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Pregnancy Physiology Flashcards

1
Q

What days is the two cell stage present?

A

First 3 days of development

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2
Q

Define Morula

A

Solid mass of blastomere cells

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3
Q

When does a morula appear?

A

Day 4

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4
Q

What day does the morula become a blastocyst?

A

Day 5

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5
Q

What is the outer layer of the blastocyst consist of?

A

Trophoblast

Placenta & fetal membranes

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6
Q

What is the inner layer of the blastocyst consist of?

A

Cell mass to become the embryo & fluid

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7
Q

What surrounds the blastocyst?

A

Zona pellucida

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8
Q

When does implantation occur?

A

Day 6-7

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9
Q

What is the stem cell of the placenta?

A

Progenitor cytotrophoblast cell

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10
Q

2 Differentiation of Progenitor Cytotrophoblast Cells

A 
Extravillous cytotrophoblast (inner)
Villous cytotrophoblast (outer)
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11
Q

Extravillous Cytotrophoblast (Inner) Cells

A

“Invasive” into decide & myometrium
“Invasive” into the spiral arteries (form uteroplacental arteries)
Form core of villi

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12
Q

Villous Cytotrophoblast (Outer) Cells

A

Forms placental villi with base of cytotrophoblast cells

Forms umbilical arteries & vein

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13
Q

Function of Villous Cytotrophoblast (Outer) Cells

A

Transport of gases
Nutrient & wastes
Synthesis of peptide & steroid hormones that influence placental, fetal, & maternal systems

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14
Q

Dicidua

A

Influence by progesterone & later with the invasion of trophoblasts

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15
Q

What forms the basal plate of the placenta?

A

Decidual cells

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16
Q

Define Trophoblast

A

Layer of trophoblast cells always separate the embryonic circulation from maternal blood & decidua

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17
Q

Define Nitabuch’s Layer

A

Layer of fibrin between the boundary zone of compact endometrium & the cytotrophoblastic shell in the placenta

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18
Q

Functions of the Placenta

A 
Extra brain
Interface between mom & baby
Prevents rejection of fetal allograft
Enables respiratory gas exchange
Transports nutrients
Eliminates fetal waste products
Secretes peptide & steroid hormones
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19
Q

Metabolic Functions of the Placenta

A

Glycogen synthesis
Cholesterol synthesis
Removal of lactate
Protein metabolism

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20
Q

Function of Cholesterol Synthesis

A

Precursor for production of progesterone & estrogen

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21
Q

Define Lactate

A

Waste product of placental metabolism

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22
Q

Placental Peptide Hormones

A

Human chorionic gonadotropin (hCG)
Human placental lactogen (hPL)
Placental corticotropin-releasing hormone (CRH)
Insulin-like growth factor (IGF)
Vascular endothelial growth factor (VEGF)
Placental growth factor

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23
Q

Function of Human Chorionic Gonadotropin (hCG)

A

Maintains corpus luteum production of progesterone until placenta takes over at 6-8 weeks
Regulates placental steroid production

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24
Q

Function of Human Placental Lactogen (hPL)

A

Antagonizes maternal secretion of insulin to increase fetal glucose supply

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25
Q

Function of Placental Corticotropin-Releasing Hormone (CRH)

A

Stimulates fetal ACTH resulting in fetal adrenal making DHEA-S as precursor to placental estrogen

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26
Q

Placental Steroid Hormones

A

Progesterone
Estrogens
Enzymes to degrade maternal glucocorticoids

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27
Q

Function of Progesterone

A

Maintains non-contractile uterus

Anti-inflammatory & immunosuppressive to protect fetus

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28
Q

Function of Estrogens

A

Stimulated by placental HCG

Maternal & fetal blood supply DHEAS

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29
Q

Enzymes to Degrade Maternal Glucocorticoids

A

Placenta regulates exposure of fetus to glucocorticoids

Regulating fetal organ development & maturation

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30
Q

Placental Transfer/Transport

A 
CO2 & O2 exchange
Glucose
Amino acid
Fatty acids
Immunoglobulin G
Drugs
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31
Q

Function of Estrogen (Maternal Physiology)

A 
Enlargement of uterus
Breast enlargement & growth of ductal structure
Enlargement of the external genitalia
Relaxation of pelvic ligaments
Affects fetal development
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32
Q

Function of Progesterone (Maternal Physiology)

