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BS - Reproductive System > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

Before fertilisation, where is the egg situated?

A

Within the Fallopian tube

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2
Q

What is the role of the fimbriae?

A

They sweep the egg from the ovary into the Fallopian tube at ovulation

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3
Q

When sperm enters the body, what is the passage it takes?

How does the uterus aid in movement of the sperm?

A

It moves up the cervix, through the cervical mucus and into the uterus

It passes through the ostia and into the Fallopian tube

The uterus contracts to aid the movement of the sperm

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4
Q

What are the ostia?

A

Small openings where the Fallopian tubes meet the uterus

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5
Q

What forms when the oocyte is fertilised?

A

The zygote

This is surrounded entirely by the zona pellucida to prevent entry of further sperm

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6
Q

What is early cleavage?

A

After fertilisation, the zygote begins to divide

When it reaches the 4-cell stage, this is early cleavage

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7
Q

What is formed 3-4 days post-fertilisation?

A

The morula

This is formed by further divisions of the fertilised oocyte

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8
Q

What is formed 4-5 days post-fertilisation?

A

Blastocyst

This consists of an inner cell mass and a blastocoele (fluid-filled space)

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9
Q

What is the trophoblast of the blastocyst?

A

It is the outer layer of cells that will go on to form the placenta

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10
Q

When does the blastocyst implant into the endometrium of the uterus?

A

Day 6 post-fertilisation

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11
Q

What are the 5 stages of early implantation?

A
  1. shedding of the zona pellucida
  2. pre-contact blastocyst orientation
  3. apposition cellular contracts
  4. adhesion
  5. penetration of endometrium
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12
Q

What happens during pre-contact blastocyst orientation?

A

The trophoblast cells invade the endometrium

The amniotic cavity forms within the inner cell mass

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13
Q

What will the amniotic cavity go on to form?

A

The amniotic fluid

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14
Q

What is the decidua?

A

it is part of the endometrium

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15
Q

What is the extravillous trophoblast?

A

The trophoblast cells which are burying their way into the decidua

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16
Q

What did Medawar suggest?

A

The foetal allograft survival

Why does the foetus survive in the body even though it is “foreign”?

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17
Q

What does Medawar suggest as the reasons why the foetus survives?

A
  1. antigenic immaturity in the foetus
  2. placental protection
  3. the foetus can block certain antibodies
  4. immune privilege
  5. altered host immunity
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18
Q

What is meant by placental protection?

A

The placenta doesn’t make certain chemicals that would usually be recognised by the body as foreign

e.g. MHC class I

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19
Q

How can the foetus block antibodies?

A

There are certain antibodies that do not make it across the placenta as they are too big

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20
Q

What is meant by immune privilege and altered host immunity?

A

In the maternal blood, there are less cell-mediated immune cells

e.g. cytotoxic T cells

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21
Q

What are the 2 types of trophoblasts involved in the decidua interaction?

A

Villous trophoblast - this is inert

Extravillous (invasive) trophoblast

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22
Q

What antigens are expressed on the surface of the extravillous trophoblast?

What is not expressed?

A

ONLY class I human leucocyte antigens

It does NOT express:

Cw, G, E, A and B

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23
Q

What is significant about the invasive trophoblast not expressing certain antigens?

A

This makes it less attractive to cytotoxic T-cells

It enables binding to NK cells

The mother’s immune system does not attack the foetus

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24
Q

What type of NK cells are secreted during the luteal/secretory phase of the cycle?

Why are they present?

A

CD56 (bright)

Their presence is due to progesterone

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25
Q

What is the role of the CD56 NK cells?

A

They have the capacity both to facilitate and impede trophoblast invasion

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26
Q

How may the CD56 NK cells determine the maternal response to pregnancy?

A

They are the main source of decidual cytokines

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27
Q

What is an example of systemic signalling in pregnancy?

A

As the trophoblast comes into the decidua, it begins to make hCG

The hCG acts on the ovary, causing it to make more progesterone

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28
Q

How do levels of hCG vary in early pregnancy?

A

hCG levels roughly double every 48 hours

It rises rapidly to peak at just over 2-3 months

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29
Q

When do hCG levels drop?

A

They drop rapidly between 2-3 months

It then plateaus and remains at a lower level until the end of pregnancy

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30
Q

How do progesterone and oestrogen levels change during pregnancy?

A

They both steadily rise throughout pregnancy

Oestrogen is at a higher concentration than progesterone

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31
Q

What happens to the levels of hCG, oestrogen and progesterone at parturition?

A

The levels rapidly drop down to 0

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32
Q

What type of molecule is hCG and from where is it produced?

A

It is a glycoprotein with a similar structure to LH and FSH ( alpha and beta chains)

It is produced by trophoblast cells

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33
Q

Why is hCG described as a luteotrophic hormone?

