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Repro > Physiology - Pregnancy > Flashcards

Physiology - Pregnancy Flashcards

1
Q

Where does fertilisation usually occur?

A

Ampulla

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2
Q

What does the fertilised ovum divide to form?

A

Blastocyst

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3
Q

When does the blastocyst implant in the uterus?

A

Day 5-8

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4
Q

What do the inner cells of the blastocyst form?

A

Embryo

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5
Q

What do the outer cells of the blastocyst form?

A

Placenta

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6
Q

What do the burrowing outer cells of blastocyst first form?

Cell type

A

cords of trophoblastic cells

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7
Q

What is the maternal response to the cords of trophoblastic cells?

A

Capillary formation and growth of decidual layer

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8
Q

From where is the placenta formed?

A

Trophoblast and decidual tissue

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9
Q

Where does the embryo get its nutrition before the placenta is functional?

A

Invasion of trophoblastic cells into the decidua

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10
Q

When does the placenta become functional?

A

Week 5

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11
Q

How does HCG enable early nutrition of the embryo?

A

Stimulates Corpus Luteum to continue secreting progesterone, causing decidual cells to concentrate glucose, proteins and lipids

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12
Q

Trophoblast cells at the Chorion differentiate into…

A

multinucleate syncytiotrophoblasts invading into decidua

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13
Q

How are placental villi formed?

A

embryo sends capillaries into syncytiotrophoblast projections, creating villi covered in thin layer of tissue within intervillous space (which is filled with maternal blood)

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14
Q

What is the respiratory function of the placenta?

A

Supply of oxygen and removal of CO2 to foetus, by exchange between O2 rich maternal blood and umbilical blood (mixed arterial and venous)

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15
Q

How does O2 travel from maternal to foetal circulation?

A

Diffusion due to difference in PO2

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16
Q

How does CO2 travel from foetal to maternal circulation?

A

Diffusion across reverse concentration gradient, partial pressure elevated in foetal blood

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17
Q

Which vessel supplies the foetus with the oxygenated blood?

A

Umbilical vein

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18
Q

Which vessels do the O2 poor maternal blood return to?

A

Uterine veins

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19
Q

How does foetal Hb facilitate O2 supply to the foetus?

A

Foetal Hb is in a 50% higher concentration in foetal blood than in adults, and foetal Hb can carry more O2 in low PCO2 than in high PCO2

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20
Q

How are the following transported between maternal and foetal circulation?

  1. Water
  2. Electrolytes
  3. Glucose
  4. Waste
A
  1. diffusion along osmotic gradient
  2. Follows water (NB iron and Ca2+ only move from mother to foetus)
  3. Simplified transport
  4. Diffusion based on concentration gradient
21
Q

What is the role of Human Chorionic Gonadotrophin (HCG)?

A

Prevents involution of Corpus Luteum

Also effects development of male sex organs

22
Q

If level of HCG has doubled, or increased > 60%, this is indicative of…

A

Ongoing viable pregnancy

23
Q

Falling levels of HCG is indicative of…

A

Failing pregnancy

24
Q

Static or slow rising HCG levels is indicative of…

A

Ectopic pregnancy

25
Q

High levels of HCG is also indicative of…

A

Multiple or molar pregnancy

26
Q

When do HCG levels normally fall?

A

12-14 weeks

27
Q

What is the role of Human Placental Lactogen?

A

Acts like Growth Hormone and causes protein tissue formation

Decreases insulin sensitivity in the mother (to give more glucose to the foetus)

Also involved in breast development

28
Q

What is the role of progesterone in pregnancy?

A

Development of decidual cells
Decreases uterus contractility
Preparation for lactation

29
Q

What is the role of Oestrogens in pregnancy?

A

Enlargement of uterus
Breast development
Relaxation of ligaments

30
Q

What are the maternal cardiovascular adaptations?

A 
Increased CO (30-50%) 
Increased Hr (90/min)
Decreased BP during 2nd trimester
31
Q

What are the maternal haematological changes?