A

Induces endometrial secretory cells to decidual cells
Contributes to development of the conceptus before implantation
Inhibits myometrial contractions
May be involved with immune tolerance of fetus
Influences breasts for lactation
Helps develop thick mucus plug
Changes cervix, vagina, & vulva to allow stretching for delivery

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33
Q

Ophthalmic Changes with Pregnancy

A 
Cornea thickens
Decrease in intraocular pressure
Visual field changes or double vision (abnormal)
Diabetic retinopathy
Secondary retinal detachments
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34
Q

Dental Changes in Pregnancy

A

Gingivitis: bleeding or inflammation
Epulis: hyperplastic, granulomatous lesions

35
Q

GI Changes in Pregnancy

A 
Relaxation of LES
Decreased PUD
Incomplete emptying of the gallbladder
Delayed gastric emptying, slowed small bowel transit & decreased large bowel peristalsis
Increased portal venous pressure
N/V
Hyperemesis gravidarum
36
Q

What does a relaxation of the LES increase the incidence of?

37
Q

Why is there decreased PUD in pregnancy?

A

Increased mucus

Decreased gastric secretion

38
Q

A decrease of gallbladder emptying increased the risk of what?

A

Gallstones

39
Q

Treatment of Nausea & Vomiting

A

Vitamin B6

40
Q

Symptoms of Hyperemesis Gravidarum

A

Persistent & severe N/V
Weight loss
Dehydration
Electrolyte imbalances

41
Q

Treatment of Hyperemesis Gravidarum

A

IV fluids
Anti-emetics
TPN (rarely)

42
Q

Renal & Urinary Changes in Pregnancy

A

Relaxes bladder wall & reduces ureteral tone & peristalsis
Hydroureter of pregnancy (R>L)
Hydronephrosis (R>L)
Predisposes to UTI’s & pyelonephritis

43
Q

Urinary Bladder in Pregnancy

A

Flattens bladder
Decreases capacity
Associated with incontinence
Asymptomatic bacteruria

44
Q

Asymptomatic Bacteruria

A

Acute pyelonephritis
Preterm labor
Low birth weight

45
Q

Renal Function in Pregnancy

A

Kidneys increase in size
Renal blood flow & GFR increase by mid-trimester
Hyperventilation
Extracellular volume increases

46
Q

Cardiovascular Changes in Pregnancy

A 
Increase in stroke volume
Increase HR
Increases cardiac output
Decreased systolic vascular resistance
Decreased mean BP
Increased oxygen consumption
Uterine blood flow- 700 mL/min
Placental blood flow 500 mL/min
Increased heart muscle mass
Heart shifted to left
Apical pulse moves to 4th intercostal space
Louder heart sounds
Wide split S1 & S2
47
Q

Physiologic Anemia of Pregnancy

A

Increased plasma volume
Increased red cell mass
Increased blood volume

48
Q

Nutritional Supplements in Pregnancy

A

Folic acid
Oral iron
Magnesium (opposite of iron)

49
Q

Coagulation Changes in Pregnancy

A

Increase in fibrinogen
Increase in clotting factors II, VII, VIII, X, IX, XII, & XIII
Decrease in protein S levels & inhibition of fibrinolysis

50
Q

Respiratory Tract Changes in Pregnancy

A

Increased nasopharyngeal blood flow
Increased phagocytic activity in the upper respiratory tract
Decreased residual lung capacity

51
Q

Progesterone Effects on Respiratory Tract Changes

A 
Stimulates respiratory drive
Minute ventilation increases
Tidal volume increases
Oxygen consumption increases
PaO2: 100-110 mmHg
PaCO2 decreases: 27-32 mmHg
52
Q

Musculoskeletal Changes in Pregnancy

A

Joint laxity of lumbar spine
Separation & stretching of abdominal muscles
SI joints & pubic symphysis widen (increased mobility)
Pelvis tilted anteriorly
Carpal tunnel syndrome
Sciatic nerve pain

53
Q

Why carpal tunnel syndrome in pregnancy?

A

Inflammation, fluid retention, and swelling

54
Q

Why sciatic nerve pain in pregnancy?

A

Extra weight & pressure causes compression of sciatic nerve

55
Q

Endocrine Adaptations in Pregnancy

A 
Interactions of fetal-placental-maternal unit
Hypothalamus
Pituitary
Parathyroid
Thyroid
Adrenal glands
56
Q

Hypothalamic Hormones in Pregnancy

A

Gonadotropin-releasing hormone (GnRH)

Corticotropin-releasing hormone (CRH)

57
Q

What does placental CRH drive?

