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3- Reproduction > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

Conception

A

initial stage that allows for establishment of pregnancy.
After sperm has been deposited at the cervix, it I transported to uterus where it fertilise the ovum and implants in uterine stroma.

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2
Q

where must sperm travel for conception to occur

A

ampulla in fallopian tube

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3
Q

Changes sperm needs to undergo for conception to occur

A

Oxytocin: stimulates uterine contraction which, alongside sperm propulsive activity, aids in transporting sperm nd helping it travel.

Sperm undergoes capacitation in order to prevent oocyte. Capcitation: sperms tail changes from beat-like action to whip-like to help propel forward

Changes that occur are induced by removal of protein coat exposing acrosome enzymes.
Acrosome reactions allow penetration Zona pellucid

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4
Q

Zon pellucida and sperm interaction

A

Specific cell surface glycoprotein interacts with sperm and allow calcium to enter spermatozoa- increase in intracellular cAMP.
Acrosome swells and outer membrane fuses -> release of enzymes from acrosome into space surrounding head of sperm

Inner cell membrane of acrosome exposed and glycoprotein holds sperm near egg. Proteolytic enzymes released from acrosome then allow for penetration of Zona pellucida by sperm.

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5
Q

Changes following penetration of Zona pellucida

A

Penetration allows sperm and oocyte membranes to fuse.
Calcium enters oocytes

Changes in oocyte as result of increased calcium

  • egg cell membrane depolarises to prevent polyspermy
  • Cortical reaction occurs (cortical granules fuse with membrane and release contents into Zona pellucida)
  • egg completes fine meiotic division
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6
Q

labour

A

physiological process by which a foetus is expelled from uterus to outside world

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7
Q

Braxton Hicks contractions

A

involuntary contractions of uterine smooth muscle.

Occur irregularly- not regarded as part of labour

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8
Q

initiation of labour

A

cervical ripening
myocetrial excitability
Oxytocin

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9
Q

Cervical ripening

A

softening of cervix.
Occurs in response to oestrogen, relaxin and prostaglandins.

Ripening involves

  • reduction in collagen
  • increase in glycosaminoglycans
  • increase in hyaluronic acid-reduced aggregation of collagen fibres
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10
Q

Bishop score

A

assesses cervical ripeness

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11
Q

Myometrial excitability

A

Relative decrease in progesterone in relation to oestrogen
-facilitates increase in excitability of uterine musculature.

Progesterone typically inhibits contractions and oestrogen increases contractility.

Mechanical stretching of uterus also helps to increase contractility.

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12
Q

role of oxytocin in initiation of labour

A

invites uterine contractions.

~36 weeks gestation- increase in number of oxytocin receptors present within myometrium. Uterus begins to respond to pulsatile release of oxytocin from posterior pituitary gland

Oxytocin production increased by afferent impulses from cervix and vagina

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13
Q

stages of labour

A

First stage

  • Latent
  • Active

Second Stage

  • Passive
  • Active

Delivery

Third Stage

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14
Q

First stage of labour

A

Creation of birth canal.
Beginning ofd labour -> cervix fully dilated.

Contractions every 2-3 minutes

Foetal membranes rupture if they have not already.

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15
Q

Latent first stage of labour

A

slow cervical dilatation over several hours until cervix has reached 4cm dilatation

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16
Q

Active first stage of labour

A

Faster rate of cervical dilatation until 10cm is reached

Typical rate

  • Nulliparous: 1cm per hour
  • Multiparous: 2cm per hour

Should not last longer than 16 hours

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17
Q

second stage of lavbour

A

Full dilatation of cervix until foetus is fully expelled.

Uterine contractions expulsive and pushes foetus through birth canal

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18
Q

Passive 2nd stage of labour

A

Head of foetus reaches pelvic floor.
Women experiences desire to push.
Rotation and flexion of head are completed

19
Q

Active 2nd stage of labour

A

Pressure of foetal head on pelvic floor results in urge to ‘bear down’
Women push in conjunction with contractions in order to expel foetus.

Typically

  • 20 minutes in multiparous women
  • 40 minutes in nulliparous women
  • > 1hr: spontaneous delivery unlikely.
20
Q

Hormones associated with contractions

A

Prostaglandins
- more intracellular calcium is released per AP, increasing force of contractions

Oxytocin: lowers threshold for APs, increasing frequency of contraction

21
Q

Delivery of foetus

A

Once head of foetus reaches perineum, it extends in order to come up and out of pelvis.
Following delivery of head, rotes 90 degree to assist with delivery of shoulders.

Anterior shoulder delivers first, coming under pubic symphysis pubis while body flexes laterally and posteriorly to aid passage.

Body then flexes laterally and anteriorly to help deliver posterior shoulder. Rest of the body follows

22
Q

Third stage of labour

A

Follows delivery and lasts until placenta has been delivered.
Uterine muscle fibres contract to compress blood vessels supplying placenta, which then shears away from uterine wall.
Contaction continues until placenta and membrane delivered.

Typically lasts;15 mintutes
Up to 500ml blood loss normal

23
Q

Control of bleeding during 3rd stage of labour

A

Contraction of uterus constricts blood vessels in myometrium.
Pressure exerted on placental site once it has been delivered by walls of contracted uterus.
Normal blood clotting mechanism.

