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Reproductive System > Placenta And Maternal Problems > Flashcards

Placenta And Maternal Problems Flashcards

1
Q

The outer cell mass turns into …

A

Syncytiotrophoblast

Cytotrophoblast

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2
Q

The inner cell mass turns into…

A

Epiblast

Hypoblast

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3
Q

Which tissues form the bilaminar disk?

A

Epiblast and hypoblast

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4
Q

Describe the syncytiotrophoblast

A

Multinucleated sheet
Well adapted for transport
Minimal cellular barriers

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5
Q

What do we mean when we say the human placenta in haemomonochorial?

A

One layer of trophoblast ultimately separates the maternal blood from the foetal capillary wall

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6
Q

Describe the chorionic villi as development proceeds

A

Primary - early finger-like projections of trophoblast
Secondary - invasion of mesenchyme into core
Tertiary - invasion of mesenchyme core by foetal vessels

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7
Q

What anchors the placenta in position?

A

Establishment of an outermost cytotrophoblast shell

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8
Q

What is the cytotrophoblast layer for?

A

Stem cell layer for the syncytiotrophoblast

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9
Q

What is the most common site of ectopic pregnancy?

A

Ampulla of Fallopian tubes

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10
Q

What is placenta praevia?

A

Implantation in the lower uterine segment
Can cause haemorrhage in pregnancy
Requires C section
May grow across internal Os then birth canal cannot function

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11
Q

What are pre-decidual cells?

A

Cells specialised to control implantation

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12
Q

Why doesn’t implantation in the Fallopian tubes work?

A

No pre-decidual cells as no endometrium in tubes
Cannot control implantation
Risk of haemoperitoneum

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13
Q

What is the basic pathology of pre-eclampsia?

A

Invasion is incomplete

Inadequate modification of vessel walls

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14
Q

What are the 2 clinical signs of pre-eclampsia?

A

Hypertension

Proteinuria

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15
Q

Describe a first trimester placenta

A

Placenta established
Placental barrier still relatively thick
Complete cytotrophoblast layer beneath syncytiotrophoblast

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16
Q

Describe a placenta at term

A

Increased SA for exchange - optimised for transport
Placental barrier is now thin
Cytotrophoblast layer lost

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17
Q

How many umbilical arteries are there and carrying what?

A

2

Deoxygenated blood

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18
Q

How many umbilical veins are there and carrying what?

A

1

Oxygenated blood

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19
Q

What are the steroid hormones produced by the placenta?

A

Oestrogen

Progesterone

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20
Q

What are the protein hormones produced by the placenta?

A

hCG
hCS
hCT
hCC

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21
Q

What is a molar pregnancy?

A

Abnormal growth of pregnancy tissue
Placental overgrowth
Massive overproduction of hCG

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22
Q

What crosses the placenta via simple diffusion?

A

Water
Electrolytes
Urea and uric acid
Gases

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23
Q

What crosses the placenta via facilitated diffusion?

A

Glucose

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24
Q

What needs active transport to cross the placenta?

A

Amino acids
Iron
Vitamins

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25
Q

Describe passive immunity in babies

A

Foetal immune system immature
Receptor mediated endocytosis allowing IgG to cross placenta
Foetus likely to encounter same agents as mother

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26
Q

Describe haemolytic disease of the newborn

A

Rhesus blood group incompatibility of foetus and mother
Mother makes antibodies that attack foetal blood
Mothers given prophylactic anti-D treatment

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27
Q

Name some infectious agents that can cross the placenta

A

Varicella zoster
Cytomegalovirus
Treponema pallidum (syphilis)
Rubella

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28
Q

What do you test for in mother’s blood at antenatal screening?

A

Blood group - Rhesus status
Hb
Infections

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29
Q

What do we check mother’s urine for at antenatal screening?

A

Signs of infection

Protein

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30
Q

By how much does blood volume change in pregnancy?

A

Increases

~50%

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31
Q

Why does maternal blood volume increase in pregnancy?

A

Increased blood to kidneys as acting for foetus and mother

In anticipation of blood loss of birth

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32
Q

How much blood is typically lost at birth?

A

500 ml - normal delivery

1 L - C section

33
Q

By how much does cardiac output change in the mother?

A

Increases

~ 40%

34
Q

By how much does stroke volume change in the mother?

A

Increased

~35%

35
Q

By how much does heart rate change in the mother?

A

Increases

~15%

36
Q

What is the change to TPR in the mother and how?

A

Decreases
25-30%
High conc of progesterone relaxes the SM

37
Q

What happens to BP of the mother during pregnancy?

A

T1 and T2 = decreased

T3 = returns to normal

38
Q

Is there any time when systolic BP naturally increases in pregnancy?