A

It continues to stimulate the corpus luteum to make progesterone

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34
Q

What is meant by the production of hCG being autonomous?

A

Production is independent of the hypothalamus and pituitary

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35
Q

What is hCG thought to be the cause of?

A

Morning sickness

Morning sickness usually tends to drop off when the levels of hCG begin to drop

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36
Q

What is the clinical use of hCG?

A

Pregnancy test

this uses an immunoassay that detects the beta subunit of hCG in urine

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37
Q

How is pregnancy dated clinically?

A

From last menstrual period

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38
Q

What will be visible in a pregnancy image in weeks 5, 6, 7, and 8?

A

5 - gestation sac, placenta (brighter white)

6 - foetal pole, yolk sac, vitelline veins

7 - fetal heart activity, 3 vessel cord

8 - foetal limbs, movement

yolk sac, amniotic and chorionic cavities

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39
Q

how may imaging in pregnancy be conducted?

A

Either transvaginally (easier to see much smaller pregnancies) or transabdominal

40
Q

At which stage may pregnancy be dated through imaging?

A

11 weeks

41
Q

What % of fertile women will have a miscarriage?

How does this change with age?

A

25% of fertile women will have at least one miscarriage

  1. 6.4% under 35
  2. 14.7% 35-40
  3. 23% over 40
42
Q

What is an incomplete miscarriage?

A

Some pregnancy tissue is left behind from the foetal pole or the placenta after miscarriage

43
Q

What is expectant management of miscarriage?

A

This is allowing the body to deal with the miscarriage and do things naturally

44
Q

What are the medical treatments for miscarriage?

A
  1. progesterone receptor antagonist - mifepristone

combined with

  1. prostaglandin analogue - misoprostol
45
Q

What is the usual prognosis for miscarriage?

A

Usually a good prognosis

Even after 3 miscarriages, there is a 70% chance of success

46
Q

Why is misoprostol used in miscarriage?

A

It will open up the cervix and start some contractions of the uterus

47
Q

What is recurrent miscarriage?

A

Having 3 or more miscarriages in a row

There is a higher chance of having a further miscarriage

48
Q

What is ectopic pregnancy and how many pregnancies does it affect

A

It accounts for 1% of all pregnancies

It is implantation outside of the uterine cavity

49
Q

What are the 3 reasons for a rising incidence of ectopic pregnancies?

A
  1. assisted conception
  2. pelvic inflammatory disease

This is scarring in the fallopian tubes due to chlamydia, that narrows them

  1. sterilisation reversal
50
Q

What is a scar ectopic pregnancy?

A

When a pregnancy implants within a scar that is present from a previous C-section

51
Q

What is meant by the decidual reaction?

A

This is where you would expect to see the pregnancy on an ultrasound

There may be an ectopic pregnancy that has implanted elsewhere

52
Q

What are the 3 ways of managing an ectopic pregnancy?

A
  1. expectant
  2. medical - one off dose of methotrexate
  3. surgical - salpingectomy - removal of uterine tube and ectopic pregnancy
53
Q

When is ectopic pregnancy managed expectantly?

A

When hCG levels are monitored and they begin to fall naturally

54
Q

How does ectopic pregnancy affect future pregnancies?

A

There is an increased risk of recurrence in future pregnancies

55
Q

Why must methotrexate only be given to terminate an ectopic pregnancy?

A

it is teratogenic so will cause foetal abnormalities

56
Q

Why is methotrexate often not used in older patients?

A

it has a long half life so people must wait at least 3 months before trying to get pregnant again

57
Q

What are the 2 different types of oestrogens?

A

Estradiol (E2) is produced by the corpus luteum and the placenta

Estriol (E3) is produced by the foetus and placenta (feto-placental unit)

58
Q

what is the function of oestrogens?

A

To encourage growth and increase the strength of the myometrium

59
Q

How does oestrogen allow for accommodation of the growing foetus?

A

It increases the amount of contractile proteins

60
Q

How does oestrogen affect the sensitivity of the uterus?

A

Increases the sensitivity of the uterus to smooth muscle uterotonics towards term

e.g. PGF2a, oxytocin

61
Q

How does oestrogen affect the breasts?

A

it prepares the breasts for lactation

62
Q

What does oestrogen stimulate?

A

it stimulates hormone binding proteins that act as a reservoir

CBG, SHBG, TBG

63
Q

How does oestrogen affect blood flow through the placenta?

A

It increases blood flow through the placenta

This allows for more efficient exchange of nutrients and waste products

64
Q

How does progesterone affect the uterus?

A

It reduces uterine smooth muscle contractility to keep the uterus quiescent during pregnancy

65
Q

What will progesterone block/inhibit?

