & Sexual Health > Physiology of Pregnancy and Lactation > Flashcards

Physiology of Pregnancy and Lactation Flashcards

1
Q

At Day 1: Fertilization occurs in the ______ of the Fallopian Tube.

A

At Day 1: Fertilization occurs in the ampulle of the Fallopian Tube.

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2
Q

3-5 days: Transport of ______ into the _____

A

3-5 days: Transport of blastocyst into the uterus

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3
Q

5-8 days: _____ attaches to _____ of uterus.

A

5-8 days: blastocyst attaches to lining of uterus.

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4
Q

Blastocyst: - ____ cells develop into embryo - Outer cells burrow into uterine wall and become ______

A

Blastocyst: - inner cells develop into embryo - Outer cells burrow into uterine wall and become placenta

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5
Q

What happens when the blastocyst adheres to the endometrial lining?

A

cords of trophoblastic cells begin to penetrate the endometrium

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6
Q

What do advancing cords of trophoblastic cells do?

A

tunnel deeper into endometrium, carving out a hole for the blastocyst. The boundaries between cells in the advancing trophoblastic tissue disintegrate

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7
Q

When implantation is finished the blastocyst is _______ ______ in the endometrium - by day __

A

When implantation is finished the blastocyst is completely buried in the endometrium - by day 12

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8
Q

What is the placenta derived from?

A

Trophoblast and decidual tissue

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9
Q

What do trophoblastic cells do?

A

Trophoblastic cells (chorion) differentiate into multinucleate cells (syncitiotrophoblasts) which invade decidua and break down capillaries to form cavities filled with maternal blood

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10
Q

How do placental villi form?

A

Developing embryo sends capillaries into the syncitiotrophoblast to form placental villi

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11
Q

What does each placental villus contain?

A

contains fetal capillaries

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12
Q

Is there direct contact between foetal and maternal blood?

A

No - fetal capillaries separated from maternal blood by a thin layer of tissue

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13
Q

When is the placenta and foetal heart functional?

A

by 5th week of pregancy

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14
Q

Describe early nutrition of the embryo

A
  • invasion of trophoblastic cells into the decidua
  • Human chorionic gonadotropin (HCG) signals the corpus luteum to continue secreting progesterone
  • Progesterone stimulates decidual cells to concentrate glycogen, proteins and lipids
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15
Q

How does the placenta increase contact area between uterus and placenta?

A

As it develops it extends villi into uterine wall so that more nutrients and waste products can be exchanged

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16
Q

Circulation within the intervillous space acts partly as an ________ _____.

A

Circulation within the intervillous space acts partly as an arteriovenous shunt.

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17
Q

What role does the placenta play?

A

The role of the foetal lungs

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18
Q

What is the respiratory function of the placenta?

A

Makes supply of oxygen and removal or carbon dioxide

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19
Q

Oxygen diffuses from the maternal into the foetal circulation (PO2 ____ > PO2 ____)

A

Oxygen diffuses from the maternal into the foetal circulation (PO2 maternal > PO2 foetal)

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20
Q

Carbon dioxide (partial pressure is elevated in _____ blood) follows a _____ gradient.

A

Carbon dioxide (partial pressure is elevated in foetal blood) follows a reversed gradient.

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21
Q

Fetal, oxygen-saturated blood, returns to the fetus via the ______ vein, while maternal, oxygen-poor blood, flows back into the _____ veins.

A

Fetal, oxygen-saturated blood, returns to the fetus via the umbilical vein, while maternal, oxygen-poor blood, flows back into the uterine veins.

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22
Q

What three factors facilitate oxygen transport to the foetus?

A
  1. Foetal Hb (increased ability to carry O2)
  2. Higher Hb concentration in foetal blood (50% more than in adults)
  3. Bohr effect (foetal Hb can carry more oxygen in low pCO2 than in high pCO2)
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23
Q

What classic transport mechanisms do placental exchange processes occur via?

A
  • Passivetransport (without energy consumption)
  • Simple diffusion
  • Osmosis
  • Simplified transport
  • Active transport
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24
Q

Water diffuses into placenta along its ______ gradient. Exchange increases during pregnancy up to the __th week (___l/day)

A

Water diffuses into placenta along its osmotic gradient. Exchange increases during pregnancy up to the 35th week (3.5l/day)

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25
Q

Electrolytes follow ___ (____ and ____) only go from mother to child.

A

Electrolytes follow H2O (iron and Ca2+) only go from mother to child.

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26
Q

Glucose, (foetus’ main source of energy), passes the placenta via ______ transport (high glucose need in ___ trimester).

