Pregnancy & medical disorders I Flashcards
List the 3 main hormones involved in pregnancy and where they’re produced?
hCG: the blastocyst
Progesterone: corpus luteum and after 8 weeks the placenta
Oestrogen: ovary initially, then derived from androgen precursors
What is:
- the blastocyst
- the corpus luteum?
Blastocyst: the fertilised egg which has developed into a ball of cells
Corpus luteum: the empty follicle where the ova was released from
What does hCG do in pregnancy?
Prevents the corpus luteum dying so it can continue making progesterone
If not pregnant corpus luteum dies so progesterone levels drop
What does progesterone do in pregnancy?
Proliferation and vascularisation of the endometrium
Promotes myometrium relaxation
Glucose deposition in fat stores
Increases depth of ventilation
What does oestrogen do in pregnancy?
Promotes physiological changes to mother’s CV system
Increases no. of P receptors in endometrium, so enhances P action
What is meant by the ‘window of implantation’? When is it?
The endometrium is receptive to implantation of blastocyst only temporarily
Day 20-24
What are the spiral arteries? And what happens to them in pregnancy?
They supply the endometrium
In pregnancy they are remodelled making them wider and straighter
What can result from failed remodelling of spiral arteries?
Pre-eclampsia
Intra-uterine growth restriction
How does the blastocyst not get rejected as foreign by the mothers immune system?
Because it is able to turn off some of the maternal genes that code for immune proteins
In labour, what stimulates oxytocin secretion?
Myometrial stretching and cervical stimulation
Aside from hormonal changes, what physiological changes take place in the body of a pregnant woman?
Plasma blood volume increases
Cardiac output rises
Peripheral resistance falls
Venous pressure raises (leading to varicose veins, oedema)
Ventilation depth increases
Reduced gut motility
Lax lower oesophageal sphincter
Frequency of micturition due to pressure on bladder
List some problems that are brought about by pregnancy?
Pre-eclampsia
Thromboembolism
Obstetric cholestasis
Acute fatty liver
Anaemia
What pre-pregnancy care should be give to women suffering from a chronic condition that could be exacerbated by pregnancy?
Optimise disease control
Rationalise drug therapy to minimise effects on baby
Advise on the risks there could be to mum and baby
Advise if conception is not safe
What ante-partum (during pregnancy) care should be give to women suffering from a chronic condition that could be exacerbated by pregnancy?
Liaison between maternity care and usual care of condition
Extra monitoring
Plan for the delivery:
- safest method
- neonatal support
- anaesthetics
- HDU/ITU
Why does anaemia occur in pregnant women?
Big increase in requirement for iron and folate
What problems are associated with anaemia in pregnancy?
Low birth weight
Pre-term delivery
Macrocytic anaemia is likely to be what?
Microcytic anaemia is likely to be what?
Macro = folate deficiency
Micro = iron deficiency
What’s the treatment for anaemia in pregnancy?
Replace folate or iron
Monitor that levels are rising
What might you find on an ABG of a pregnant woman, which is normal?
Mild compensated metabolic alkalosis
pO2 increases
pCO2 decreases
What are the effects of asthma on the fetus?
If poorly controlled…
Risk of fetal growth restriction due to inadequate placental perfusion
Premature delivery, if mother is not well with it
How does obstetric cholestasis present?
Itching with no rash is often the only symptom
Sometimes malaise
Very rarely jaundice
Obstetric cholestasis goes away within 6 months of birth. true or false?
False
It resolves after delivery
What is the effect of obstetric cholestasis on the fetus? Why?
Bile salts in the blood
Can lead to premature labour and stillbirth
What’s the treatment of obstetric cholestasis?
ursodeoxycolic acid
