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pregnancy and parturition Flashcards

1
Q

fertilization

A

1 day

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2
Q

blastocyst enters uterine cavity

A

4 days

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3
Q

implantation

A

5 days

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4
Q

trophoblast froms and attaches to endometrium

A

6 days

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5
Q

trophoblast begins to secrete HCG

A

8 days

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6
Q

HCG rescues corpus luteum

A

10 days

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7
Q

HCG

A

from syncytiotrophoblasts
pregnancy test detect beta subunit
responsible for nausea
peaks 10 weeks after implantation

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8
Q

actions of HCG

A

stimulates LH receptors on corpus luteum
weakly binds TSH receptors (transient gestational hyperthyroidism)
stimulates fetal leydig cells -> T
stimulates fetal adrenal Cx

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9
Q

progesterone production requires

A

CYP11A1 and 3beta HSD and cholesterol

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10
Q

progesterone actions in pregnancy

A

decrease uterine motility/contractions
increase secretory activity necessary for nourishment, growth, and implantation of embryo
increase fat deposition early in pregnancy (drives appetite)

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11
Q

E production during preg

A

comes from placenta, but needs DHEA-S from fetal adrenal gland, therefore E3 levels can indicate fetal health

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12
Q

E actions while prego

A 
increase uteroplacental blood flow
increase uterine smooth m hypertrophy
increase LDL receptor expression on synctiotrophoblasts
increase prostoglandins
increase oxytocin receptors
increase mammary gland growth
increase prolactin
needed for parturition
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13
Q

E:P

A

P higher early
around wk24 switches and E higher
P drops after parturition for PRL to have effect

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14
Q

hPL

A

aka hCS
produced by synctiotrophoblasts
detected in maternal serum by wk 3
directly proportional to placental growth

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15
Q

hPL actions

A

antagonizes insulin (diabetogenicity of pregnancy)
increase glucose of fetus
lypolytic action
stimulates mammary gland development

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16
Q

mom->fetus

A 
O2
water, electrolytes
carbs, lipids, aa, vitamins
hormones
antibodies
drugs
viruses
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17
Q

fetus -> mom

A

CO2
water, urea
waste
hormones

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18
Q

fnx of placenta

A

synctiotrophoblasts produce steroids and peptide hormones
maintain pregnant state
stimulate luboloalveolar growth and fnx of breasts
adapt aspects of maternal meta and phys to support fetus
regulate aspects of fetal development
regulate timing and progression of parturition

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19
Q

placental limtations

A

cannot make adequate cholesterol
lacks enzymes for estrone and estradiol production
lacks enzyme for estriol production

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20
Q

LH and FSH prego

A

down, due to high levels of estrogen and progesterone

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21
Q

ASH prego

A

secretion augmented
threshold altered by P
ADH released at lower osmolality

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22
Q

thyroid prego

A

increases in size b/c stimulated by hCG
increase in total T4 and T3 due to hCG
no change in free

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23
Q

cortisol prego

A

high, due to E stimulated liver production of CBG
increase free cortisol late in pregnancy
inactivated by placental 11beta dehydrogenase type II to protect fetus

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24
Q

aldosterone prego

A

increased b/c E stimulate liver production of angiotensisogen and renal renin
does not result in hypernatremia, hypokalemia, of HTN, b/c P blunts action of aldosterone by competing for receptor