A

Glucose, (foetus’ main source of energy), passes the placenta via simplified transport (high glucose need in 3rd trimester).

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27
Q

There is free diffusion of _____ _____ across the placenta

A

There is free diffusion of fatty acids across the placenta

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28
Q

What is diffusion of waste products across the placenta based upon?

A

The concentration gradient

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29
Q

What % of all congenital malformations are due to drugs?

A

3%

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30
Q

What does HCG prevent?

A

Prevents involution of corpus luteum by stimulating progesterone and oestrogen.

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31
Q

What does HCG contribute to the development of?

A

Development of foetal sex organs

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32
Q

What is human placental lactogen (human chorionic somatomammotropin)?

A

Hormone produced from week 5 of pregnancy

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33
Q

What does human placental lactogen (human chorionic somatomammotropin) do?

A

Growth hormone life efffects- protein tissue formation

Decreases insulin sensitivity in mother (more glucose for the foetus)

Involved in breast development

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34
Q

What does the rise in progesterone cause?

A
  • development of decidual cells
  • decreases uterus contractility
  • preparation for lactation
35
Q

What does the rise in oestrogens cause?

A
  • enlargement of uterus
  • breast development
  • relaxation of ligaments
36
Q

The serum level of HCG doubles every __ hours in a singleton early pregnancy

A

The serum level of HCG doubles every 48 hours in a singleton early pregnancy

37
Q

What can changes in levels of HCG be used to diagnose?

A
  • ectopic pregnancy (static or slow rising)
  • failing pregnancy (falling)
  • ongoing viable pregnancy (doubling or >60% rise)
38
Q

What are the side effects of HCG rising?

A

Nausea and vomitting

39
Q

What can cause very high levels of HCG?

A

Multiple pregnancy

Molar pregnancy

40
Q

When do HCG levels begin to fall?

A

12-14 weeks

41
Q

Placenta produces CRH (corticotrophin releasing hormone) which is turned into ____ by mother.

This makes ________ and ______.

_________- increases BP

_______- Oedema & insulin resistance = _________ _______

A

Placenta produces CRH (corticotrophin releasing hormone) which is turned into ACTH by mother.

This makes aldosterone and cortisol.

Aldosterone- increases BP

Cortisol- Oedema & insulin resistance = gestational diabetes

42
Q

Placenta produces HCG (HC thyrotropin) which causes __________ in the mother.

A

Placenta produces HCG (HC thyrotropin) which causes hyperthyroidism in the mother.

43
Q

The increased Ca2+ demands of the placenta cause hyperparathyoidism in the mother.

A

The increased ____+ ________ of the placenta cause hyperparathyoidism in the mother.

44
Q

Increase in Cardiac Output (CO) during pregnancy is due to demands of the __________ ________.

A

Increase in Cardiac Output (CO) during pregnancy is due to demands of the uteroplacental circulation.

45
Q

CO is __-__% above normal (beginning at 6 weeks gestation and peaking at around __ weeks)

A

CO is 30-50% above normal (beginning at 6 weeks gestation and peaking at around 24 weeks)

46
Q

What can increased CO present as?

A

Physiological;

  • ECG changes
  • functional murmurs
  • heart sounds
47
Q

When does CO decrease?

A

In last 8 weeks

48
Q

In the last 8 weeks CO becomes sensitive to what?

A

To body position- compresses vena cava

49
Q

CO increases __% more during labour.

A

CO increases 30% more during labour.

50
Q

Heart rate (HR) increases up to __ beats/min to increase CO.

A

Heart rate (HR) increases up to 90 beats/min to increase CO.

51
Q

When does BP drop and why?

A

During 2nd trimester (uteroplacental circulation expands & peripheral resistance decreases)

52
Q

With multiple pregnancy __ increases more and __ drops more

A

With multiple pregnancy CO increases more and BP drops more

53
Q

What are the haematologic changes of pregnancy?

A
  • plasma volume increases proportionally with CO (50%)
  • Erythropoeisis (RBC) increases 25%
  • Hb is decreased by dilution (increasing blood viscosity)
  • iron requirements increases significantly (6-7mg/day in 2nd half of pregnancy)
54
Q

Why does lung function change in pregnancy?

A

Partly due to progesterone increases and partly because the enlarging uterus interferes with lung function.

55
Q

Describe the respiratory changes in pregnancy

A

Progesterone signals the brain to lower CO2 levels

O2 consumption increases to meet metabolic need of foetus, placenta and mother (20% above normal)

Growing uterus

56
Q

How are CO2 levels reduced in pregnancy?

