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pregnancy physio Flashcards

1
Q

what layers of the egg must a sperm penetrate?

A

penetrates corona radiata and zona pellucida

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2
Q

what stops poly spermy?

A
  • Usually only one sperms gets through and depolarises outer layers and stops polyspermy
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3
Q

what is a zygote

A

fertilised ovum
combo of 23 chromosomes from egg and 23 chromosomes from sperm to from fertilised cell

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4
Q

where does fertilisation usually take place?

A

within ampulla

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5
Q

how long does it take to form blastocyte

A

usually 7-10 days post ovulation - should be in uterus now

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6
Q

what are the outer cells of a blastocyst called?

A

trophoblast

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7
Q

when does implantation occur?

A

when blastocyte arrives at uterus at 8-10 days after ovulation it reaches endometrium

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8
Q

what does the trophoblast do?

A

Trophoblast: outer layer of blastocyte
- These cells undergo adhesion to stroma (supportive outer tissue of endometrium)
-

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9
Q

what is the outer most layer of the trophoblast?

A

syncytiophoblast

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10
Q

what does the syncytiophoblast do?

A
  • Outer layer of trophoblast - syncytiophoblast
  • Cells of stroma convert tissue into decidua  specialised in providing nutrients to trophoblast
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11
Q

what does the syncytioblast produce when impanted into endometrium

A

When blastocyte implants onto endometrium  syncytioblast produces HCG

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12
Q

what is the role of HCG?

A
  • HCG very important to maintain corpus luteum  allowing it to continue to make progesterone and oestrogen
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13
Q

describe the basic embryology in the early stages?

A

a week following fertilisation  implanted blastocyte starts to differentiate into various types of cells
- Embryoblast splits into two  yolk sac and amniotic cavity
- Embryonic disc sits between yolk and amniotic cavity
- Cells of embryonic disc develop into foetal pole  eventually foetus

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14
Q

what are the hormonal changes within pregnancy?

A
  • Increase in steroid hormones
  • Increase in T3/T4  TSH remains the same
  • Increase in prolactin
  • Melanocyte SH
  • Oestrogen
  • Progesterone
  • HCG
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15
Q

what does the increase in melanocyte SH do?

A

more pigmentation in mother

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16
Q

how does oestrogen continue to rise?

A

produced by placenta

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17
Q

what is the role of progesterone in pregnancy?

A

maintains pregnancy, prevents contractions and suppresses mothers immune reaction to foetal antigens

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18
Q

how does HCG increase through the pregnancy?

A

doubles every 48hrs until they plateau at around 8-12weeks then start to fall (can then test -ve on tests)

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19
Q

what does rise in ACTH result in?

A
  • ACTH causes rise in cortisol and aldosterone
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20
Q

what does increased prolactin result in?

A
  • Increased prolactin: suppressed FSH and LH

no follicular stimualtion hence no menstruation cycle

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21
Q

where does pregnancy progesterone come from?

A

Corpus luteum produces progesterone until 10weeks then placenta takes over

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22
Q

what are the CVS changes through pregnancy?

A
  • Increase in blood volume
  • Increase in plasma
  • Increase in CO
  • Decrease in vascular resistance
  • Decrease in BP  in early and middle pregnancy returning to normal by term
  • Vasodilation
    varicose veins
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23
Q

what does vasodilation cause in preg?

A

flushes and hot sweats

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24
Q

why are there more varicose veins within preg?