A
  1. inhibits production of PGF2a and oxytocin (these start contractions)
  2. blocks T-lymphocyte cell-mediated responses and the cellular immune response
66
Q

What is HPL?

A

human placental lactogen

67
Q

How does HPL secretion change as pregnancy progresses?

A

It is secreted in increasing concentrations during pregnancy as the placenta grows

68
Q

How will HPL affect energy substrates within the mother?

A
  1. stimulates lipolysis to increase free fatty acids as an energy substrate
  2. inhibits glucose uptake in the mother
  3. favours glucose and protein transport into the foetus
69
Q

How does HPL affect the breasts?

A

It promotes the growth and differentiation of the breasts in preparation for lactation

70
Q

How does blood volume change in pregnancy?

A

There is a 40% increase in blood volume

There is an increase in total body water content and plasma volume

71
Q

What hormone is increased during pregnancy that affects the cardiovascular system?

A

There is an increase in erythropoietin

This leads to an increase in red cell mass

72
Q

Why is there sodium and water retention in pregnancy?

A

Oestrogen stimulates the renin-angiotensin-aldosterone system

73
Q

What is meant by the physiologic anaemia of pregnancy?

A

The red cell mass increases, but not as much as the blood volume increase

74
Q

How does cardiac output change in pregnancy?

A

Cardiac output increases 30-50% in pregnancy

Stroke volume rises by 30% and cardiac output rises by 10%

75
Q

How does blood pressure change during pregnancy?

A

Greater fall in TPR leads to initial drop in BP

BP then rises to prepregnancy levels later in pregnancy

76
Q

What blood pressure readings may be indicative of pre-eclampsia?

What other symptoms should be looked for?

A

Persistent BP > 150/90 mmHg

This is accompanied by:

  1. high blood pressure
  2. proteinuria
  3. peripheral oedema
77
Q

How does pre-eclampsia tend to affect women later on in life?

A

Tendency to have hypertension in later life

78
Q

What are the cardiovascular clinical consequences of pregnancy?

A
  1. fainting
  2. haemorrhoids
  3. varicose veins
79
Q

How does coagulation change during pregnancy?

A

There is increased clot formation

There is decreased clot lysis

80
Q

Why is there an increase in clot formation during pregnancy?

A

Due to an increase in factors I, V, VII, VIII, IX, X, XII

81
Q

Why is there decreased clot lysis in pregnancy?

A
  1. the placenta increases plasminogen activator inhibitors
  2. activated protein C resistance
  3. reduced protein S levels
82
Q

What factors lead to increased clot formation?

A
  1. thromboplastin
  2. fibrinogen
  3. fibrin
83
Q

What factors are decreased in pregnancy that reduce clot lysis?

A
  1. antithrombin
  2. plasminogen
  3. plasmin
84
Q

What is the problem with increasing coagulability of the blood?

A

There is an increased risk of thromboembolism

85
Q

How does oxygen consumption change during pregnancy?

A

There is an increase in oxygen consumption

This is due to the demands of the developing foetus

86
Q

What is meant by respiratory compensation during pregnancy?

A
  1. increase in tidal volume
  2. increase in alveolar ventilation
  3. vital capacity is unchanged
87
Q

What is the result in changing central control of respiration during pregnancy?

A

There is altered chemoreceptor PaCO2 sensitivity

This triggers and increase in respiration

88
Q

What is the clinical consequence of respiratory changes during pregnancy?

A

There is a disproportionate sense of dyspnoea on exertion

89
Q

How does renal blood flow during pregnancy and why?

A

There is an increase in renal blood flow due to:

  1. rise in plasma volume and cardiac output
  2. fall in renal vascular resistance
  3. increase in renal vasodilatory prostaglandins - PGI2, PGE2
90
Q

What is the result of an increase in GFR during pregnancy?

A
  1. urea and creatinine fall as there is no change in production
  2. renal threshold to glucose diminished
  3. RAAS activated in first trimester
91
Q

What are the other renal changes in pregnancy?

A
  1. pelvicalyceal and ureteric dilatation (smooth muscle)

2. bladder capacity decreases

92
Q

What are the clinical consequences of the renal changes during pregnancy?

A
  1. increased frequency of micturition

2. tendency to UTIs

93
Q

What are the consequences of a decrease in gastrointestinal motility during pregnancy?

A
  1. prolongation of gastric emptying and transit time
  2. increase in water reabsorption
  3. this leads to constipation
94
Q

What are the other gastrointestinal consequences of pregnancy?

A
  1. altered appetite (cravings)

2. lower oesophageal pressure and incompetence of cardia

95
Q

What are the clinical consequences of the gastrointestinal changes during pregnancy?

A
  1. nausea and vomiting - can lead to hyperemesis gravidarum
  2. heartburn

3, constipation

BS - Reproductive System (12 decks)

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