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LCRS RepDevAge > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

when is spontaneous loss of pregnancy common?

A

in the first trimester (33%)

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2
Q

duration of first trimester

A

0-13 months

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3
Q

duration of second trimester

A

14-26 weeks

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4
Q

duration of third trimester

A

27-39 weeks (end of pregnancy)

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5
Q

when is the term delivery?

A

Term (39-40 weeks) is expected delivery time and is stated as ~280 days (40 weeks) since LMP.

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6
Q

what is pre-term delivery?

A

premature birth more than 3 weeks before the predicted delivery date (32-37 week)

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7
Q

what is very pre-term delivery?

A

premature birth (at 28-32 weeks)

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8
Q

what are the main maternal changes during pregnancy?

A 
Increased weight.		
Increased hormone levels
Increased body temperature
Increased blood clotting
Decreased BP
Increased breast size.
Increased vaginal mucus
“Morning sickness”
Altered brain function.
Altered appetite.
Altered fluid balance.
Altered emotional state
Altered joints.
Altered immune system.

these vary with individuals

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9
Q

when do abdominal changes become apparent in the mother?

A

abdominal changes in the mother only become apparent during the 2nd trimester +.

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10
Q

when does a foetus become viable?

A

The end of the 2nd trimester marks the limit of infant survival (after this, the child is viable).

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11
Q

when is pregnancy counted from?

A

first day of the last menstrual period (LMP)

significance: embryologist and an obstetrician would use different time-scales

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12
Q

what is the difference in pregnancy start with IVF and normal? what does this determine?

A

There will be a difference in time of 2-2.5w from the gestational age (GA, derived from LMP) and the GA in an IVF pregnancy

the viability date

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13
Q

what contributes to the weight gain of the mother during pregnancy?

A 
baby
placenta
amniotic fluid
increased fluid retention
increased stores
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14
Q

when does hCG peak?

name a use of hCG?

A

peaks 1st trimester and decreases thereafter

used as pregnancy test at home

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15
Q

what happens to other hormones (not hCG) during pregnancy?

A

progesterone, oestrogens, lactogen slowly increase as the pregnancy progresses

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16
Q

what is the key steroid in maintaining pregnancy?

name an antagonist

A

progesterone

[antagonists e.g. mifepristone: inhibition of progesterone will lead to loss of pregnancy]

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17
Q

what is the progesterone source beginning pregnancy? 2 sources

A

o Fertilisation to 8 weeks’ gestation
– corpus luteum source via hCG.

o 8+ weeks
– placenta supplies progesterone.

this shift in source of progesterone is the “Luteo-placental shift”

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18
Q

what is the source of oestrogen beginning pregnancy?

A

o Fertilisation –> Luteo-placental shift
– corpus luteum.
o 8+ weeks
– complex interplay between foetal/maternal adrenals and placenta.

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19
Q

why does androgen production occur in the foetal adrenals?

A

Human placenta does not express the enzymes needed to convert pregnenolone to androgens

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20
Q

how is the female foetus protected from exposure to androgens?

A

The weak androgen produced (DHEA) is sulphated to give DHEA-S which is inactive then goes to the placenta to be converted to 17beta-oestradiol

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21
Q

what is the effect of high steroid levels during pregnancy?

A

supress HPG-axis therefore low FSH and LH throughout.

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22
Q

what is the link between blood pressure and clotting tendency in pregnant women?

A

Decreased blood pressure
– is lowest during 2nd trimester and is why pregnant women should not stand for long

Increased blood clotting tendency
– protective against losing blood at delivery.

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23
Q

what happens to basal body temperature during pregnancy?

A

Increased basal body temperature – possibly by role of progesterone. Also, mediated by increased foetal size

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24
Q

what are some other changes in the mother during pregnancy?

A

 Increased breast size
– changes start in 1st trimester and continue throughout due to all hormones!
 Increased vaginal mucus
– more clear mucus produced.
 “Morning sickness” – affects 80%, more severe version is “Hyperemesis gravidarium”.
Unknown cause but maybe linked to hCG levels being high in the first trimester.
 Altered brain function
 Altered appetite
 Altered emotional state
 Altered joints
 Altered fluid balance and urination frequency
Altered immune system

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25
Q

altered brain function explanation

A

– due to high levels of steroids, such as progesterone.

