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LCRS 1 > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

4 satges to foetal development

A

embryo
foetus
viability
term

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2
Q

Main maternal changes of pregnancy

A 
Increased weight
Increased hormone levels
Increased clotting
Decreased BP
Increase in body temperature
Increased breast size
Increased vaginal mucus production
Increased nausea and vomiting
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3
Q

when is start of pregnancy

A

first day of menstrual cycle that results in fertilisation

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4
Q

What happens to levels of hCG during pregnancy

A

increases during first trimester and peaks here but then declines rapidly at end of first tirmester

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5
Q

What happens to levels of placental lactogen during pregnancy

A

increase steadily whole way through

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6
Q

What happens to levels of progesterone during pregnancy

A

increase steadily whole way through

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7
Q

What happens to levels of oestrogens during pregnacny

A

increase steadily whole way through

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8
Q

What are increases in oestrogens, placental lactogens and progesterone paralelled with

A

Plaental size

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9
Q

What produces hCG

A

Placenta

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10
Q

What is the luteo-placental shift

A

Change from corpus luteum to placenta as main source of progesterone and oestrogens

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11
Q

When does placenta become main source of progesterone

A

10 weeks

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12
Q

What facilitates this luteo-placental shift

A

increase in size of placenta and from 6 weeks the corpus luteum gradually produces less progesterone despite the elevated levels of

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13
Q

whats special about fetal adrenal glands

A

well developed and large even in first trimester

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14
Q

What is involvement of fetal adrenals in production of circulating maternal oestrogens

A

Placenta lacks the enzyme that converts pregnenolone to androgens. The fetal adrenals are able to produce a weak androgen DHEA which is sulphated in the fetal liver to give DHEA-S

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15
Q

Significance of androgen produced by fetal

A

It is inactive so a female fetus isnt exposed to an androgen during development

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16
Q

What happens to DHEA-S after its sulphation in fetal liver

A

circulates to placenta where is converted to 17beta-oestradiol

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17
Q

Pathway leading to high levels of circulating maternal oestriol

A

DHEA-S is induced to be hydroxylated to form 16aOH-DHEA-S which is precursor for estriol. The precursor circulates to placenta where is converted to estriol

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18
Q

Reason for increased blood clotting tendency

A

thought to be protective against losing too much blood during delivery and to do with the interactions between maternal and foetal blood

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19
Q

Changes in maternal BP during pregnancy

A

BP decreases for first two trimesters and is lowest in second then increases during the third one

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20
Q

Cause for concern of lowered BP in pregnant women

A

Susceptible to fainting if stand for too long

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21
Q

Reason for increased size of breasts

A

Increased levels of prolcatin, oestrogens and placental lactogen

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22
Q

Reason though to behind altered appetite

A

Baby puts pressure on GI tract decreasing its distensibility so smaller meals more often are what is suggested

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23
Q

Reason for altered emotional state

A

Hormones

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24
Q

Altered joints during pregnancy

A

Connections between bones in pelvis become more flexible to permit growth of baby

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25
Q

2 reasons behind how there is no signs of rejection reaction despite a non self entity surviving in a woman for 9 months

A

Utero-placental interface produces numerous factors that modify mothers immune response
Placenta expresses bizarre HLA antigens- normaly HLA are very polymorphic with millions of variants however placenta HLA only has 5 variants. The structure of placental HLA is very simplistic giving message to maternal immune system that the tissue is human but not non-self which downregulates action of leukocytes

26
Q

What controls development of the features

A

Genetic

Environmental factors such as maternal diet

27
Q

Evidence for importance of genetic control

A

Any chromosome abnormalities show large changes in development

28
Q

Only viable example of too few chromosomes

A

Turners syndrome- 45-X0

29
Q

When is embryo most vulnerable to abnormalities

A

Early trimester

30
Q

What is a teratogen

A

Agent that can hinder embryo development

31
Q

Most dynamic part of human development

A

Embryology- first 8 weeks when go from single cell to something resembling a human

32
Q

Define conceptus

A

Everything resulting from a fertilised egg

33
Q

Define embryo

A

baby up to 8 weeks of development

34
Q

Define fetus

A

Baby for the rest of pregnancy

35
Q

Define infant

A

Applied after delivery

36
Q

Where does embryo recieve nutrients in first week of development

A

Secretions of fallopian tube

37
Q

Differing meaning of embryo

A

During this first week (PF), the whole conceptus is the embryo. After differentiation to form a blastocyst, the embryo refers to the cells that contribute to (or are) the baby alone; other tissues have separate identities

