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Human development > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

Which macromolecules increases in the pregnant mother’s circulation?

A

Lipids

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2
Q

Why is there increased loss of electrolytes like Ca from the pregnant mother?

A

Increased GFR

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3
Q

What is involved in insulin resistance in gestational diabetes?

A

Placental lactogen

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4
Q

What is DHA?

A

The precursor of all oestrogens pregnancy

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5
Q

Functions of oestrogens?

A 
Increase the liver synthesis of lipids and cholesterol
Growth and priming of the uterus
Anti-insulin
Cervical ripening
Stimulated of RAAS
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6
Q

Functions of progesterone?

A

Maintains endometrium (D0-60 is c. luteum then placenta)
Suppresses mat immune response to fatal antigens
Partuition
Substrate for fetal adrenal production
Inhibits uterine contractility and ripening
Inhibits over breathing
Stimulates RAAS
Growth of mammary glands

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7
Q

Function of hCG:

A

Binds to TSH receptors and increases metabolic rate

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8
Q

Function of hPL:

A 
Lipolysis
Anti-insulin
Protein synthesis
Gluconeogenesis
Neovascularisation
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9
Q

Cortisol?

A

Increases

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10
Q

Cardio changes:

A

Heart rate increases
Cardiac output increases
Total peripheral resistance decreases
Blood pressure decreases early in the pregnancy

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11
Q

What causes increased secretion of aldosterone?

A

Oestrogen
Progesterone
Prostaglandins

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12
Q

What causes increased sympathetic tone and renin release in pregnancy?

A

Shunting of blood to the uterine circulation

Also increased GFR resulting in Na loss as well as hCG increases renin secretion

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13
Q

GFR pattern in pregnancy:

A

GFR rises sharply over pregnancy until the 26th week where it decreases (renal plasma flow mirrors)

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14
Q

Renal changes in pregnancy:

A

Reduced plasma concentration of urea and creatinine
Glycosuria
Calciuria
Frequency
Stasis due to dilatation of the collecting system

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15
Q

Pulmonary changes in pregnancy:

A 
FRC decreases 20% by term 
Expiratory reserve volume down 30% by term
Tidal volume increases 30-40% by term
Residual volume reduces 20% by term - SOB
pCO2 decreases (progesterone)
Increase in pO2
pH unchanged
Decrease in bicarbonate
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16
Q

Vascular changes in pregnancy:

A 
Slight increase in coagulability - for delivery
Increase in Factors VII, VIII and X
Increase in plasma fibrinogen
Increased ESR
Decreased fibrinolytic activity
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17
Q

Smooth muscle changes in pregnancy:

A

Decreased tone causing biliary stasis, reflux and increased absorption

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18
Q

Gas exchange in the pregnancy:

A

Maternal uterine artery: mmHg
pO2 = 95, pCO2 = 35
Fetal umbilical artery: mmHg
pO2 = 24, pCO2 = 50

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19
Q

Where does the fetus get insulin?

A

It produces its own fetal insulin from weeks 9-11 - doesn’t not get in from the mother

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20
Q

What is the ductus venosus?

A

Duct bypassing the liver

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21
Q

What is the foramen ovale?

A

Opening from the right to the left heart

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22
Q

What is the ductus arteriosus?

A

Duct from the pulmonary artery to the descending aorta

only 20% of the fetal circulation reaches the lungs

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23
Q

What is the fatal circulatory response to hypoxia?

A

Heart rate falls
Resistance in the umbilical cord increases
Resistance in the MCA decreases to protect fetal brain
Blood flow to the heart and adrenals increases
Blood flow to the kidneys decreases (reduced amniotic fluid vol)

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24
Q

What effects on foetal physiology does delivery have?

A

Cord occlusion decreases right atrium pressure so f. ovale closes
Inspiration causes vasodilation of the pulmonary artery and decreased resistance through f. ovale and ductus a.
Increased PaO2 leads to closure of ductus a.

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25
Q

What modulates ductus arteriosus closure?

A

Prostaglandin E2 + prostacyclin delay duct closure

NSAIDs accelerate duct closure

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26
Q

What stimulates the synthesis, specialisation and release of surfactant as well as lung lipid resorption and epithelial cell differentiation from 30 weeks?

A

Cortisol

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27
Q

How is foetal PaO2 only 30mmHg?