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25
cardio prego
increased volume (decreased hematocrit) increased CO decreased TPR (decreased hematocrit, increased vasodilation, increased vascularity) decreased to normal MAP
26
increased plasma volume prego
increased NaCl retention increased aldosterone due to E increased water retention and uptake due to P effect of ADH release
27
decreased hematocrit prego
increased RBC production rate cannot match increase plasma expansion decreased viscosity decreased TPR, minimize material cardiac work and CO increases
28
SV prego
late stages may periodically decrease due to compression of IVC
29
distribution of blood flow
``` uterus 15% CO renal increases by 40% skin for temp reg heart support increased CO breasts no change to brain, gut, skeleton ```
30
decreased TPR
additional low-resistance circuit | vasodilation
31
elevation of diaphragm
increased intra-abdominal pressure w/fetal growth P effect to relax m and fascia decreased RV and decreased FRC
32
respiratory changes
``` elevation of diaphragm increased O2 demand and CO2 production increased sensitivity to CO2 decreased FRC and RV increased TV and alveolar ventilation RR unchanged decreased PCO2 increased V respiratory alkalosis renal compensation increase bicarb excretion ```
33
increased sensitivity to CO2
P decreased medullary respiratory center set point increase TV and alveolar ventilation
34
renal changes
``` increase RBF and GFR increase plasma renin, angiotensin II, aldosterone increased Na retention increased water retention and intake decreased serum Na ```
35
increased RBF and GFR
increased blood flow and CO
36
increased plasma renin, angiotensin II, and aldosterone
E stimulates renin release
37
increased Na retention
increased aldosterone
38
increased water retention and intake
decreased threshold for ADH/AVP and thirst | increased sensitivity of osmoreceptors
39
decreased serum Na
change in set point for ADH/AVP and osmoreceptors
40
GI changes
decrease gastric empty rate and decrease LES tone both increase reflux, both due to P increased intra-abdominal pressure also increase reflux decreased intestinal motility -> constipation
41
protein
extra 30g/day | supports fetus, placenta, uterus, breasts, blood
42
iron
7mg/day absorbed therefore 60mg/day supplement | supports increased maternal Hb, placenta, fetus
43
folate
400-800 mg/day supports RBC, protects against neural tube defects
44
myometrial quiescense
during pregnancy due to P and relaxin
45
onset of labor
38wks from fertilization, 40 wks after last period initiated by hormonal factors positive feedback mechanisms
46
braxton hicks contractions
periodic episodes of weak slow rhythmic contractions
47
labor contractions
stretching of cervix | push baby out
48
false labor
contractions initially become strong, but fade away | failure to re-excite uterus w/subsequent positive feedback
49
stage 0
uterine tranquility and refractoriness to contractions
50
stage 1
uterine awakening, initiation of parturition, extending to complete cervical dilation increase in number of gap jnxs btwn myometrial cells and increase number of OT receptors
51
stage 2
active labor from complete cervical dilation to delivery
52
stage 3
from delivery to expulsion of placenta and final uterine contraction
53
cervical dilation and effacement
stage 1 initiation of labor contraction from 30min to 10min apart average 7-12 hourr,
54
descent and expulsion
``` stage 2 active labor cervix fully dilated (10cm) contractions push fetus average 20-50min ```
55
expulsion of placenta
stage 3 uterus contracts reducing area of attachment separation of placenta results in bleeding and clotting bleeding limited by uterine contractions compressing vessels average 15 min
56
protaglandins
initiate labor increase before onset synthesized by uterus, placenta, and fetal membranes increase uterine contractility increased synthesis is stimulated by E, oxytocin, uterine stretch increase gap jnx softening, dilation, and thinning of cervix can induce labor
57
E and parturition
increased placental secretion throughout pregnancy increases Gap jnx increase oxytocin receptors increase myometrial sensitivity to oxytocin increase prostaglandins
58
oxytocin
maintains labor uterus only sensitive to it at end of pregnancy primary stimulus for its release is dilation of cervix released from post pit (neurogenic reflex) released in bursts of increasing frequency promotes uterine smooth m contraction stimulates protaglandin production
59
placental corticotropin releasing hormone
CRH production and maternal levels rise quickly late in pregnancy and in labor due to large decrease in CRH binding protein and increased production sensitizes uterus to prostaglandins and oxytocin stimulates fetal ACTH increases fetoplacental E
60
relaxin
produced by corpus luteum and placenta promote myometral quienscence production increases during labor, may soften cervix
61
fetal pituitary
produces oxytocin
62
fetal placental membranes
produce prostaglandin
63
fetal adrenal
produce cortisol which induces surfactant production
64
ferguson reflex
uterine contractions push baby againt cervix -> stretch cervix -> stimulates more oxytocin

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