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Pregnancy > Pregnancy II > Flashcards

Pregnancy II Flashcards

1
Q

What is HPL in term of

  1. Structure
  2. Location of synthesis
  3. Function
A
  1. Human Placental Lactogen (HPL) is a single chain polypeptide with 96 % homologous with human growth hormone (hGH)
  2. It is synthesised by syncytiotrophoblast
  3. Lactogenic and small amount of growth-stimulating activity

↓ maternal insulin sensitivity, leading to an increase in maternal blood glucose levels.

↓ maternal glucose utilization, which helps ensure adequate fetal nutrition (the mother responds by increasing beta cells). Chronic hypoglycemia leads to a rise in hPL.

↑ lipolysis with the release of free fatty acids. With fasting and release of hPL, free fatty acids become available for the maternal organism as fuel, so that relatively more glucose can be utilized by the fetus. Also, ketones formed from free fatty acids can cross the placenta and be used by the fetus.

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2
Q

What is Relaxin in term of

  1. Structure
  2. Location of synthesis
  3. Function
A
  1. Made up of polypeptide
  2. i) Corpus luteum of menstruation and corpus luteum of pregnancy
    ii) Secretory phase of endometrium
    iii) Placenta
    iv) Prostate gland in male
    v) Mammary gland in female

3.

  • Inhibit contractions of uterus during pregnancy
  • Relaxes the ligaments of the symphysis pubis and other pelvic joint
  • Softens and dilates the cervix
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3
Q

What is the function of placenta in terms of immunology?

A

Transplacental passage of maternal antibodies (IgGs) allows immunological protection of neonate up to 3 to 5 months of age (from common infection)

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4
Q

What happens to the uterus from week 38 to week 40?

A

The uterus reaches its peak height at week 38, near to the sternum.
At week 40, the uterus may drop slightly as the fetal head settles into the pelvis, preparing for delivery. This dropping is referred to as “lightening.”

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5
Q

What are the causes of physiological alterations during early changes?

A
  1. Metabolic demands brought on by the foetus

2. Increasing levels of pregnancy hormones, especially oestrogen and progesterone

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6
Q

What are the causes of physiological alterations during later changes (starting in mid-pregnancy)

A
  1. Anatomical in nature and are caused by mechanical pressure from the expanding uterus
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7
Q

Gestational weight gain of a female

A 
Breasts +0.5kg
Placenta +0.7kg
Uterus +1.6kg
Baby +3.5kg
Amniotic fluid +(1-1.5) kg
Extra blood volume and fluid +4kg

Total weight gain
+(11-16)kg

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8
Q

What are the changes in cardiovascular system during pregnancy?

A 
Cardiac output +(40-50)%
Stroke volume +30%
Heart rate +(15-25)%
Intravascular Volume +45%
O2 consumption +(30-40)%
Systemic vascular resistance -20%
Systolic BP - minimal changes
Diastolic BP -20% (decreases during mid-pregnancy)(Pre-pregnant value at term)
CVP (Central venous pressure, pressure at vena cava) - unchanged
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9
Q

What will happen if there is a foetal compression on inferior vena cava?

A

Venous pressure increases, which causes lower limb oedema, haemorrhoids and varicose veins

Haemorrhoids - vascular structures in the anal canal

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10
Q

What are the haematological changes during pregnancy?

A

Blood volume 4000ml->5500ml (during week 34)

Plasma volume 2500ml->3750ml (during week 34)

Red cell volume 1400ml->1650ml (during week 24)

Haematocrit level (Red cell volume/Blood volume) 38%->32%

Haemoglobin 12-13g/dl ->10.5-11g/dl

WBC 7000/mm3 -> 10000-15000/mm3

Fibrinogen 200-300mg/dl -> 400-600mg/dl

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11
Q

Define minute or pulmonary ventilation

A

Frequency of breath per minutes x amount of air crossing the nose and mouth with each breath

Does not equal to alveolar ventilation

Minute Ventilation= f(breathing) x tidal volume

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12
Q

Define Alveolar ventilation

A

Amount of fresh air that enter the alveoli per minute

Alveolar ventilation= (Tidal volume - amount of air that does not enter-alveolus or anatomical dead space) x respiratory rate

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13
Q

Define the following term

Total lung capacity

A

Total lung capacity is the volume of air contained in the lungs at the end of a maximal inspiration.
Equals to the sum of
Vital Capacity + Residual Volume or
Inspiratory Capacity + Functional Residual Capacity or
Tidal Volume + Inspiratory Reserve Volume + Functional Residual Capacity or
Tidal Volume + Inspiratory Reserve Volume + Expiratory Reserve Volume + Residual Volume

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14
Q

Define the following term

Residual volume

A

Volume of air that remains in the lungs after maximum forceful expiration.
It is the volume of air that cannot be expelled from the lungs
This volume remains unchanged regardless of the lung volume at which expiration was started

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15
Q

Define the following term

Expiratory reserve volume

A

The additional amount of air that can be expired from the lungs by determined effort after normal expiration

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16
Q

Define the following term

Functional residual capacity

A

Volume of air present in the lungs at the end of passive expiration

17
Q

Define the following term

Inspiratory capacity

A

The maximum volume of air that can be inspired after reaching the end of a normal, quiet expiration

18
Q

Define the following term

Inspiratory reserve volume

A

The extra volume of air that can be inspired with maximal effort after reaching the end of a normal quiet inspiration

19
Q

Define the following term

Vital capacity

A

Maximal volume of air that can expired following maximum inspiration

20
Q

What are respiratory system changes during pregnancy?