24
Q

Induction of labour & methods

A

Process of initiation labour artificially.
Typically 40-42 weeks gestation

Vaginal Prostaglandins
amniotomy
membrane sweep

25
Q

lactation

A

maternal physiological response where milk is secreted from mammary glands to feed the infant

26
Q

breast changes during pregnancy

A

significant hypertrophy of the ductular-lobular-alveolar system. prominent lobules form and mid-gestation alveolar cells differentiate to be capable of milk production.

Little milk secretion due to high progesterone:oestrogen ratio which favour growth rather than secretion.

27
Q

regulation of milk production

A

Primarily under control of prolactin

During pregnancy, high progesterone:oestrogen ratio favours development of alveoli but not secretion.

Delivery of placenta- source of circulating steroids (progesterone) is removed allowing alveoli to respond to prolactin.
Breast milk forms within 24-48 hours

28
Q

prolactin

A

Polypeptide hormone
Secreted by anterior pituitary gland
Secretion is controlled by dopamine (prolactin inhibiting hormone) from the hypothalamus
Factors promoting secretion of prolactin reduce dopamine secretion in a negative feedback loop
Also produced by decidual cells

29
Q

prolactin stimulation

A

promoted by suckling.
Neuro-endocrine reflex
Suckling mechanically stimulates receptors in the nipple and impulses pass up to the brain stem and to hypothalamus to reduce secretion of dopamine and increase vasoactive intestinal protein (promotes prolactin secretion)

Suckling at one feed promotes prolactin release, which causes production for the next feed. Accumulates in alveoli and ducts

30
Q

Milk let-Down reflex

A

mechanical stimulation of nipple is responsible for milk delivery to infant and maintenance of lactation.
Milk is ejected by let-down reflex

In response to suckling, oxytocin is released from pituitary gland which stimulates myoepithelial cells that surround alveoli to contract -> squeezing milk out of breast.

31
Q

maintaining milk production

A

sufficient suckling stimulation at each feed to maintain prolactin secretion and to remove accumulated milk

32
Q

milk suppression

A

If suckling stops, milk production ceases gradually due to turgor induced damage to secretory cells and low prolactin levels

Can also be achieved via steroids

33
Q

hyperprolactinaemia

A

elevated prolactin levels.
Can cause infertility, low sex drive and bone loss

Causes

  • prolactinoma
  • medicine induced (result of hypothyroidism)
  • idiopathic

Treatment: dopamine-receptor agonists (bromocriptine/cabergoline)

34
Q

endocrine maternal adaptions in pregnancy

A

Increased oestrogen & increased total T3 & T4
Increased progesterone
Increase in human placental lactogen, prolactin and cortisol levels.
Increase in lipolysis

35
Q

cardiovascular maternal adaptations in pregnancy

A

increased progesterone levels

  • decreases systemic vascular resistance
  • decrease in diastolic BP in 1st & 2nd trimester
  • Cardiac output increase by 30-50%

Activation of RAAS, leading to an increase in sodium levels and water retention
-Total blood volume increases

36
Q

respiratory maternal adaptations in pregnancy

A

increased metabolic rates
- increased demand for oxygen

Tidal volume and minute ventilation rate increases.

May experience hyperventilation

  • increased CO2 production and increased RR caused by progesterone.
  • respiratory alkalosis with compensated increase in renal bicarbonate excretion
37
Q

GI maternal adaptations in pregnancy

A

Upward displacement of stomach

  • increase intra-gastric pressure
  • predisposes to GI reflux

Increase in progesterone

  • smooth muscle relaxation (decreases gut motility. can lead to constipation)
  • relaxation of gallbladder (predisposes to gallstones0
38
Q

Urinary maternal adaptations in pregnancy

A

Increased CO causes increase in renal plasma flow.
Increased GFR increases renal excretion
–> lower levels of urea & creatinine

Progesterone

  • relaxation of ureter
  • relaxation of muscles of bladder
  • -> urinary stasis which predisposes to UTIs, commonly pyelonephritis
39
Q

haematological maternal adaptations in pregnancy

A

increase in fibrinogen and clotting factors
Decrease in fibrinolysis
Increase in progesterone level (stasis of blood and ventilation)

Increase risk of thromboembolic disease

Plasma volume increases significantly. Red cell mass does not increases as much
- physiological dilution anaemia

40
Q

Pregnancy anticoagulant of choice

A

LMWH

Warfarin can NOT be given as it is teratogenic and can cross placenta

41
Q

Gestational diabetes mellitus

A

Compensatory increase in insulin levels does not occur resulting in high blood sugar levels.

42
Q

GDM Diagnostic Criteria and Risk factors

A

Flasting plasma glucose: 5.6 and above
Two-hour plasma glucose: 7.8 or above

Risk Factors

  • Age
  • high BMI before pregnancy
  • Family history of T2DM
  • Snoking
43
Q

Consequences of gestational diabetes mellitus

A

Unmanaged
-macrosomia (increased risk of shoulder dystocia)

Managed
- intrauterine growth retardation

3- Reproduction (15 decks)

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