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Human Development > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

What does ‘6 weeks pregnant’ mean in terms of gestational age and embryonic age?

A

Gestational age = 6 weeks (since LMP)

Embryonic age = 4 weeks (since conception)

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2
Q

What is the embryonic period defined as?

A

Up to 8 weeks

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3
Q

What is the fetal period defined as?

A

After 8 weeks

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4
Q

When does implantation begin?

A

Day 6/7 (after conception)

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5
Q

When is implantation complete?

A

Day 10

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6
Q

What is the ‘implantation window’?

A

The period in which implantation must occur (between days 20 and 24 of normal menstrual cycle)

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7
Q

What is the essential condition for implantation?

A

Low oxygen tension (remains until 16 weeks)

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8
Q

What causes the low oxygen tension in the first 16 weeks?

A

Trophoblast cells migrate into the spiral arteries and plug them
This blocks maternal blood flow to the placenta

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9
Q

What kind of nutrition does the foetus rely on for the first 16 weeks before the placenta development is complete?

A

Anoxic histiotrophic nutrition (diffusion)

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10
Q

What are the 3 stages of implantation?

A
  1. Apposition
  2. Attachment
  3. Penetration
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11
Q

What occurs during apposition?

A

Progesterone gets endometrium ready for fetus.

Becomes rich in glands, capillaries and stroma

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12
Q

What occurs during attachment?

A

Pinopodes from endometrium and microvilli on trophoblast help attachment

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13
Q

What molecules does penetration during implantation involve?

A

Prostaglandins (mediated by COX1 and COX2)

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14
Q

What do the uterine glands produce?

A

Lots of hormones that stimulate growth of embryo, e.g. VEGF, hCG.

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15
Q

Which 2 layers does the outer cell mass form?

A
  1. Synctiotrophoblast (outer layer, multinucleated)

2. Cytotrophoblast (inner layer, mononuclear)

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16
Q

Where is hCG produced?

A

Synctiotrophoblast

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17
Q

Where does hCG act?

A

On corpus luteum (positive feedback) to sustain progesterone levels
–> prevents menstruation and promotes decidualisation

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18
Q

What is the relationship between uterine microbiome and implantation?

A

Microbiome affects implantation

Recurrent miscarriage lady likely to have abnormal uterine microbiome (more anaerobic bacteria)

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19
Q

How can pre-eclampsia be diagnosed?

A

Doppler screening of the uterine artery

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20
Q

What are the risk factors for pre-eclampsia?

A
  • previous history
  • multiple gestation (twins etc)
  • chronic hypertension/ diabetes etc
  • obesity
  • family history
  • first pregnancy
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21
Q

What prophylaxis for pre-eclampsia is given if patient is high risk?

A

Aspirin should be given in first trimester

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22
Q

Which molecule is a good diagnostic indicator of pre-eclampsia?

A

Placental growth factor

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23
Q

What causes pre-eclampsia?

A

Placenta does not develop properly due to blood vessels supplying it

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24
Q

When do the chorionic villi appear?

A

At the end of the second week

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25
Q

How do the placental villi form/

A

Primary villus –> secondary villus –> tertiary villus

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26
Q

What kinds of villi make up the outer placenta?

A

Chorion lavae and chorion frondosum

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27
Q

What is the final form of the placenta made up of?

A

Decidual plate (maternal portion) and chorion frondosum (fetal portion)

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28
Q

What does the placenta regress to form?

A

Discoid placenta (16 weeks)

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29
Q

Where should placenta be at 38 weeks?

A

At top of uterus otherwise it causes huge haemorrhage

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30
Q

Name 3 placental complications.

A
  1. Low lying placenta
  2. Retained placenta
  3. Placental abruption (premature separation of the placenta from the uterus)
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31
Q

What are the main functions of the placenta?

A

Respiratory organ
Nutrient transfer
Excretion of fetal waste products
Hormone synthesis

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32
Q

What are the 2 stages of the formation of the maternal circulation?

A
  1. Differentiation of endometrium into decidua

2. Transformation of uterine spiral arteries

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33
Q

What is the function of the uterine NK cells?

A

Alter structure of spiral arteries/ open them

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34
Q

What happens if the opening of the spiral arteries fails?

A

Fetal growth restriction

or pre-eclampsia

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35
Q

What happens if the spiral arteries open too early?

A

Implantation failure
Miscarriage
(also oxidative stress causing congenital malformations)

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36
Q

At what point in pregnancy does the placenta not undergo any more anatomical changes?

A

End of 4th month

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37
Q

What is the difference between monozygotic and dizygotic twins?

A

Monozygotic - one egg, identical

Dizygotic - two eggs, non-identical

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38
Q

What are the types of monozygotic twinning?

A
  1. Dichorionic (2 placentas) - cleavage before implantation
  2. Monochorionic, diamniotic - cleavage day 6-8
  3. Monoamniotic - cleavage after day 8
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39
Q

How do conjoined twins arise?

A

Cleavage during embryogenesis (rare)

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40
Q

What increases the chances of monozygotic twins occurring?

A

Assisted conception like IVF

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41
Q

Are dizygotic twins mono or di chorionic?