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26
Q

altered emotional state explanation

A

– due to hormone levels and can vary in people (e.g. happy  post-natal depression).

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27
Q

altered appetite explanation

A

– due to increased height of fundus, stomach may be impinged and mother may need smaller meals.

28
Q

altered joints explanation

A

– changes in pelvis to make connections more flexible to permit child-birth.

29
Q

what explains the altered fluid balance and urination frequency in the mother?

A

kidney functions change:

  • Fluid balance: ~50% increase in plasma fluid volume by term
  • Increased urination: increasing abdominal size also puts pressure on bladder so more frequent urination.
30
Q

what are the alterations in the immune system during pregnancy?

A

o Production of factors
– supress the maternal immune system from the utero-placental interface. This results in a reduction of Th1 responses and increased Th2 responses.

o Placenta expresses unusual HLA
– placental HLA are almost invariant (HLA-G has 5 known sequence variants and very simple)
- identify the tissue as human but due to its simplicity, no other information is given.
- HLA-G can also supress some leucocytes and down-regulate maternal immune responses.

31
Q

definition of conceptus

A

everything resulting from the fertilised egg

32
Q

definition of embryo

A

the baby up to week 8 of development

hard to tell what species it belongs to

33
Q

definition of foetus

A

the baby for the rest of pregnancy (after 8 weeks)

can tell its human

34
Q

definition of infant

A

applied after delivery typically

35
Q

how does the weight of the baby change throughout pregnancy

A

o First trimester
– 50g.

o Second trimester
– 1050g – viable at 500-820g stage (21-24 weeks).

o Third trimester
– 2100g.

36
Q

what are the different chromosomal abnormalities that can occur? give examples of resulting syndromes?

A

o Too few sex chromosomes – Turner’s syndrome (45 X0)

o Too many sex chromosomes
– Klienfelter’s syndrome (47 XXX, 47 XYY etc)

o Too few autosomes
– non-viability, as does 45 Y0

o Too many autosomes
– Downs Syndrome (trisomy 21)

37
Q

at what stage of pregnancy is it at most risk?

A

first trimester –> miscarriage (13 weeks)

the risks associated in the third trimester relate to delivery of the baby

38
Q

which organs have late development in utero?

A 
brain
immune system 
lungs
digestive system 
[BILD]

this is because they have limited use in utero but issues become apparent at birth

39
Q

what are the main functions of the placenta?

A
  1. Exchange of nutrients and waste products.
  2. Connection/Anchorage
    – the foetus is bound to the mother’s arterial blood supply.
  3. Separation
    – the foetus and the maternal vascular system must remain separated.
  4. Biosynthesis
    – second only to the liver in the biosynthesis functions
  5. Immunoregulation
    – ensures no rejection of conceptus. Not function of the uterus as ectopic pregnancies outside of the uterus can still proceed.

ectopic pregnancy: implantation in fallopian, ovaries, cervix or abdomen

40
Q

where does the embryo produced its blood cells?

A

in the liver as bone marrow is not available

41
Q

what is the primary subunit of the placenta? what is its function?

A

placental villus with branches

- provides a large surface area for exchange between the maternal and foetal vascular systems

42
Q

what do the veins and arteries of the placental villus carry?

A
  • veins contain oxygenated blood (to the foetus having picked it up from mum)
  • arteries contain deoxygenated blood (away from foetus to dump waste)

the placenta carries out a parallel function to the lungs during pregnancy.

43
Q

what are the villi of the placenta distributed on?

A

Cotyledons

– the maternal surface of the placenta is sub-divided into 30-60

44
Q

when does the placenta develop?

A

Approx. 9 days post fertilisation ,the conceptus (blastocyst) is completely implanted in the endometrium

Placenta originates from the cytotrophoblasts layer (inner layer of the trophoblast layer surrounding the blastocyst)

45
Q

how do the cytotrophoblasts become the placental villi?

A

cytotrophoblasts proliferate into the syncytium (made of syncytiotrophoblasts) to form a columnar structure

fewer cytotrophoblasts present at term so that there can be a closer apposition between the syncytium and placental capillaries.

