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Reproductive > Physiology of Pregnancy: Schlabritz-Lutsevich > Flashcards

Physiology of Pregnancy: Schlabritz-Lutsevich Flashcards

1
Q

What increases in CV during pregnancy?

A

BV
CO
SV
HR

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2
Q

What does not change in CV during pregnancy?

A

Veinous pressure
Mean arterial BP:
Although systolic and diastolic both go down

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3
Q

What goes down in CV during pregnancy?

A

TPR
Osmotic pressure
Hemoglobin

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4
Q

What is the name of the cells in the cytotrophoblast that cause drop from arterial to venous?

A

Extravillous trophoblast: invade spiral arteries of endometrium to form invasive cell columns

This drop in pressure keeps things from exploding… allows ex

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5
Q

What do decimalized cells look like at 4 weeks?

A

Large pale cells

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6
Q

What is the timeline of vascular remodeling?

A

4 weeks, it begins

5 weeks, heart beats for first time

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7
Q

What happens in vessel changes during remodeling?

A

Small size to large, high resistance to low resistance

0 Unmodified: 0 weeks
4 Vessel priming
8 Trophoblast invasion, loss of EC and VSMC
12 TC plugs dissolve
16 TC infiltration ceases
20 remodeling complete
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8
Q

When is local spiral artery remodeling complete?

A

20 wks

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9
Q

When is systemic artery remodeling complete?

A

24-28 weeks

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10
Q

What happens to arteries in pregnancy?

A

Less resistance, (maybe larger diameters?)

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11
Q

The remodeling of the spiral done when? systemic?

A

20-spiral

24-28-systemic

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12
Q

What happens to TPR in gestation at 5 weeks?

A

20-25% deducting by 5 weeks

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13
Q

What is the reduced TVR due to?

A

Reduced vasomotor tone

Remodelling of resistant size arteries (MMP9/3)

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14
Q

What are changes in vessels due to, broadly?

A

Angiogenic and antigenic factor balance

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15
Q

What placental growth factor a analogue for?

A

VEGF: angiogenesis

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16
Q

What percent of maternal blood goes to fetus eventually?

A

35%

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17
Q

If we have imbalance in angiogenic/antiangiogenic factors, what happens?

A

Pre-ecclampsia

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18
Q

Remember what anti-angiogenic factors?

A

Soluble VEGF-Receptor 1

S-Fleet

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19
Q

TPR is decreased due to what?

A

NO
PGI2 from COX1 and 2
cGMP (decreases Ca+2)

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20
Q

What is emphasized as important to keep vessel relaxed and TPR low?

A

cGMP

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21
Q

What is cause of relaxation in regard to K channels?

A

Hyperpolarization

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22
Q

Placental casues and increase in?

A

ATII??

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23
Q

What is increased compliance?

A

distensibility (by blood volume)

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24
Q

What does increased compliance do to after load of heart?

A

Decreased after load

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25
Q

What happens first, increased BV or decreased TPR?

A

We don’t know… she thinks vascular remodeling

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26
Q

What is an important mechanism to allow fetal growth?

A

Increased plasma volume, erythrocyte volume

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27
Q

What happens to the HCT in pregnancy?

A

Decreases

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28
Q

Does erythrogenesis match plasma volume increase?

A

No, thus HCT is low

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29
Q

When does BV return to normal after delivery?

A

by 6 weeks

30
Q

What happens to heart chambers in pregnancy?

A

Left ventricular hypertrophy (same as athletes!)

31
Q

What is the difference between the physiological and pathological heart hypertrophy?

A

Fibrosis and elasticity!

Patho: fibroblasts increase, walls thicken too much
Phys: myocytes increase, walls proportionate thick

32
Q

What increases with heart wall stretching?

A

ANP
BNP
cGMP**emphacized
*feedback to decrease BP in kidneys and adrenals

33
Q

What is the role of microRNA?

A

MiR208 is heart specific microRNA

34
Q

Animals treated with miR208 are resistant to what?