A

All dichorionic

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42
Q

What are risk factors for having twins?

A 
Age over 35 - FSH rises with age and causes double ovulation
Family history
Previous multiple birth
Black ethnicity
Increased BMI 
Smoking
Pill
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43
Q

What is a sacrococcygeal teratoma?

A

Remnant of the primitive streak

Can take large blood supply and cause fetal heart faiulre

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44
Q

What switch in the placental circulation occurs at 12 weeks?

A

Switch from histiotrophic nutrition to haemotrophic nutrition (large rise in intraplacental oxygen)

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45
Q

What is the job of the two umbilical arteries?

A

Carry deoxygenated blood from fetus to placenta

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46
Q

What is the job of the umbilical vein?

A

Carries oxygenated blood from placenta to fetus

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47
Q

What is special about the umbilical vein?

A

ONLY time a vein carries oxygenated blood

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48
Q

How are the cells of the synctiotrophoblast specialised?

A

Brush border

Lots of mitochondria

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49
Q

Why is the fetal pO2 always low?

A

Protect from oxidative stress and enable easy transfer of oxygen from mother to baby

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50
Q

What is a common cause of fetal growth restriction?

A

Defects in amino acid transporters across the placenta

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51
Q

What regulates the growth and development of the alimentary tract?

A

Gastrin, motion and somatostatin are ingested by the fetus

52
Q

When does the fetus start making insulin?

A

9 weeks

53
Q

Why do all pregnant women become a bit diabetic?

A

Increase in their blood glucose to help transfer of glucose to the baby

54
Q

What is gestational diabetes?

A

Diabetes during pregnancy - more common in pre-diabetic women

55
Q

What is macrosomia?

A

When the baby is overweight at birth (associated with maternal obesity and diabetes)

56
Q

What are the complications of macrosomia?

A

Labour issues
Increased risk of still birth
C section often needed

57
Q

How is fluid balance maintained in the fetus?

A

Mostly by the placenta

Fetus also has a functional kidney that makes dilute urine (ADH is immature)

58
Q

What is Oligohydramnios?

A

Too little amniotic fluid

59
Q

What is Polyhydramnios?

A

Too much amniotic fluid

60
Q

What is amniotic fluid made up of?

A 
Urine
Amniotic membrane secretions
Fetal lung secretions
Salivary secretions
Fetal epithelial cells
61
Q

How is fetal heart rate mainly controlled?

A

Through the autonomic nervous system (parasympathetic/ vagal tone dominates)

62
Q

What are 4 adaptations of the fetal circulation seeing as it does not go to the lungs?

A
  1. Umbilical vein/arteries
  2. Ductus venosus (blood bypasses liver)
  3. Foramen ovale (blood from R heart to L heart)
  4. Ductus arteriosus
63
Q

What is the fetal response to hypoxia?

A 
Heart rate falls
More resistance in umbilical artery
Less resistance to middle cerebral artery
Increased blood flow to heart
Decreased blood flow to kidneys
64
Q

What causes the foramen ovale and ductus arteriosus to close?

A

At delivery, cord occlusion decreases right atrial pressure
Inspiration causes vasodilation of pulmonary artery
Increased arterial pO2

65
Q

Which molecules delay ductus arteriosus closure?

A

Prostaglandin and prostacyclin

66
Q

What drugs accelerate closure of the ductus arteriosus?

A

NSAIDs

67
Q

How are the fetus’ lungs cleared of their liquid?

A
  1. Physical force during labour
  2. Activation of ENaC channels
  3. Transpulmonary hydrostatic pressure gradient
68
Q

What do some babies need to help them take their first breath?

A

Cold shock

69
Q

When does pulmonary surfactant start to be secreted?

A

30 weeks

70
Q

What is given to a woman with a pre-term baby to stimulate surfactant production?

A

Glucocorticoid

and give baby artificial surfactant when born

71
Q

What can happen if a baby is not treated to stimulate surfactant production if premature?

A

Neonatal respiratory distress syndrome

72
Q

What is the function of pulmonary surfactant?

A

Reduces surface tension
Increases lung compliance
Stabilises the lung

73
Q

What occurs late in pregnancy to stimulate surfactant production?

A

Surge in cortisol

74
Q

When does the switch from HbF to HbA begin?

A

28 weeks

75
Q

What happens to plasma volume during pregnancy?

A

Increases

–> RAAS increases

76
Q

What happens to red cell mass during pregnancy?

A

Increases

- being anaemic is v bad

77
Q

What happens to the haematocrit during pregnancy?

A

Decreases

- plasma volume goes up more than red cell volume (diluted)

78
Q

Why is physiological anaemia normal during pregnancy?

A

Plasma volume increases more than red cell volume

79
Q

Why is folate important in pregnancy?

A

Important in DNA methylation and synthesis

Needed in early pregnancy to reduce neural tube defects

80
Q

What are the 3 sources of steroids in pregnancy?

A

Placenta
Fetus
Mother

81
Q

Where is progesterone produced during pregnancy?

A

By corpus luteum then placenta

82
Q

What effects does progesterone have on fetal antigen responses and tidal volume?