A

due to peripheral vasodilation and obstruction of inferior vena cava by uterus

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25
what are the haematological changes?
- Anaemia - Clotting factors such as fibrinogen, factor VII, VIII and X increase in pregnancy - Increase in ALP: up to 4x higher due to secretion by placenta - Reduced albumin due to loss of proteins - Higher WCC, decreased platelets, increases ESR and D dimer,
26
what does increase in clotting factors mean during preg?
higher risk of VTE, DVT and PE
27
what are the resp changes?
- Increase in tidal volume - Increase in resp rate
28
what are the renal changes?
- Increase in blood flow - Increase in GFR  more waste to filter - Increase in Na reabsorption - Increase in water reabsorption - Increase in protein excretion - Physiological hydronephrosis
29
what is physiological nephrosis?
blocking dilation of ureters and collecting system – more on right side
30
what are the reproductive changes?
Uterus: increases in weight from 100g to 1.1kg - Myometrium: hypertrophy - Cervix: more discharge and ectropion - Vagina: hypertrophy, more discharge, candida bacteria more common
31
how do prostaglandins prepare the cervix for delivery?
Before delivery prostaglandins breakdown collagen in cervix and allow it to dilate and efface for childbirth
32
what are the skin changes within pregnancy?
linea nigra melasma MSH - Striae gradvidarum – stretch marks - Spider naevi - Palmar erythema - Pruritis
33
what is linea nigra?
dark line of skin down middle of abdo from belly button to pubic area
34
what is melasma?
brown to grey-ish patches on face  increased pigmentation due to more MSH pregnancy mask?
35
what can excessive pruritus indicated within preg?
general itchiness can indicate obstetric cholestasis
36
when should PP hair loss return to normal?
should improve within 6mths post delivery
37
how does foetus receive O2?
foetal HB has higher affinity for O2 than adult - Oxygen is drawn off maternal Hb across placental membrane - CO2, hydrogen ions , bicarb and lactic acid are exchanged at placenta
38
how does fetus receive nutrients?
across plancenta mostly in form of glucose - Can transfer vitamins and minerals - Potentially harmful substances can be transferred eg medications, alcohol, caffeine, cigarette smoke
39
how is fetus waste excreted?
via placenta filters waste including urea and creatinine
40
what symptoms do HCG produce?
- this causes N+V, higher levels occur with multiple pregnancies (twins) and molar pregnancies
41
what are molar pregnancies?
problem with fertilised egg  baby and placenta do not develop normally following conception  no chance of survival
42
what ais role of oestrogen in preg?
helps soften tissues and makes them more flexible and allows muscles and ligaments of uterus and pe;vis to expand - softens cervix ready for birth, enlarges and prepares breasts/ nipples for breastfeeding
43
what is role of progesterone in preg?
causes relaxation of uterine muscles(preventing contractions) and maintains endometrium
44
what symptoms arise from preg progesterone?
can cause relaxing of other muscles eg lower oesophageal sphincter (heart burn) - bowels (constipation) - blood vessels (hypotension, headaches, skin flushing) - can cause body temp to raise
45
how is fetus gettin immunity?
mothers AB transfer across placenta to foetus during pregnancy - AB protect foetus throughout pregnancy and shortly after birth
46
how many veins and arteries in placenta to baby?
2 umbilical arteries - deoxygenated blood 1 x umbilical vein - oxygenated blood
47
when is L+D normally?
normally at 37 to 42weeks
48
what is first stage of labour?
from onset of labour (true contractions) until 10cm dilated
49
what is second stage of labour?
10cm cervical dilation to delivery of baby
50
what is third stage of labour?
: delivery of baby to delivery of placenta
51
how are prostaglandins important in preg and L+D?
act like local hormones and triggering specific effects on local tissues  effect tissues all over body - Play crucial role in menstruation and contraction of uterine muscles  also ripen cervix ready for delivery
52
what are braxton hicks?
occasional irregular contractions of uterus felt in second and third trimester - Irregular tightening and mild cramping in abdo - Not true contractions – do not indicate onset of labour
53
what can help braxton hicks?
- Staying hydrated and relaxing can help reduce Braxton-hicks
54
what is involved within first stage labour?
- Cervical dilation and effacemens (getting thinner from front to back) - The mucus plug – help preventing bacteria entering uterus  falls out latent phase active phase transition phase
55
what is latent phase of first stage?
0-3cm usually progresses at 0.5cm per hour
56
what is active stage of first stage?
3cm to 7cm: progresses at 1cm per hour and regular contractions
57
what is transition phase of first phase?
7cm to 10cm dilation of cervix – progresses 1cm per hr – strong and regular contractions
58
what is diff between first and second+ mums in first stage labour?
second + will be alot faster
59
what dictates second stage?
10cm to delivery of baby – 3Ps power passenger passage
60
what is the power within 3Ps?
strength of contractions
61
what is the passenger within 3Ps?
Passenger: description of foetus - Size: size of head at largest part - Attitude: posture of foetus – is back rounded, are limbs flexed? - Lie: position of fetus in relation to mother eg longitudinal – straight up and down, transverse – side to side, oblique- at an angle - Presentation: cephalic – head first, shoulder – shoulder first, breech – legs first
62
what is the passage of the 3Ps?
Passage: size and shape of passageway mainly pelvis
63
what are the cardinal movements of labour?
engagement, descent, flexion, internal rotation, extension, restitution and external rotation and expulsion
64
what is meant by descent?
- Descent: how obstetricians describe position of baby head in relation to ,mothers ischial spines – measured in cm between -5cm to +5cm
65
what are the physiological methods of third stage?
delivered by maternal effort without medications/ cord traction
66
what are active management towards third stage of labour?
Active management: midwife/ Dr assisted in delivering placenta  shortens 3rd stage and reduced risk of haemorrhage – 60 minute delay should prompt active management oxytocin to help uterus contract - Careful traction of umbilical cord to guide placenta out of uterus and vagina
67
what is third stage of labour associated with?
N+V
68

Obs&Gynae (17 decks)

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