46
Q

how does contact with endometrial cells change over time from when the conceptus implants itself to the endometrium?

A

From contact to isolation-

  • Early: conceptus is in contact with endometrial cells.
  • As it grows, the conceptus makes transient contact with maternal capillaries
  • But rapidly proliferating cytotrophoblasts cells form a capsule around the conceptus, isolating it about 4 weeks at 2 weeks LMP GA
47
Q

what provides nutrients for the placenta and baby?

A

Decidual glands
that undergo hypertrophy during the 1st trimester

placenta is the source of nutrients rather than the maternal blood

48
Q

what blocks spiral artery formation?

A

Cytotrophoblast shell (plugs)

Trophoblastic plugs obstruct maternal blood flow into the intervillous space and prevent flow until the end of first trimester of pregnancy

49
Q

what happens after trophoblastic plugging?

A

Cytotrophoblast plugs break down and the spiral arteries form to supply the foetus with blood normally (10-12 weeks GA)

50
Q

what is the risk involved in starting the blood supply from the maternal blood supply after plug breakdown?

A

if the placenta is not anchored properly, the increased pressure, as it is exposed to the maternal blood supply, can lead to a detach and a miscarriage.

51
Q

how does the size of the placenta change over the trimesters?

A

During the 1st trimester, the placenta is ~5cm diameter but this increases to ~20cm during 2nd and 3rd.

52
Q

what is the role of the cytotrophoblast after start of the maternal blood supply?

A

remodel the spiral arteries during the 1st trimester until ~16-18w GA.

53
Q

what occurs in spiral artery remodelling?

A

converts the narrow bore spiral vessels into wide-bore vessels to transport more volumes of blood

54
Q

how is vasoconstriction of the spiral arteries made redundant?

A

The ctb cells replace the vascular endothelium and VSMCs so they cannot respond to vasoconstrictors.

55
Q

is the placenta innervated?

A

no, so it can be cut out without harm

56
Q

how is placental growth regulated?

A
  • Placenta regulates its own growth/development through autocrine functions.
  • Maternal decidua restrains (modulate) placental development so the placenta is optimal both for the baby and mother.
57
Q

what are the risk associated with delivery and labour?

A

o remodelling of the spiral arteries :
- means that vessels can lose relatively large amounts of blood after delivery

o Left over placenta:
- must be checked carefully to make sure all has been delivered as it is quite inflexible and any left in the uterus may lead to ineffective uterine contractions.

58
Q

what limits the blood loss during delivery after remodelling of spiral arteries?

A

contractions of the uterus after the placenta has been delivered

[involution]

59
Q

what is the risk associated with defects in gametes?

A

chromosome irregularities

  • Loss of any autosome is not compatible with life –> miscarriage
  • Changes in sex chromosomes is generally less severe
    e. g. Turners–> infertility
60
Q

rule of thumb with chromosomal abnormalities

A

loss is worse than gain

61
Q

what is the most serious problem regarding the placenta?

A

incomplete anchorage in the 1st trimester due to:

  • Developmental problems.
  • Detachment in the late 1st trimester.

after viability has been reached, delivery is the next risk

62
Q

what are the reasons for early delivery?

A
  • Labour starting before term.

* Deteriorating maternal or foetal health so delivery is the best option.

63
Q

why are infants born before 32W (very preterm) at greatest risk?

A

incomplete development of the 4 organs (brain, lungs, digestive and immune systems)

37 W is term

64
Q

what is stillbirth?

A

death of the infant within the uterus, so that it is delivered without signs of life (after the 23 Week mark) and occur at any GA

may be linked to labour but it is also a complication of pregnancy.

before 23 Weeks–> miscarriage

65
Q

how can detection occur to prevent stiilbirth? what is done if abnormalities are seen?

A 
via monitoring of foetal wellbeing
o Ultrasound
 – monitor foetal movements.
o Foetal blood flow assessment 
– Doppler ultrasound.

If abnormalities are detected, C-section must be undertaken immediately.

66
Q

what are the causes of still birth?

A

o 50% due to labour.
o Possibly increased risk of still birth with subsequent pregnancies.

not well understood

LCRS RepDevAge (9 decks)

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