A
  • RR increases
  • tidal and minute volume increases (50%)
  • pCO2 decreases slightly
  • vital capacity and PO2 don’t change
57
Q

Describe the urinary system changes in pregnancy?

A
  • GFR and RPF increases up to 30-50% peaking at 16-24 weeks
  • increased re-absorption of ions and water
    • placental steroids
    • aldosterone
  • slight increase of urine formation
58
Q

Postural changes affect renal function

A
  • upright position (Decreased)
  • supine posiiton (increased)
  • lateral position during sleep (marked increase)
59
Q

What is pre-eclampsia?

A

Pregnancy induced hypertension + proteinuria

60
Q

How does kidney function deterioration present?

A

Oedema formation (especially hands and face)

61
Q

Who is more likely to get pre-eclampsia?

A

Women with;

  • pre-existing hypertension
  • diabetes
  • autoimmune disease (lupus)
  • renal disease
  • FHx of pre-eclampsia
  • obesity
  • multiple pregnancy
62
Q

What is the single most significant risk factor for pre-eclampsia?

A

Previous pre-eclampsia

63
Q

What causes pre-eclampsia?

A

Unsure

  • extensive secretion of placental hormones?
  • immune response to foetus?
  • insufficient blood supply to placenta- ischaemia?
64
Q

What is eclampsia?

A

Extreme pre-eclampsia (fatal without treatment)

65
Q

How does eclampsia present?

A

Vascular spasms

Extreme hypertension

Chronic seizures

Coma

66
Q

What is the treatment for eclampsia?

A

Vasodilators and caesarean section

67
Q

What is the average weight gain in pregnancy?

A

11kg

5kg- foetus

6kg - mother

68
Q

how many extra calories/protein should be ingested per day by mother?

A

200 extra kcal/day

30g/day protein

At end of pregnancy foetal glucose need is 5mg/kg/min and mothers is 2.5mg/kg/min

69
Q

What are the two phases of pregnancy regarding nutrition?

A

1st phase- mothers anabolic phase 1st-20th week

  • anabolic metabolism of mother
  • quite small nutritional demands of the conceptus

2nd phase- 21-40th week

  • high metaboic demands of foetus
  • accelerated starvation of mother
70
Q

Describe mothers anabolic phase?

A
  • normal or increased sensitivity to insulin
  • lower plasmatic glucose level
  • lipogenesis, glucogen stores increase
  • growth of breast, uterus, weight gain
71
Q

Describe mothers catabolic phase?

A
  • Maternal insulin resistance- caused by HPL, cortisol and GH
  • increased transport of nutrients thorugh placental membrane
  • lipolysis
72
Q

What are the special nutritional needs in pregnancy?

A
  • folic acid (folate)- reduces risks of neural tube defects
  • vitamin D supplements
  • higher protein diet, higher energy uptake
  • iron supplementation
  • B vitamins- erythropoeisis
73
Q

What alters the excitability of uterus?

A
  • Estrogen:progesterone ratio alters increasing excitability
  • Progesterone inhibits contractility while oestrogen increases contractility*
  • oxytocin from maternal PP glandl increases contractions and excitability
74
Q

What do foetal hormones do during parturition?

A

Oxytoxin, adrenal gland, prostaglandin= control timing of labour

75
Q

Mechanical stretch of _______ _______ increases contractility

Stretch of the ______ also stimulates uterine contractions

A

Mechanical stretch of uterine muscles increases contractility

Stretch of the cervix also stimulates uterine contractions

76
Q

Describe the onset of labour

A
  • Braxton Hicks contractions
    • increase toward the end of pregnancy
  • Positive feedback
    • stretch of the cervix by fetal head increases contractility
  • Cervical stretching also cause further oxytocin release
  • Strong uterine contraction and pain from the birth canal cause neurogenic reflexes from spinal cord that induce intense abdominal muscle contractions
77
Q

What are the three stages of labour?

A

1st stage: cervical dilation (8-24 hours)

2nd stage: passage through birth canal (few min to 120 mins)

3rd stage: expulsion of placenta

78
Q

What does oestrogen stimulate regarding lactation?

A

Growth of ductile system

79
Q

What does progesterone stimulate regarding lactation?

A

Development of lobule-alveolar system

80
Q

What do E and P inhibit?

A

Milk production

81
Q

What stimulates milk production

A

Prolactin- steady rise from week 5-birth

82
Q

_-_ days after birth, prolactin induces high milk production.

Stimulates colostrum (low _____, no ___)

A

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

Stimulates colostrum (low volume, no fat)

83
Q

What causes milk let-down reflex

A

Sucking stimulus and oxytoxin

Reproductive & Sexual Health (54 decks)

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