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Sem 4 > Repo 8: Pregnancy > Flashcards

Repo 8: Pregnancy Flashcards

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1
Q

What happens to the yolk sac as the foetus grows?

A

Yolk sac disappears as the amniotic sac enlarges due to growth of the foetus
So chorionic sac is occupied by the expanding amniotic sac

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2
Q

What is meant by the term haemomonochorial?

A

That only one single trophoblast layer separates maternal blood from foetal capillary blood
The two circulations never mix!

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3
Q

What are chorionic villi?

A

Finger like projections that the Charon forms

They represent the point of exchange between the maternal and foetal circulations

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4
Q

What is an ectopic pregnancy?

A

Implantation at a site other the the uterine body, often in the Fallopian tube

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5
Q

What is placenta praevia?

A

Implantation int eh lower uterine segment that can cause haemorrhage in pregnancy
Requires a c-section as the birth canal is obstructed

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6
Q

Which cells in the endometrium prepare for implantation?

A

Pre-decidual cells

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7
Q

How must the flow and resistance of the blood supply in the endometrium adapt for pregnancy?

A

Spiral artery remodelling
To create a high flow and low resistance blood supply

(This does not happen in pre-eclampsia)

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8
Q

Which layer of trophoblast impedes the mother?

A

Cytotrophoblast (lined with syncytiotrophoblast)

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9
Q

How does the barrier of the placenta change over the course of pregnancy?

A

Barrier is thick in first trimester (OK as demands of foetus are fairly low)
As placenta matures to meet increasing foetal demands, is decreased the interhaemal distance by thinning the trophoblast layers (now just syncytiotrophoblast) and increasing the SA for exchange through branching of the villus tree

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10
Q

Which vessels carry oxygenated and deoxygenated blood to the foetus?

A

2 umbilical arteries carry deoxygenated blood from foetus to placenta
1 umbilical vein carries oxygenated blood from placenta to foetus

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11
Q

What is the function of hCG?

A

Produced in first 2 months of pregnancy to support CL

Excreted in maternal urine (used for pregnancy testing)

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12
Q

Which trophoblast layer secretes hCG?

A

Syncytiotrophoblast

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13
Q

Which steroid hormones does the placenta produce?

A

Progesterone and oestrogen

Responsible for maintaining pregnancy state (progesterone increases maternal appetite to lay down fats for late pregnancy)
Placenta takes over CL production by 11th week

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14
Q

What is the main function of hPL?

A

Increases glucose availability to foetus

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15
Q

Give an example of molecules that are transported across the placenta by simple diffusion, facilitated diffusion, active transport, and receptor mediated transport.

A

Simple diffusion: water, urea, electrolytes, gases
Facilitated diffusion: glucose
Active transport: AAs, iron, vitamins
Receptor mediated transport: IgG

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16
Q

How does the foetus develop passive immunity?

A

IgG transported from mother to foetus by receptor mediated transport

17
Q

What is haemolytic disease of the newborn?

A

Rheus blood group incompatibility between mum and foetus
So mums IgG transports across placenta and binds to antigens on foetal RBCs and attacks them, causing haemolysis

Now uncommon because of prophylactic treatment

18
Q

How does alcohol cross the placenta and what implications does this have for the development of a baby whose mother drinks during pregnancy?

A

By diffusion because it’s lipid soluble
Can cause foetal alcohol syndrome causing foetus of low weight and with growth retardation and head and facial abnormalities

19
Q

How does CO, SV and HR alter with pregnancy?

A

All increase

20
Q

Why does systemic vascular resistance decrease in pregnancy?

A

Due to progesterone relaxing smooth muscle

21
Q

How does blood pressure change along the course of pregnancy?

A

In T1 and T2, blood pressure drops (due to progesterone systemic vascular resistance) then returns to normal in T3 due to aortocaval compression by Gracie uterus

22
Q

How does the renal system change in pregnancy?

A 
GFR increases (possibly due to progesterone acting on glomerular arterioles)
Creatine, protein and urea excretion all increase so are lower in mother
23
Q

Why are pregnant women at increased risk of UTIs?

A

Due to urinary stasis brought about by hydroureter (dilated ureter due to progesterone), and obstruction by compression of gravid uterus

24
Q

How does pregnancy alter maternal respiration?

A

Diaphragm displaced by gravid uterus
But AP and transverse diameters of thorax increase

Tidal volume increases but RR unchanged
O2 consumption increases

25
Q

How is vital capacity unchanged in pregnancy?

A

Even thought tidal volume increase, this means expiratory reserve volume decreases

26
Q

How is pH altered in pregnancy?

A

State of compensated respiratory alkalosis due to decrease on arterial pCO2, which is compensated by increased renal bicarbonate excretion

27
Q

How does carbohydrate metabolism change in pregnancy?

A

Glucose is supplied to the foetus by facilitated diffusion across the placenta
Mother develops insulin resistance during second half of pregnancy so switches to gluconeogenesis and use of alternative fuels (FAs, ketones, triglycerides) which is achieved by hPL

28
Q

What are the risks for the foetus if the mother develops gestational diabetes?

A

Macrosomic foetus
Congenital defects
Still birth

29
Q

How does lipid metabolism change in pregnancy?

A

From T2 there is increased lipolysis so more free FAs

FAs don’t cross the placenta so are reserved for maternal metabolism, leaving glucose for the foetus

30
Q

How do levels of thyroid hormones change throughout pregnancy?

A

TBG increases
Levels of T3 and T4 increases but T4 still in normal range due to increased TBG
hCG has effect to raise TSH, but not significantly
(Huge rise in TSH may indicate iodine deficiency of hypothyroidism)

31
Q

Where does the appendix move to in pregnancy?

A

RUQ, due to enlargement of uterus

32
Q

How is the GI system affected by pregnancy?

A

Smooth muscle relaxation due to progesterone, hence…

  • heartburn (relaxed lower oesophageal sphincter enables reflux)
  • constipation (slower transit time to allow more nutrient absorption)
  • gallstone (due to stasis in biliary tree)
  • risk of pancreatitis due to hyperlipidaemia of pregnancy
33
Q

How does pregnancy affect maternal haematology?

A

Pregnancy is a pro-thrombotic state (to prepare for blood loss at parturition)
Increased levels of fibrinogen and clotting factors, and reduction of fibrinolysis

34
Q

Why could anaemia form in pregnancy?

A
  • due to Fe and folate deficiency

- or dilutional anaemia due to increase in plasma volume but little increase in RBCs

35
Q

Why could warfarin not be prescribed to a pregnant women with thromboembolic disease?

A

As warfarin is a teratogen and can cross the placenta

36
Q

How does the maternal immune system change in pregnancy?

A
  • foetus is an allograft so there is suppression of immune response at maternal-foetal interface
  • mum also supplied IgG to foetus across placenta (Rheus incompatibility)
37
Q

Why would there be a concern if a pregnant woman had Graves/ Hashimoto’s?

A

These are autoimmune diseases, so it is possible these antibodies could transfer from the mum to the foetus and have the same affect on it

Sem 4 (25 decks)

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