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Body Systems > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

describe the terminology of a fertilised egg from day 1 to 6

A 
zygote 
early cleavage (4 cell stage) 
morula (3-4 days) 
blastocyst (4-5)
implantation
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2
Q

what are the 5 steps of early implantation

A 
shedding of the ZP
pre-contract blastocyst orientation 
apposition cellular contracts 
adhesion 
penetration of endometrium
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3
Q

what is medawar

A

fetal allograft survival
the foetus has protection against the body immune reposes such as placental protection
antigenic immaturity
altered host immunity

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4
Q

describe the response between trophoblasts and the decidua in terms of immunity

A

you have villous trophoblasts which are inert and do nothing

extravillous and invasive which contain only class 1 human leucocyte antigens
less attractive to cytotoxic T cells
enables binding to NK cells

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5
Q

what is the type of NK cell present in the decidua

A

CD56 bright

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6
Q

what produces hCG (glycoprotein)

A

trophoblast cells

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7
Q

what is the role of hCG

A

luteotrophic - continues to stimulate the corpus luteum for foetal survival
its production is independant of the hypothalamus and pituitary

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8
Q

what is thought to be the cause of morning sickness

A

production of hCG

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9
Q

what can hCG be used for

A

pregnancy test - immunoassay detects beta subunit of hCG

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10
Q

what can you see about the foetal development in weeks 5-8 in terms of imaging

A

5 wks: gestation sac
6 wks: fetal pole, yolk sac
7 wks: fetal heart activity
8 wks: fetal limbs, movements

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11
Q

what percentage of fertile women have at leats one miscarriage

A

25%

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12
Q

what happens to the likelihood of a miscarriage as you get older

A

increases

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13
Q

what is the management of miscarriage

A

progesterone receptor antagonist (mifepristone) with a prostaglandin analogue (misoprostol)

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14
Q

even after 3 miscarriages what is the chance of having a baby

A

70%

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15
Q

what is an ectopic pregnancy and how common are they

A

implantation outside of the uterine cavity

1% of all pregnancies

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16
Q

what are possible reasons for rising likelihood of ectopic pregnancy

A

assisted conception
pelvic inflammatory disease - maybe due to chlamydia
sterillisation reversal

17
Q

in the management of ectopic pregnancy what is the medical and surgical terminology

A

medical - methotrexate

surgical salpingectomy

18
Q

what happens to hCG, oestrogen’s and progesterone during pregnancy up until giving birth (parturition)

A

hCG increases around 2 months then falls to constant low levels until birth
estrogens increase at a higher rate than progesterone
all three fat to zero at brith

19
Q

what are the two types of estrogens during pregnancy

A

estradiol (E2) produced by the corpus luteum and placenta

estriol (E3) produced by foetus and placenta - feta placental unit

20
Q

what the difference between E3 and E2

A

estriol has three OH molecules

21
Q

what are the functions of oestrogen’s

A

growth/strengthen the myometrium
increase contractile proteins to accommodate growing foetus
increase blood flow through placenta for exchange of waste and nutrients
negative feedback of FSH and LH
stimulation of CBG SHBG and TBG to act as reservoir (hormone binding proteins)
prepare breast for lactation
increase sensitivity of uterus to smooth muscle urotonics such as oxytocin and PGFa oxytocin

22
Q

what is the function of progesterone

A

reduces uterine smooth muscle contractility to keep uterus quiescent during pregnancy
inhibits production of PGF2a and oxytocin
blocks T lymphocyte cell mediated responses and cellular immune response

23
Q

what is human placental lactogen

A

polypeptide hormone

secreted in increasing concentrations during pregnancy as the placenta grows

24
Q

what is the function of human placental lactogen

A

lactogenic and GH like actions

stimulates lipolysis in the mother, increases free fatty acids as energy substrate
inhibits glucose uptake in the mother and favours glucose and protein transport to the foetus
promotes the growth and differential of the breast in preparation for lactation

25
Q

describe the cascade of reactions that occur due to actions of the placenta

A

check photos

26
Q

describe the cardiovascular changes that occur during pregnancy

A

blood volume 40% increase - including water content and plasma volume
increase in EPO and RBC mass increases
sodium and water retention
mechanism - oestrogen stimulation of RAAS
CO increases by 30-50% (SV 30%) HR (10%)
initial drop in BP then slow increase during the process - drop 0 - 20 weeks then increase back to normal at 40 weeks

27
Q

what can indicate pre-eclampsia

A

> 150/90 mmHg persistantly high BP

28
Q

what are common clinical consequences of pregnancy in association with cardiovascular issue

A

syncope
haemorrhoids
varicose veins

29
Q

how is coagulation affected during pregnancy

A 
increased clot formation with decreased clot lysis 
clotting factors (I, V, VII, VIII, IX, X, XII)

there is increased plasminogen activator inhibitors (less breakdown)
activated protein C resistance
reduced protein S levels

30
Q

what is the risk of increased coagualation risk in pregnancy

A

thromboembolism

31
Q

what are the respiratory changes during pregnancy

A

increase in O2 consumption
increase in TV, alveolar ventilation, vital capacity unchanged
altered chemoreceptor PsCO2 sensitivity - triggers increase in respiration

32
Q

what is the clinical consequence of increase in respiratory demand during pregnancy

A

disproportionate sense of dyspnoea on exertion

33
Q

what are the changes in renal blood flow during pregnancy

A

rise in plasma volume and CO

fall in renal vascular resiatnce and increase in renal vasodilatory prostaglandins (PGI2, PGE2)

34
Q

what is the effect of increased GFR during pregnancy

A

urea and creatinine fall as no change in production
renal threshold to glucose is diminished
RAAS increased in 1st trimester

35
Q

what are the clinical consequences of renal changes during pregnancy

A

deceased bladder capacity - micturition

tendency to UTI’s

36
Q

what GIT changes are there during pregnancy

A

cravings
lower oesophageal pressure and incompetence of cardia
decrease in motility - increase in water reabsorption
prolongation of gastric emptying - constipation

37
Q

what are the clinical consequences of changes to GIT in pregnancy

A

nausea, vomiting
heartburn
constipation

Body Systems (77 decks)

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