A

high fat diet

35
Q

What does miR208 inhibit?

A

MED13, an inhibitor of mediators of fat storage

36
Q

Deletion of MED13 causes what?

A

Obesity

37
Q

How does the heart regulate fat storage?

A

Thorugh miR208 and MED13

38
Q

What are the changes in kidney in pregnancy?

A

GFR increases up to 50%

39
Q

What happens to creatinine in pregnancy?

A

0.4 mg/dl increase on average (0.9 to 1.3)

40
Q

What happens to the collecting system of the kidneys?

A

physiological hydronephrosis due to increased progesterone relaxation of ureters and fetal compression

41
Q

Which side has more hydronephrosis in pregnant kidneys?

A

Right side

42
Q

What is the respiratory changes in pregnancy?

A

Diaphragm elevation
widened rib cage (2cm diameter, 6 cm circumference)
Bigger chest (5-7cm)
Subcostal angle from 68 to 103 degrees

43
Q

Is respiratory muscle function effected by pregnancy?

A

NO! no change in reap. muscles

44
Q

What happens to abdominal muslces in pregnancy?

A

Less tone
Less active
Respiration is diaphragmatic

45
Q

What is the change in the subcostal angel?

A

68 to 103 degrees

46
Q

What is the change in tidal volume?

A

increase 35-50%

47
Q

What is the change in total lung capacity?

A

4-5% reduction by elevation of diaphragm

48
Q

What happens to functional residual capacity, residual volume, respiratory reserve volume?

A

Decrease about 20%

49
Q

What causes increase in alveolar ventilation in pregnancy?

A

Larger tidal volume

Smaller residual volume

50
Q

What happens to inspiratory capacity?

A

increase 5-10%

51
Q

What percent of oxygen is taken by placenta?

A

40%!!!

52
Q

Vital capacity is what?

A

Almost the SAME

53
Q

Overall what happens in respiratory pregnancy?

A

More efficient gas exchange

54
Q

What are the increases in hormones in pregnancy?

A 
Increase:
Estrogen/Progesterone Ratio
Prolactin
Placental GH
TNF-a
Leptin
Free cortisol
55
Q

What are the decreases in hormones in pregnancy?

A

Decrease:
Pituitary GH
Adiponectin

56
Q

What do the changes in hormones in pregnancy compare to?

A

Obesity! We need to deposit fat… insulin resistance and available glucose.

57
Q

Our babies are what?

A

Fat!

58
Q

What hormonal adaptations lead to fat babies?

A

Increased TNF-a
Leptin
Cortisol
Deacrease Adiponectin

59
Q

Majority of Leptin comes from where in pregnancy?

A

Placenta! 10 fold increase

60
Q

What is the pregnancy response to leptin?

A

Leptin resistant state, like obesity

61
Q

What is the overview of gut micro biome and metabolic change in pregnancy?

A

Weight gain
Insulin desensitization
Altered microbiota: transplant makes fatter mouse

62
Q

What happens to fat in pregnancy?

A

Shunt to fetus?

63
Q

What acts as a barrier to active glucocorticoids (cortisol) in placenta?What does it do to them?

A

11 beta hydroxysteroid dehydrogenase type 2 in placenta

Converst to cotisone

64
Q

What happens if 11 BHSD2 is low in placenta?

A

Cortisol gets across

Growth retardation

65
Q

What deactivates cortisol in placenta?

A

11bHSD2

66
Q

What can happen to molecules from mother in placenta?

A

Metabolism
Transport
No transport

67
Q

What protects barrier of blood-blood barrier placenta?

A

Syncytiotrophoblast:

Vasculosyncyntial membrane

68
Q

What GLUT gets glucose in in placenta?

A

GLUT 1

69
Q

What may interfere with amino acid transport in placenta?

A

Glucose

Lipid metabolism

70
Q

What type of fats does placenta prefer?

A

Long chaing polyunsaturated fatty acids (LC-PUFAs)
Building blocks for fetal brain
(cholesterol not quite known yet)

Reproductive (31 decks)

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