38
Q

5 functions of placenta

A 
Exchange of nutrietns and waste products
Anchorage of conceptus to maternal decidua
Separation between 2 tissues
Biosynthesis
Immunoregulation
39
Q

Primary subunit of placenta and function

A

Placental villus- This provides a very large surface area (estimated to be 11 square metres) for exchange between the maternal and fetal vascular systems, thus meeting a primary requirement for exchange functions

40
Q

Structure of placental villus

A

Within each villus there is a complex blood supply, including arterial and venous vessels, connected to smaller capillaries in the terminal portions of each villus. Note that the arterial system contains de-oxygenated blood, and the venous blood is oxygenated – because the placenta has a parallel function to the lungs for the fetus during pregnancy

41
Q

What is placenta subdivided into

A

The maternal surface of a placenta is sub-divided into cotyledons (30-60 per placenta). Each cotyledon contains one or more villi, with larger cotyledons containing more villi

42
Q

Describe development of placenta

A

9 days post fertilisation the conceptus is almost completely implanted within the maternal decidualising endometrium. At this stage of development, the outer layer of the conceptus are multinucleated syncytiotrophoblast, which contain fluid-filled lacunae. The underlying layer of cytotrophoblast is proliferating adjacent to the embryo: this is where the placenta will develop. Following implantation, the cytotrophoblast proliferate into the syncytium; first a columnar structure is formed (cytotrophoblast column), which then undergoes branching (villous sprouts). At the centre of each villus are mesenchymal (extra-embryonic mesoderm) cells, from which the villus vascular system develops. The branching process continues through out pregnancy, giving rise to the complex branched villi

43
Q

Outer layer of conceptus at implantation stage

A

Syncytiotrophoblast

44
Q

Second outer layer of conceptus at implantation stage

A

Cytotrophoblast

45
Q

For how long is conceptus separated from maternal blood supply and how

A

As conceptus grows it does make transient contact with maternal capillaries however the rapidly proliferating cytotrophoblast cells form shell around the conceptus which completely isolates it by 4 weeks post fertilisation

46
Q

Histotrophic nutrition

A

Nutrition to conceptus via endometrial glands

47
Q

Haemotrophic nutrition

A

Nutrition to conceptus via maternal blood

48
Q

Source of nutrition in first trimester of pregnancy

A

Histotrophic

49
Q

How does change from histotrophic nutrion to haemotrophic nutrition occur

A

For first 8 weeks post fertilisation spiral arteries are blocked by cytotrophic plugs then for next 4 weeks these plugs begin to break down beginning with those nearest periphery

50
Q

Arteries supplying placenta

A

spiral arteries

51
Q

Cause of miscarriage late first trimester

A

If placenta is not fully anchored to maternal decidua then the increased pressure when it is exposed to maternal arterial supply can detach the placenta

52
Q

Overall regulation of placental growth

A

In general terms, the placenta regulates its own growth and development through autocrine mechanisms. We know that it can produce a range of different growth factors and other proteins

53
Q

Effect of maternal decidua on placental growth

A

The maternal decidua mainly seems to modulate (restrain) placental growth and development, so that the placenta is optimal for both the mother and the fetus

54
Q

Maternal risks during pregnancy

A

Very rare during gestation but issues come from labour and delivery

55
Q

How is blood loss minimised from severing on uterine spiral arteries

A

Contraction of the uterus after placenta has been delivered- sometimes drugs can be given for this

56
Q

Important thing to check post delivery relating to placenta

A

If there are pieces missing

57
Q

Problem of placental tissue being left behing

A

Placental tissue is very inflexible so prevents contraction of placenta and allows continued blood flow through spiral arteries

58
Q

Main risk to conceptus during development

A

Chromosome aneuploidy

59
Q

Breakdown of early delivery

A

About 10% of infants are delivered early; half of these result from the process of labour starting before term. The other half are from pregnancies with deteriorating maternal or fetal health, to the extent that delivery is the best option to save the life of the mother, or the fetus, or both. of them

60
Q

Define stillbirth

A

Stillbirth refers to the death of an infant within the uterus, so that it is delivered without any signs of life. Precise definitions vary, and may include gestational age or fetal weight limits. Post 23 weeks (the viability limit) is often used

61
Q

How to detect stillbirth

A

Monitor health of fetus using doppler and ultrasound

LCRS 1 (58 decks)

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