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Obs&Gynae > pregnancy physio > Flashcards

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
Q

what are the haematological changes?

A
  • 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,
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26
Q

what does increase in clotting factors mean during preg?

A

higher risk of VTE, DVT and PE

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27
Q

what are the resp changes?

A
  • Increase in tidal volume
  • Increase in resp rate
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28
Q

what are the renal changes?

A
  • 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
Q

what is physiological nephrosis?

A

blocking
dilation of ureters and collecting system – more on right side

30
Q

what are the reproductive changes?

A

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
Q

how do prostaglandins prepare the cervix for delivery?

A

Before delivery prostaglandins breakdown collagen in cervix and allow it to dilate and efface for childbirth

32
Q

what are the skin changes within pregnancy?

A

linea nigra
melasma
MSH
- Striae gradvidarum – stretch marks
- Spider naevi
- Palmar erythema
- Pruritis

33
Q

what is linea nigra?

A

dark line of skin down middle of abdo from belly button to pubic area

34
Q

what is melasma?

A

brown to grey-ish patches on face  increased pigmentation due to more MSH

pregnancy mask?

35
Q

what can excessive pruritus indicated within preg?

A

general itchiness can indicate obstetric cholestasis

36
Q

when should PP hair loss return to normal?

A

should improve within 6mths post delivery

37
Q

how does foetus receive O2?

A

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
Q

how does fetus receive nutrients?

A

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
Q

how is fetus waste excreted?

A

via placenta
filters waste including urea and creatinine

40
Q

what symptoms do HCG produce?

A
  • this causes N+V, higher levels occur with multiple pregnancies (twins) and molar pregnancies
41
Q

what are molar pregnancies?

A

problem with fertilised egg  baby and placenta do not develop normally following conception  no chance of survival

42
Q

what ais role of oestrogen in preg?

A

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
Q

what is role of progesterone in preg?

A

causes relaxation of uterine muscles(preventing contractions) and maintains endometrium

44
Q

what symptoms arise from preg progesterone?

A

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
Q

how is fetus gettin immunity?

A

mothers AB transfer across placenta to foetus during pregnancy
- AB protect foetus throughout pregnancy and shortly after birth

46
Q

how many veins and arteries in placenta to baby?

A

2 umbilical arteries - deoxygenated blood
1 x umbilical vein - oxygenated blood

47
Q

when is L+D normally?

A

normally at 37 to 42weeks

48
Q

what is first stage of labour?

A

from onset of labour (true contractions) until 10cm dilated

49
Q

what is second stage of labour?

A

10cm cervical dilation to delivery of baby

50
Q

what is third stage of labour?

A

: delivery of baby to delivery of placenta

51
Q

how are prostaglandins important in preg and L+D?

A

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
Q

what are braxton hicks?

A

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
Q

what can help braxton hicks?

A
  • Staying hydrated and relaxing can help reduce Braxton-hicks
54
Q

what is involved within first stage labour?

A
  • 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
Q

what is latent phase of first stage?

A

0-3cm usually progresses at 0.5cm per hour

56
Q

what is active stage of first stage?

A

3cm to 7cm: progresses at 1cm per hour and regular contractions

57
Q

what is transition phase of first phase?

A

7cm to 10cm dilation of cervix – progresses 1cm per hr – strong and regular contractions

58
Q

what is diff between first and second+ mums in first stage labour?

A

second + will be alot faster

59
Q

what dictates second stage?

A

10cm to delivery of baby – 3Ps
power
passenger
passage

60
Q

what is the power within 3Ps?

A

strength of contractions

61
Q

what is the passenger within 3Ps?

A

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
Q

what is the passage of the 3Ps?

A

Passage: size and shape of passageway mainly pelvis

63
Q

what are the cardinal movements of labour?

A

engagement, descent, flexion, internal rotation, extension, restitution and external rotation and expulsion

64
Q

what is meant by descent?

A
  • Descent: how obstetricians describe position of baby head in relation to ,mothers ischial spines – measured in cm between -5cm to +5cm
65
Q

what are the physiological methods of third stage?

A

delivered by maternal effort without medications/ cord traction

66
Q

what are active management towards third stage of labour?

A

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
Q

what is third stage of labour associated with?

A

N+V

68
Q
A

Obs&Gynae (17 decks)

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