A

No

39
Q

Why might hypotension occur in pregnancy?

A

T1 and T2 = increased progesterone therefore decreased TPR

T3 = aortocaval compression by gravid uterus

40
Q

Describe what is happening histologically in a pre-eclamptic pregnancy

A

Vasoconstriction
Plasma contracted - decreased volume
Opposite of what is needed therefore strain on placental and foetal demands

41
Q

What is eclampsia?

A

Fits/seizures in pregnancy

Emergency situation

42
Q

How does renal plasma flow change during pregnancy?

A

Increases

60-80%

43
Q

How does GFR change in pregnancy?

A

Increases

55%

44
Q

How does creatinine clearance change in pregnancy?

A

Increases
40-50%
Therefore creatinine itself decreases

45
Q

What happens to urea conc in pregnancy?

A

Decreases

50%

46
Q

What happens to uric acid conc in pregnancy?

A

Decreases

33%

47
Q

What is the range for bicarbonate during pregnancy?

A

18 - 22 mmol/L

48
Q

What is the range for creatinine during pregnancy?

A

25 - 75 mmol/L

49
Q

Why might urinary stasis occur in pregnancy?

A

Progesterone relaxes SM
May cause hydroureter or hydronephrosis
Or could be due to obstruction secondary to gravid uterus

50
Q

What is a potential complication of pyelonephritis for pregnancy women?

A

Pre term labour

51
Q

What is the effect of progesterone on the respiratory system?

A

Increased respiratory drive

Can result in resp alkalosis

52
Q

Why is there an increased risk of developing metabolic acidosis whilst pregnant?

A

Buffering capacity is reduced as there is chronic loss of bicarbonate during pregnancy

53
Q

How does oxygen consumption change in pregnancy?

A

Increased

20%

54
Q

How does resting minute ventilation change in pregnancy?

A

Increased

15%

55
Q

Is tidal volume changed in pregnancy?

A

Yes - increased

56
Q

Is respiratory rate changed in pregnancy?

A

No

57
Q

Is functional residual capacity changed in pregnancy?

A

Yes

Decreased but only in T3

58
Q

Is vital capacity changed in pregnancy?

A

No

59
Q

Is FEV1 changed in pregnancy?

A

No

60
Q

Is maternal ppO2 changed in pregnancy?

A

Yes - increased

61
Q

Is maternal ppCO2 changed in pregnancy?

A

Yes - decreased

62
Q

How does pregnancy change maternal use of carbohydrates?

A

Increased maternal peripheral resistance to insulin
Switches to gluconeogenesis and alternative fuels (FAs)
Via human placental lactogen (hPL)

63
Q

What is gestational diabetes?

A

Carbohydrate intolerance first recognised in pregnancy and not persisting after delivery

64
Q

What are the risks of gestational diabetes?

A

Macrosomia (C section?)
Stillbirth
Increased risk of congenital defects

65
Q

How do we test for gestational diabetes?

A

Oral glucose tolerance test

66
Q

Describe lipid metabolism during pregnancy

A

Early pregnancy = increased fat stores
Increased lipolysis from T2
Increased plasma free FAs on fasting

67
Q

Can FAs cross the placenta?

A

Only the essential FAs

68
Q

How is the thyroid affected in pregnancy?

A

Increased production TBG
Increased release of T3 and T4
Free T4 in normal range as most is bound

69
Q

What foetal hormone has a direct effect on TSH production?

A

hCG

70
Q

What happens to the appendix in pregnancy?

A

Gets moved to RUQ as uterus enlarges

71
Q

What physiological changes occur in the GI tract whilst pregnant?

A

SM relaxation causes delayed emptying/nausea etc and biliary tract stasis
Changes in bile salt composition - increased risk of stones
Increased risk of pancreatitis

72
Q

Why is pregnancy a pro-thrombotic state?

A

Lots of fibrin deposition at implantation site
Increased fibrinogen and clotting factor production
Reduced fibrinolysis
(Plus stairs and venodilation)

73
Q

Why can we not give warfarin during pregnancy?

A

It crosses the placenta

Is teratogenic

74
Q

What is the change to plasma volume in pregnancy?

A

Increases 40-50%

75
Q

What is the change to red cell mass in pregnancy?

A

Increased

20-30%

76
Q

Why is maternal physiological anaemia common?

A

There are fewer RBCs relative to the volume of plasma

77
Q

Apart from physiological anaemia, which other types of anaemia are most common with pregnancy?

A

Folate deficiency

Iron deficiency

78
Q

What do we mean by ‘the foetus is an allograft’?

A

Genetically distinct to the mother

Will express some HLA antigens from the father (that the mother does not have)

Reproductive System (17 decks)

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