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repro > pregnancy and parturition > Flashcards

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
Q

cardio prego

A

increased volume (decreased hematocrit)
increased CO
decreased TPR (decreased hematocrit, increased vasodilation, increased vascularity)
decreased to normal MAP

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26
Q

increased plasma volume prego

A

increased NaCl retention
increased aldosterone due to E
increased water retention and uptake due to P effect of ADH release

27
Q

decreased hematocrit prego

A

increased RBC production rate cannot match increase plasma expansion
decreased viscosity
decreased TPR, minimize material cardiac work and CO increases

28
Q

SV prego

A

late stages may periodically decrease due to compression of IVC

29
Q

distribution of blood flow

A 
uterus 15% CO
renal increases by 40% 
skin for temp reg
heart support increased CO
breasts
no change to brain, gut, skeleton
30
Q

decreased TPR

A

additional low-resistance circuit

vasodilation

31
Q

elevation of diaphragm

A

increased intra-abdominal pressure w/fetal growth
P effect to relax m and fascia
decreased RV and decreased FRC

32
Q

respiratory changes

A 
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
Q

increased sensitivity to CO2

A

P
decreased medullary respiratory center set point
increase TV and alveolar ventilation

34
Q

renal changes

A 
increase RBF and GFR
increase plasma renin, angiotensin II, aldosterone
increased Na retention
increased water retention and intake
decreased serum Na
35
Q

increased RBF and GFR

A

increased blood flow and CO

36
Q

increased plasma renin, angiotensin II, and aldosterone

A

E stimulates renin release

37
Q

increased Na retention

A

increased aldosterone

38
Q

increased water retention and intake

A

decreased threshold for ADH/AVP and thirst

increased sensitivity of osmoreceptors

39
Q

decreased serum Na

A

change in set point for ADH/AVP and osmoreceptors

40
Q

GI changes

A

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
Q

protein

A

extra 30g/day

supports fetus, placenta, uterus, breasts, blood

42
Q

iron

A

7mg/day absorbed therefore 60mg/day supplement

supports increased maternal Hb, placenta, fetus

43
Q

folate

A

400-800 mg/day supports RBC, protects against neural tube defects

44
Q

myometrial quiescense

A

during pregnancy due to P and relaxin

45
Q

onset of labor

A

38wks from fertilization, 40 wks after last period
initiated by hormonal factors
positive feedback mechanisms

46
Q

braxton hicks contractions

A

periodic episodes of weak slow rhythmic contractions

47
Q

labor contractions

A

stretching of cervix

push baby out

48
Q

false labor

A

contractions initially become strong, but fade away

failure to re-excite uterus w/subsequent positive feedback

49
Q

stage 0

A

uterine tranquility and refractoriness to contractions

50
Q

stage 1

A

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
Q

stage 2

A

active labor from complete cervical dilation to delivery

52
Q

stage 3

A

from delivery to expulsion of placenta and final uterine contraction

53
Q

cervical dilation and effacement

A

stage 1
initiation of labor
contraction from 30min to 10min apart
average 7-12 hourr,

54
Q

descent and expulsion

A 
stage 2
active labor
cervix fully dilated (10cm)
contractions push fetus
average 20-50min
55
Q

expulsion of placenta

A

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
Q

protaglandins

A

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
Q

E and parturition

A

increased placental secretion throughout pregnancy
increases Gap jnx
increase oxytocin receptors
increase myometrial sensitivity to oxytocin
increase prostaglandins

58
Q

oxytocin

A

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
Q

placental corticotropin releasing hormone

A

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
Q

relaxin

A

produced by corpus luteum and placenta
promote myometral quienscence
production increases during labor, may soften cervix

61
Q

fetal pituitary

A

produces oxytocin

62
Q

fetal placental membranes

A

produce prostaglandin

63
Q

fetal adrenal

A

produce cortisol which induces surfactant production

64
Q

ferguson reflex

A

uterine contractions push baby againt cervix -> stretch cervix -> stimulates more oxytocin

repro (13 decks)

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