A

Decreased response to fetal antigens

Increased tidal volume

83
Q

What does human placental lactogen do?

A

Important for maternal lipolysis and anti-insulin action

84
Q

What does leptin do in pregnancy?

A

Women become leptin restistant

Stimulates placental amino acid/fatty acid transport

85
Q

Are LH and FSH detectable during pregnancy?

A

No

86
Q

What effect does pregnancy have on BP?

A

Decreases in first 2 trimesters

Increases at end of pregnancy

87
Q

What happens to CO and O2 consumption in pregnancy?

A

Increase

88
Q

What happens to peripheral resistance in pregnancy?

A

Decreases due to increased NO synthesis etc

89
Q

What happens to the mother’s kidneys during pregnancy?

A

GFR increases by 40-65%

Urination freq increases and urinary statis causes UTIs

90
Q

Why are C section babies more likely to become obese?

A

Do not pick up vaginal microbiome during delivery

91
Q

What feature of breathing is unchanged by pregnancy?

A

Respiratory rate

92
Q

Do pregnant women have an acidosis or alkalosis?

A

Respiratory alkalosis

Low pCo2, low bicarb

93
Q

What is the relationship between pregnancy and DVT?

A

DVT more likely due to low grade increase in coagulability

should go on heparin if high risk

94
Q

What happens to the GI tract during pregnancy?

A

Smooth muscle relaxes

So constipation

95
Q

When should morning sickness due to hCG beta stop?

A

15 weeks

96
Q

What is the main danger to maternal health during pregnancy?

A

Pregnancy symptoms can mask pathology

97
Q

What is the biggest cause of maternal mortality?

A

Cardiac problems

98
Q

What are the current antenatal screening policies in the UK?

A 
Haemoglobinopathy
Infectious diseases
Chromosomal abnormalities
Fetal anomalies
Pre-eclampsia
99
Q

What are downsides to screening?

A

False positives
Harm from screening
Cost

100
Q

What are important disease characteristics for screening?

A

Important health problem
Recognisable early phase
Treatment exists

101
Q

How are pregnant women screened for sickle cell?

A

Only high risk women screened

Can offer CVS/amniocentesis

102
Q

How are pregnant women screened for thalassemia?

A

All women screened at 10 weeks by blood test

103
Q

Which infectious diseases are screened for?

A

HIV
Hep B
Syphilis

104
Q

How are chromosomal abnormalities screened for?

A

Combined test in 1st trimester

105
Q

What is the fetal anomaly scan?

A

20 week scan done by US

106
Q

What are the 3 stages of fetal growth?

A
  1. Hyperplasia
  2. Hyperplasia and hypertrophy
  3. Hypertrophy
107
Q

Which trimester does most fetal weight gain occur?

A

Third

108
Q

How is fetal growth measured?

A

Crown-rump length (CRL)

109
Q

What is the first scan for at 12 weeks?

A

Viability
Single/multiple pregnancy
Crown rump length (dates the pregnancy)

110
Q

What is the second scan fro at 20 weeks?

A

Routine anomaly scan
Assessing fetal growth
Fetal anomalies
Location of placenta

111
Q

How is fetal growth assessed?

A

Head circumference
Bi-parietal diameter
Abdominal circumference
Femur length (gives estimated fetal weight)

112
Q

What is the symphysial fundal height? (SFH)

A

Measure of bump using a tape measure

Gives gestational age plus or minus 2cm

113
Q

What should the SFH be at 20 weeks?

A

Umbilicus

114
Q

What is the amniotic fluid index? (AFI)

A

Amount of amniotic fluid on US (8-18 is normal)

115
Q

What is fetal growth restriction?

A

Placenta may not be working properly/problem with mother
Pathological
Increases risk of perinatal complications (unlike SGA babies)

116
Q

How can the chances of stillbirth be reduced?

A
  1. Reduce smoking in pregnancy
  2. Risk assessment for FGR
  3. Raise awareness of reduced fetal movement
  4. Effective fetal monitoring during labour
117
Q

What does low levels of PAPP-A at 1st trimester combined screen indicate?

A

Poor placentation
- increased risk of SGA/pre-eclampsia
Give aspirin

118
Q

What are maternal risk factors for SGA?

A

Diabetes
Hypertension
Active lupus
Sickle cell disease

119
Q

What are fetal risk factors for SGA?

A

Multiple pregnancies
Fetal structural/chromosomal abnormality
Fetal infection

120
Q

Are monochorionic or dichorionic twins more high risk?

A

Monochorionic - should be scanned every 2 weeks

121
Q

How is LGA/macrosomia defined?

A

Birth weight greater than 4kg

122
Q

What are risk factors for LGA?

A

Large parents, esp mother BMI
Previous LGA baby
Diabetes

123
Q

What are complications of an LGA birth?

A

Shoulder dystocia

Perineal trauma/PPH in mother

124
Q

What is different about first aid of a pregnant women post 20 weeks?

A

If collapsed sit her up

Take baby out if mother has cardiac arrest (helps resuscitation of mum)

125
Q

Which scan is not advised during pregnancy?

A

Abdominal/lumbar sacral spine X ray

Human Development (12 decks)

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