A

Compensated by high binding affinity of HbF for O2

(switch to HbA happens at 28 weeks

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28
Q

What can be used to clear liquid from the lung?

A

Opening of ENaC with ADH or adrenaline - reverses osmotic gradient

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29
Q

What is partuition?

A

Birth in labour
Softening and effacement of the cervix
Contractions

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30
Q

Stage 1 of labour:

A

3 contractions every 10 minutes

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31
Q

Stage 2 of labour:

A

Cervix fully dilated at 10cm

Strong contractions

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32
Q

Stage 3 of labour:

A

Placenta delivered due to oxytocin (oxytocin and ergometrine can be given artificially)

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33
Q

What can stimulate contraction?

A

Baby moving

Giving PGE2 and oxytocin

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34
Q

Effect of cortisol in pregnancy:

A 
Increases placental CRH
Increases oxytocin
Increases prostaglandins
Increases fatal membrane production
Stimulates conversion of DHEAS to oestrogen
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35
Q

How do suckling stimulate prolactin secretion?

A

Increase in VIP resulting in decreased dopamine release

36
Q

How does suckling stimulate milk ejection?

A

Paraventricular and supraoptic nuclei release oxytocin

37
Q

First trimester:

A

Week 1 to (end of) 12

38
Q

Second trimester:

A

Week 13 to (end of) 26

39
Q

Third trimester:

A

Week 27 to the end of the pregnancy

40
Q

Cardio changes in the first trimester:

A 
SVR down
BP down (110/60 is normal)
CO up (110 is not normal)
SV up
41
Q

Cardio changes in the second trimester:

A

SVR down
BP down
CO up
SV up

42
Q

Cardio changes in the third trimester:

A

SVR is beginning to rise by term
BP rises back to where it was before the pregnancy
CO is variable
SV is up

43
Q

Cardio changes intrapartum:

A

SVR down
BP variable
CO up
SV up

44
Q

Cardio changes early post-delivery:

A

SVR up
BP up
CO up
SV up

45
Q

Cardio changes late > 2/52

A

SVR up
BP variable
CO Down
SV down

46
Q

ABGs:

A

Respiratory alkalosis is normal with no change in base excess and reduced bicarbonate

47
Q

Pregnant woman with chest pain - investigation?

A

CT or perfusion lung scan to find a clot

48
Q

Why does ADH release decrease?

A

Placental vasopressin

49
Q

LH and FSH in pregnancy?

A

Virtually undetectable

Suppressed by high levels of oestrogen and progesterone

50
Q

GH in pregnancy?

A

Increases

Placental growth factors

51
Q

ACTH in pregnancy?

A

2-fold increase in the first trimester

No change in pituitary production but there is placental production of cortisol releasing factor

52
Q

IGF-1 in pregnancy?

A

Increases

Stimulated by hPL (human placental lactogen)

53
Q

ADH in pregnancy?

A

Reduction in circulation

Production of placental vasopressinase

54
Q

Prolactin in pregnancy?

A

Progressive increase
Stimulated by oestrogen
Little enters circulation from decidual tissue

55
Q

Renin in pregnancy?

A

Increase 4-fold by 20 weeks then plateaus

RAAS activation results from the drop in TPR and resultant drop in after load

56
Q

Aldosterone in pregnancy?

A

Increase 3-fold in 1st trimester and 10-fold by the third

Response to increased renin and angiotensin II

57
Q

Thyroid hormones in pregnancy?

A

Higher total levels of T4 and T3, mother needs to make 50% more
Increased renal iodine clearance and fatal iodine uptake
1st trimester there is increased T4 which suppresses TSH
hCG also activates TSH receptors
Heamodilution also helps explain why more is made

58
Q

Cortisol in pregnancy?

A

Increase 3-fold
Suppression by exogenous corticosteroid is blunted
Due to increase in cortisol binding globulin, cortisol releasing hormone and progesterone

59
Q

How is pre-eclampsia defined?

A

Gestational hypertension past 20 weeks (sys or dia over 140/90)
With one of:
1) Proteinuria
2) Systemic involvement (e.g. renal indicated by elevated creatinine)
3) Foetal growth restriction

60
Q

What can be the systemic complications of pre-eclampsia?