A

Maternal & fetal pituitary

58
Q

Anterior Pituitary Gland in Pregnancy

A

Decline in circulating gonatotropins due to high estradiol & progesterone levels
Growth hormone (GH) declines
Increase in ACTH
Thyrotropin (TSH) reduced in 1st trimester; modestly elevated at term
Prolactin levels increased

59
Q

Intermediate Lobe of Pituitary in Pregnancy

A

Increase in volume

Melanocyte-stimulating hormone (MSH) elevated

60
Q

Posterior Pituitary Hormones in Pregnancy

A 
Antidiuretic hormone (ADH)
Oxytocin
61
Q

Effects of ADH in Pregnancy

A

Women less sensitive to ADH

62
Q

Effects of Oxytocin in Pregnancy

A

Involved in onset of labor

Involved in milk “let down”

63
Q

Parathyroid Glands & Pregnancy

A

PTH increases

64
Q

Function of PTH in Pregnancy

A

Facilitates transfer of calcium across the placenta
Mobilizes calcium from maternal skeleton
Intake requirement increases

65
Q

Thyroid Glands in Pregnancy

A

Increased thyroxine-binding globulin (TBG)
Increased TSH
Increased maternal iodine needs

66
Q

Adrenal Glands in Pregnancy

A

Cortisol affected by CRH

Decreased vascular responsiveness to angiotensin II

67
Q

Glucose Metabolism in Pregnancy

A

Develops insulin- resistant state
Diabetogenic hormones: GH, CRH, chorionic somatomammotropin, & progestrone
Maternal hyperglycemia & DM (possible birth defects)
Hyperplasia of pancreatic beta cells
Increased insulin secretion
Fasting levels decreased
Relative insulin resistence & hypoglycemia with increasing lypolysis
Minimizes protein catabolism

68
Q

Lipid Metabolism in Pregnancy

A

Serum triglycerides & cholesterol levels rise
Triglycerides provide maternal fuel
Elevated LDL
2nd trimester: fat accumulation
3rd trimester: maternal consumption of stored fat
Leptin

69
Q

Define Leptin

A

Hormone secreted by adipose tissue & placenta plays key role in fat metabolism

70
Q

Other Metabolic Changes

A

Protein: increased needs
Water: 3 L/day; edema

71
Q

Changes in Reproductive ORgans in Pregnancy

A 
Uterine enlargement
20% of cardiac output to uterus
Increased blood supply to cervix, vagina, & vulva
Vulvar varicosities
Vulvar condylomata
72
Q

Skin Changes in Pregnancy

A

Striaegravidarum (stretch marks)

Rosacea worsens

73
Q

Hair & Skin Changes in Pregnancy

A

Increase or decrease growth rate
Some degree of hirsutism
Delivery may initiate shedding cycle
Nails grow faster

74
Q

Vascular Changes in Pregnancy

A

Spider telangiectasias
Palmar erythema
Saphenous, vulvar, hemorrhoidal varicosities

75
Q

Pruritis Uritcarial Papules & Plaques (PUPP) of Pregnancy

A

Associated rash with intense pruritis
3rd trimester
First on the abdomen
Common in 1st pregnancies & multiples

76
Q

Treatment for Prurits Uritcarial Papules & Plaques (PUPP)

A

Antihistamines

Topical corticosteroids

77
Q

Immunologic Changes in Pregnancy

A

Promote maintenance of antigenic fetus
Suppression of T-cell-mediated immunity
Depression of most cytokines

78
Q

Breast Changes in Pregnancy

A

Stimulated by estrogen & progesterone
Increase in size
Nipples & areola increase in size & pigmentation
Colostrum secretion after delivery

79
Q

Early Breast Changes in Pregnancy

A 
Influence by hCG
Increase in size
Tenderness
Tingle with temperature changes
Secretory glands develop
80
Q

Breast Changes in Late Pregnancy

A

Proliferation of new acini reduced
Lumen become distended
Parturition after delivery

81
Q

Define Parturition

A

Mitotic activity & further growth & differentiation with milk secretion

82
Q

Lactogenesis Stages

A

Secretory initiation

Secretory activation

83
Q

Describe Secretory Initiation

A

2nd half of pregnancy

Women able to express colostrum

84
Q

Describe Secretory Activation

A

Copious milk production after delivery

This due to decline in progesterone & elevation in prolactin, cortisol, & insulin

OB/GYN (12 decks)

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