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YEAR 4 REPRO > Pregnancy Physiology > Flashcards

Pregnancy Physiology Flashcards

1
Q

What systems undergo adaptations for pregnancy?

A

Endocrine
Immune
CVS
Resp
Haemotological
GI
Urinary

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2
Q

What is responsible for these maternal adaptations?

A

HORMONES:
hCG
Oestrogen
Progesterone
Relaxin (softens ligaments)
hPL (involved in fat breakdown for glucose)

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3
Q

What are the adaptations within the immune system in pregnancy?

A

Fetus= hemi allograft- recognised by the maternal immune system

Placental progesterone changes balance between Th1 cells (cytotoxic) and Th2 cells (non-cytoxic)–> this causes reduction in Th1 and increase in Th2–> provides immune tolerance–> don’t have an immune response to baby

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4
Q

Consequences of pregnancy being an immunosupressed state?

A

Higher attack rate and severity of certain viral pathogens ie. varicella

May improve certain autoimmune conditions (cytotoxic mediated conditions) e.g.g graves

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5
Q

Adaptations in resp system during pregnancy?

A

Tidal volume- increases by 30-40%
Minute ventilation- increase by 40-50%
PaO2- increase
PCo2- decrease
Expiratory reserve volume- decrease by 20%
Total lung capacity: decrease by 5% as baby pushes up on diaphragm

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6
Q

Consequences of adaptations in the resp system in pregnancy?

A

Dyspnea- due to hyperventilation due to increase CO2 production- not major shouldn’t happen at rest

Need to consider pathology if it marked:
Physiological e.g. anaemia
Primary cardiac or resp condition e.g. asthma
Is it an acute condition in pregnancy? e.g. PE, pneumonia, ARDS?

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7
Q

Maternal adaptations in CVS due to pregnancy

A

Cardiac output increases:
Early pregnancy–> increase volume
Later–> increase HR

Progesterone: smooth muscle relaxation
Causes decreases systemic vascular resistance
Drop in diastolic BP during the first and second trimester of pregnancy

RAAS activated
Leading to increased sodium levels and water retention–> total blood volume increases

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8
Q

Affect of pregnancy on clotting factors?

A

Increased procoagulants: fibrinogen, factor VIII, vWF)
Decreased anticoagulants (protein s)
Reduced fibrinolysis

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9
Q

Consequences of adaptations in CVS/clotting?

A

Increase RAAS: peripheral oedema

Change in plasma volume: dilution anaemia

Clotting: hyper coagulable state–> risk of thromboembolic events

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10
Q

Adaptation of Renal system in pregnancy?

A

Systemic vasodilation= increased renal blood flow:
Increased GFR–> 50%
Decrease serum urea and creatinine by 25%

Decrease PCT absorption:
Glucosuria

Structural: smooth muscle relaxation + obstruction
Increased size of kidneys R>L
Decreased speed of urine passage- cause stasis–> more UTIs

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11
Q

Maternal adaptations in GI system when pregnant?

A

Structural- gravid uterus displaces the bowel- can cause mechanical obstruction

Slow transit due to progesterone effects and increased water absorption- constipation

LFTs: ALP increased due to placental synthesis

Decreased LES tone- GORD, Aspiration

Decreased gallbladder contractility: Gallstones

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12
Q

Maternal adaptations in endocrine system in pregnancy?

A

Fetus reliant on maternal thyroxine until 8-12 weeks–> takes up a lot of free thyroxine

Increased oestrogen results in increase of hepatic production of TBG–> more free T3 and T4 bind to the TBG–> more TSH to be release–> free T3 and T4 increases but total stays the same

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12
Q

Maternal adaptations in endocrine system in pregnancy?

A

Fetus reliant on maternal thyroxine until 8-12 weeks–> takes up a lot of free thyroxine

Increased oestrogen results in increase of hepatic production of TBG–> more free T3 and T4 bind to the TBG–> more TSH to be release–> free T3 and T4 increases but total stays the same

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13
Q

Maternal changes to glucose regulation?

A

Pregnancy= diabetogenic
Insulin resistance as need more glucose to shunt to the baby
Increased insulin secretion
Increased risk of ketoacidosis

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14
Q

Why is there insulin resistance in pregnancy?