Signs

A

Cerebral or visual disturbance
Impaired renal function (creatinine >1.1mg/L or doubled)
Pulmonary oedema
Liver dysfunction (transaminase twice normal amount)
Thrombocytopenia - platelets <100,000/uL

61
Q

What is HELLP?

A

It is a non-hypertensive subtype of pre-eclampsia
H - Haemolysis
EL - Elevated liver enzymes
LP - Low platelets

62
Q

Risk factors for pre-eclampsia?

A 
Primiparity
Multiple pregnancy
Previous occurence/FH
Pre-gestation diabetes
PCOS
AI conditions
Renal disease
Chronic hypertension or gestational hypertension
BMI >30, age >35
63
Q

Symptoms of pre-eclampsia?

A 
Headache (frontal)
Right upper quadrant pain
Visual disturbances (photopsia, retinal vasospasm, scotomata)
Breathlessness
Seizures
Oliguria
64
Q

Investigations to be done in pre-eclampsia:

A

Urinalysis for protein
Foetal ultrasound
Umbilical artery Doppler velocimetry
Coagulation screen if platelets <100,00/uL

65
Q

Differentials for pre-eclampsia:

A

Other forms of hypertension
Epilepsy
Anti-phospholipid antibody syndrome (Hx of repeated early pregnancy loss)

66
Q

Management before delivery:

A 
1) Admission and monitoring
\+ decision regarding monitoring
Adjunct: corticosteroid
\+ (w/ BP >160/110) anti-hypertensive
\+ (w/ seizures) magnesium sulfate
67
Q

Management after delivery:

A

1) Close monitoring of fluid balance

+ continue anti-hypertensives and magnesium sulphate

68
Q

Appropriate management for a woman with 3 risk factors for thromboprophylaxis?

A

LMWH from 28 weeks to 6 weeks post natal

69
Q

Risk factors for thromboprophylaxis in pregnancy:

A 
Age>35, BMI>30, Parity>3
Smoker, gross varicose veins
Current pre-eclampsia, immobility
FH of unprovoked VTE
Low risk thrombophilia
Multiple/IVF pregnancy
70
Q

Appropriate management for a woman with >3 risk factors for thromboprophylaxis?

A

Immediate LMWH

71
Q

Which thrombolytic drugs should be avoided in pregnancy?

A

DOACs and warfarin

72
Q

Diagnosis of DVT shortly before pregnancy management?

A

Continue anticoagulation treatment for 3 months postpartum

73
Q

Causes of primary postpartum haemorrhage?

A 
The 4 T's:
Tone (uterine atony)
Tissue (retained products of conception)
Trauma (to the genital tract or perineum)
Thrombin (coagulation abnormalities)
74
Q

Secondary PPH?

A

24 hours-12 weeks

Due to retained placental tissue or endometritis

75
Q

Risk factors for shoulder dystocia?

A

Fetal macrosomia
Diabetes mellitus
Premature labour
High maternal BMI

76
Q

What can happen as a result of shoulder dystocia?

A

Brachial plexus injury in the newborn such that they cannot move their arm properly and it is fixated medially
Perineal tears to the mother

77
Q

Effect of maternal diabetes mellitus on fetus?

A

Insulin resistance
Polyuria
Polyhydramnios
Macrosomia

78
Q

Effect of rhesus incompatibility of newborn?

A

Hydrops fetalis (effusions, loss of oncotic pressure as liver is trying to primarily produce for RBCs)
Jaundice, anaemia, hepatosplenomegaly
HF
Kernicterus (brain damage from jaundice)

79
Q

Treatment for rhesus incompatibility:

A

Anti-D Ig

For the baby: transfusions and UV phototherapy

80
Q

When is the baby at risk of rhesus incompatibility?

A

If the mother is rhesus negative and the baby is rhesus positive

81
Q

Effect of gestational diabetes?

A

Macrosomia (child is large) and infant hypoglycaemia as the child will have developed large amounts of insulin to deal with the high glucose concentrations in the mothers blood

82
Q

Determinant of foetal growth?

A

Insulin

83
Q

Determinant of infant growth (0-2 years)?

A

Nutrition and insulin

84
Q

Determinant of childhood growth (3-11 years)?

A

Growth hormone and thyroxine

85
Q

Determinant of growth in puberty (12-18 years)?

A

Growth hormone and sex steroids

Human development (7 decks)

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