A 
Total lung capacity 4200ml -> 4000ml
Tidal volume 450ml -> 600ml
Residual volume 1000ml -> 800ml
Expiratory reserve volume 700ml -> 550ml
Functional residual capacity 1700ml -> 1350ml
Inspiration capacity 2500ml -> 2650ml
Inspiratory reserve volume 2050ml -> 2050ml
Vital capacity 3200ml -> 3200ml
21
Q

What are the changes during pregnancy in term of

Arterial pH

A

Partially compensated respiratory alkalosis due to increased breathing rate (hyperventilation)

Lowered pCO2: 27-32mmHg
Increased pH: 7.4-7.45
Increased renal excretion of bicarbonate, decreased HCO3: 17-22mEq/l

mEq/l is milliequivalent per litre

An equivalent (symbol: officially equiv; unofficially but often Eq) is the amount of a substance that reacts with (or is equivalent to) an arbitrary amount of another substance in a given chemical reaction. It is an archaic unit of measurement that was used in chemistry and the biological sciences in the era before researchers knew how to determine the chemical formula for a compound. The mass of an equivalent is called its equivalent weight.

In a more formal definition, the equivalent (in term of mole) is the amount of a substance needed to do one of the following:

react with or supply one mole of hydrogen ions (H+) in an acid–base reaction
react with or supply one mole of electrons in a redox reaction.

22
Q

What are the changes during pregnancy in term of

Gastro-intestinal changes

A

The relaxant effect of progesterone on smooth muscle causes

-The competence of the lower oesophageal sphincter is reduced, however, no evidence of delayed gastric emptying during pregnancy
(Gastric emptying is a test that measures the time it takes for food to empty from the stomach and enter the small intestine)
-Reduced gastric motility
Contractions of gastric smooth muscle which causes
Ingested food to be crushed, ground and mixed, liquefying it to form what is called chyme.
Chyme is forced through the pyloric canal into the small intestine, a process called gastric emptying.

23
Q

What are the changes during pregnancy in term of

Renal changes

A

Glomerular filtration rate - Increase rapidly in 1st trimester
Renal plasma flow - Increase
Urine production and frequency of micturition - Increase

Micturition - action of urinating

24
Q

What are the changes during pregnancy in term of

Osmotic Set Point

A

Decreases by 10 mOsm/Kg

25
Q

What are the pathway that causes decrease in plasma osmolarity during pregnancy? (Start using normal negative feedback mechanism)

A

In normal situation
Dehydration -> Increased osmolarity of plasma -> Detected by osmoreceptors in hypothalamus -> Posterior pituitary gland is stimulated + Feel Thirsty -> ADH secretion increase -> Kidney stimulated to increase reabsorption of water

Increased water intake and reabsorption induce negative feedback mechanism on the sensation of dehydration

In pregnancy, ADH secretion occurs at lower threshold of plasma osmolarity. Osmolarity threshold when thirst is first perceived is reduced

In pregnant woman, they feel thirsty easily

26
Q

What are the changes during pregnancy in term of

Maternal pituitary secretion

A

LH, FSH, GH - greatly decreased
TSH - unchanged
ACTH - increase by 2 to 3 fold (Capillary blood glucose “CBG” increase, free cortisol level unchanged)
Vasopressin (Antidiuretic Hormone)- increase
Prolactin - increases steadily in 1st trimester and reaches by 10 times at term

Adrenocorticotropic hormone (ACTH) is a polypeptide tropic hormone produced by and secreted by the anterior pituitary gland. ACTH stimulates secretion of glucocorticoid steroid hormones from adrenal cortex cells

27
Q

What are the changes during pregnancy in term of

Thyroid changes

A

Thyroid binding globulin - increase

Free T4 and T3 -decreases

28
Q

What are the changes during pregnancy in term of

Calcium

A

GIT absorption - increase

Total serum calcium- decrease

29
Q

What are the changes during pregnancy in term of

Uterine contraction

A

Early pregnancy - weak irregular contraction

Advanced pregnancy - Increase in frequency

Last few weeks - rhythmic and powerful

30
Q

What happen during parturition?

Describe the pathway

A

Ferguson reflex

Pressure at internal end of cervix -> signal transmitted to spinal cord and to paraventricular and supraoptic nucleus in pituitary gland -> oxytocin released (pituitary gland)-> uterine contract -> further increase pressure at the cervix

(positive feedback mechanism)

Pregnancy (2 decks)

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