A

Increased plasma volume
Increased erythropoiesis (25%)
Hb decreased by dilution which decreases viscosity
Iron requirements increase to 6-7mg/day

32
Q

What changes are made to coagulation? And what are the benefit and risk?

A

Hypercoagulable state

Benefit - reduces risk of haemorrhage during and after delivery
Risk - increased risk of venous thrombosis

33
Q

What are the maternal respiratory changes?

A

Progesterone signals to lower CO2 levels and increase O2 consumption. This is done via:
Increased RR
Increased tidal and minute volume
Slightly decreased PCO2

34
Q

What are the maternal urinary changes?

A

Increased GFR and plasma flow
Increased reabsorption of ions and water due to placental steroids and aldosterone
Slight increase in urine formation
Postural changes

35
Q

Reference ranges in pregnancy (normal)

A

ALT < 30 uL (5-55)
Urea <3.5 mmol/L 9(2.5-7.8)
Creatinine <50 umol/L (44-80)
Albumin 20-40 g/L (30-50)

36
Q

How many kcals extra is required by mother during pregnancy, and how many g of protein?

A

200 kcals

30g protein

37
Q

What are the two phases of pregnancy regarding metabolism?

A
  1. Week 1-20 - mothers anabolic phase where glycogen stores increased (lipogenesis)
  2. Week 21-40 - high metabolic demands of the foetus (lipolysis)
38
Q

What are the special nutritional needs during pregnancy?

A 
Folic acid (folate) 
Vitamin D 
High protein 
Iron 
B vitamins
39
Q

Why is folic acid important in pregnancy?

A

Reduces the risk of neural tube defects

40
Q

What influences uterine excitability?

A

Oestrogen:Progesterone ratio
Prostaglandins from placental and decidua
Oxytocin from maternal posterior pituitary
Mechanical stretch of uterine muscles

41
Q

How does the Oestrogen:Progesterone ratio effect uterine excitability?

A

Progesterone inhibits contractility.
Oestrogen increases contractility.
Towards the end of pregnancy, increase of oestrogen from the ovaries induces oxytocin receptors on the uterus. Oxytocin from others posterior pituitary causes uterus to contract, and stimulates placenta to make prostaglandins, which stimulate more vigorous contractions.

42
Q

What is the pattern of contractions during the onset of labour?

A
  1. Braxton Hicks increase towards the end of pregnancy
  2. Cervical ripening occurs, stretch of cervix increased contractility and oxytocin release
  3. Stronger contractions and pain from birth canal cause neurogenic reflexes to induce intense abdominal muscle contractions
43
Q

What are the three stages of labour, and how long does each roughly last?

A
  1. Dilatation - 8-24 hours
  2. Expulsion - passage of foetus through birth canal (up to 120 mins)
  3. Placental
44
Q

What hormones influence lactation?

A

Oestrogen
Progesterone
Prolactin
Oxytocin

45
Q

What are the roles of oestrogen and progesterone in lactation?

A

Oestrogen - growth of ductile system
Progesterone - development of lobule alveolar system

Both inhibit milk production - these suddenly drop at birth.

46
Q

What is the role of prolactin in lactation?

A

Stimulates milk production - steadily rises from week 5 until birth, and first 7 days after birth there is very high milk production.
Also stimulates colostrum.

47
Q

What is the role of oxytocin in lactation?

A

Milk Let Down Reflex

48
Q

Describe the milk let down reflex

A
  1. Receptors in nipple stimulated
  2. Impulses propagated to spinal cord
  3. Stimulation of hypothalamic nuclei
  4. Oxytocin released
  5. Milk ejected
49
Q

Describe the signalling pathways in lactation

A
  1. Stimulus at higher brain centres (mechanical or sound of cry)
  2. Oxytocin neurons activated and PIH cells inhibited at hypothalamus
  3. Increased prolactin from anterior pituitary, and increased oxytocin released from posterior.
  4. Milk secretion and smooth muscle contraction, respectively.

Repro (4 decks)

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