A

As need more glucose to shunt to the foetus

Increase in human placental lactogen, prolactin, cortisol levels- ANTI-INSULIN HORMONES–> increase resistance

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15
Q

Maternal MSK adaptations in pregnancy?

A

Change in centre of gravity-
Increase lordosis and kyphosis
Forward flexion of neck

Stretching of abdo muscles
Impede posture
Strain paraspinal muscles
this causes: back pain, shoulder pain, tension headaches

Increased mobility of sacroiliac joints and pubic symphysis
Anterior tilt of pelvis
causes pelvic pain

Fluid retention can compress structures e.g. median nerve (carpal tunnel)

16
Q

Where does the placenta come from?

A

Begins to develop in the second week of development
Provides nutrients and support for early embryo
Is a type of foetal membrane

17
Q

What happens in week 2 of gestation/

A

2 distinct cell layers emerge from:

Outer cell mass- syncytiotrophoblast and cytotrophoblas. Becomes the foetal membrane

Inner cell mass becomes the bilaminar disc: epiblast an hypoblast–> becomes embryo

18
Q

When does implantation begin?

A

Day 6

Day 9- conceptus impeded into endometrial wall

19
Q

What os a chorionic villus?

A

Placenta is a specialisation of the chorionic membrane
Finger like projections- allow rapid exchange of nutrients

20
Q

What are some implantation defects?

A

1) Wrong place: ectopic pregnancy, placenta praaevia

2) Incomplete invasion: Placental insufficiency, pre-eclampsia

21
Q

What is the decidual reaction?

A

Transformation of the endometrium in the presence of conceptus–> becomes the DECIDUA–> managed depth of invasion

Decidual reaction provides balancing force for the invasive force of the trophoblast

22
Q

What happens if decidual reaction is suboptimal?

A

Can lead to a range of adverse pregnancy outcomes- doesn’t go deep enough–> need depth to be just right

23
Q

What are the cotyledons of the placenta?

A

Functional units
Site of distinct villi
Allows transport of metabolites, O2 and nutrients

24
Q

How does the chorionic villus change as the pregnancy continues?

A

First trimester- thicker barrier of villi

Third trimester- barrier at optimal thinner

25
Q

What is the endocrine function of the placenta?

A

Hormones produced to keep it in place

Protein hormones: Ensures wellness of foetus
hCG
Human chorionic somatomammotrophin
Human chorionic thyrotrophin
Hman chorionic

Steroid: Takes over from corpus lute after 1st trimester
progesterone and oestrogen

26
Q

What is hCG?

A

Produced during the first 2 months of pregnancy
Supports the secretory function of the corpus luteum
Produced by syncytiotrophoblast- so pregnancy specific
Excreated in lateral urine- basis of pregnancy tests
Trophoblast disease- cause up regulation–> molar pregnancy and choriocarcinoma

27
Q

When does the placenta start secreting oestrogen and progesterone?

A

11th week, takes over from corpus luteum

28
Q

What is colostrum?

A

After birth, the breast produce 40ml/day of colostrum

Has less soluble vitamins, fat and sugar than mature milk but contains more proteins particularly immunoglobulins and fat soluble vitamins

29
Q

What hormone regulates milk production?

A

Prolactin

30
Q

How does breast milk initially develop?

A

During pregnancy, high progesterone:oestrogen favours development of alveoli (in the breasts) but not secretion.

When placenta is removed, source of the previously circulating steroids (mainly progesterone), is removed which is allows alveoli to respond to prolactin.

Breast milk begins to form with 24-48 hours

31
Q

How is prolactin stimulated in breast-feeding?

A

Stimulated by suckling–> mechanically stimulates receptors in the nipple–> signals to brainstem to reduce dopamine and increase vasoactive intestinal protein (this promotes prolactin secretion)

32
Q

What is the milk let-down reflex?

A

Babies do not suck milk out of the breast, it is EJECTED via the milk let down reflex.

Suckling–> oxytocin released in response–> stimulates the myoepithelial cells that surround the alveoli to contact–> squeezing milk out of the breast

This reflex can be conditioned–> cry or sight of the infant may cause the let down, pain or embarrassment may inhibit it

33
Q

How do you maintain milk production?

A

Sufficient suckling to maintain prolactin secretion and to remove accumulated milk.

If suckling stops–> milk production ceases gradually

YEAR 4 REPRO (26 decks)

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