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Physiology 2 > Reproduction: Maternal changes during pregnancy > Flashcards

Reproduction: Maternal changes during pregnancy Flashcards

1
Q

Give examples of pre-exisiting conditions that can worsen during pregnancy

A
  • Congenital heart disease
  • Asthma
  • Diabetes
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2
Q

During pregnancy what are the main changes/events that occur to the mother and foetus?

A
  • Increase in uterus size
  • Increased metabolic requirements of uterus
  • Increased metabolic requirements of foetus
  • Waste removal from foetus
  • Provision of amniotic fluid
  • Preparation for delivery
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3
Q

What are the main body systems that experience changes during pregnancy?

A
  • Energy balanace
  • Cardiovascular system
  • Respiratory system
  • Gastrointestinal system
  • Urinary system
  • Endocrine system
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4
Q

What placental peptides are responsible for the changes that occur during pregnancy?

A
  • hCG (human chorionic gonadotrophin)
  • hPL (human placental lactogen)
  • GH (Growth hormone)
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5
Q

What placental/foetal steroid hormones are responsible for the changes that occur during pregnancy?

A
  • Progesterone
  • Oestradiol
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6
Q

What maternal/foetal pituitary hormones are responsible for changes that occur during pregnancy?

A
  • Growth hormone
  • Thyroid hormones
  • Prolactin
  • CRF (Corticotrophin releasing factor)
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7
Q

What is the total amount of weight gain during pregnancy?

A

Around 12.5-13Kg increase

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8
Q

Why do energy output and energy storage need to increase during pregnancy?

A
  • Energy output needs to increase to deal with increased respiration and cardiac output
  • Energy storage needs to increase to provide energy for foetus and for when labour occurs
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9
Q

Where does most of the extra protein and fat gained during pregnancy get stored?

A

Anterior abdominal wall

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10
Q

How does glucose get exchnaged between the mother and the foetus?

A

Gluocose moves via active transport acroos the placenta

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11
Q

During the 1st trimester of pregnancy why does the production of pancreatic beta cells increase?

A

Because during 1st trimester foetal glucose requirements aren’t high so mother can store more glucose for her own requirements

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12
Q

What occurs a result of increase in pancreatic beta cells in mother?

A
  • Increased production leads to increase in insulin within blood of mother
  • Increased insulin leads reduction in glucose in blood
  • Instead glucose put into maternal stores
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13
Q

Explain how maternal/foetal glucose levels change during 2nd trimester

A
  • hPL (human placental lactogen) causes an increase in maternal insulin resistance
  • This means glucose doesn’t respond to insulin and so more stays in maternal circulation
  • This results in more glucose being transferred to foetus via placenta
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14
Q

Why do maternal/foetal glucose levels change during 2nd trimester?

A

Foetal requirement for glucose increases

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15
Q

What condition can occur as a result of the changes in glucose during 2nd trimester and why?

A
  • Gestational diabetes can occur in mother
  • This can happen if foetus doesn’t take up glucose from other so maternal glucose levels in circulation will remain high
  • Can also occur if hPL causes massive increase in insulin resistance so even when foetus takes up glucose maternal circulation levels still high
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16
Q

What changes occur to the renin-angiotensin system during pregnancy?

A
  • Increased sodium retention
  • Resetting of the osmostat - region in hypothalamus that controls osmolarity
  • Decrease thirst threshold
  • Decrease in plasma oncotic pressure
17
Q

What is the main result of the changes to the renin-angiotensin system during pregnancy?

A

Mother retains more water

18
Q

What hormones are responsible for changes in renin-angiotensin system?

A

Oestrogen and progesterone

19
Q

What effect do oestrogen and progesterone have on the respiratory system?

A
  • They increase CO2 sensitivity of the respiratory centre in the brain
  • This causes the mother to breathe more deeply
  • This causes an increase in oxygen levels within arterial blood and decrease in CO2 levels
20
Q

What effect does an increase in arterial O2 and a decrease in arterial CO2 have on gas transfer between mother and foetus? Why?

A
  • Facilitates faster gas transfer between mother and foetus
  • This is because higher maternal arterial oxygen and lower maternal arterial CO2 create higher concentration gradients between mum and foetus
  • This allows for more oxygen to enter foetal circulation and more CO2 to leave
21
Q

What changes occur to the maternal blood during pregnancy?

A
  • Plasma volume increases by 45%
  • Red cell mass increases by 18%
  • This causes a decrease in haemoglobin concentration
22
Q

What condition can occur due to the decrease in haemoglobin concentration seen during pregnancy?

A
  • Haemodilution - apparent anaemia
23
Q

What other changes occur to maternal blood during pregnancy?

A
  • Increase in white blood cells
  • Increase in clotting factors (e.g. fibrinogen)
  • This means blood becomes hypercoagulable
24
Q

How is foetal blood adapted to ensure that the foetal blood has high oxygen binding?

A
  • Foetal blood contains HbF which has a higher affinity for Oxygen than maternal HbA
  • Foetal blood also has much higher Hb concentration than maternal blood
25
How can smoking during pregnancy lead to foetal hypoxia?
* Smoking during prenancy leads to presence of carboxy-Hb in maternal blood * Carboxy-Hb has even higher affinity for oxygen than HbF so oxygen transferred from foetus to mother * This can lead to hypxia in foetus if too much oxygen transferred
26
What changes occur to cardiovascular system during pregnancy?
* Expanding uterus pushes heart around * This leads to changes in ECG and heart sounds * Increased cardiac ouput - this is because of: * Increased stroke volume and heart rate * Increased blood flow to: * Uterus * Placenta * Muscle * Kidney * Skin
27
Why does Total peripheral resistance decrease during pregnancy?
* TPR decreases to avoid a massive increase in blood pressure due to the increase in cardiac ouput
28
How does TPR decrease during pregnancy?
Steroids (especially progesterone) cause vasodilation of vessels
29
What condition can develop as a result of failure to reduce TPR during pregnancy?
* Preeclampsia - rise in blood pressure due to failure to decrease TPR in response to increased cardiac output
30
What changes occur to the GI tract during pregnancy?
Steroids (progesterone) lead to relaxation of smooth muscle of GI tract this leads to: * Reduced GI motility - can cause constipation * Relaxation of lower oesophageal sphincter - can cause acid reflux * Increased appetite and thirst
31
Apart from sommoth muscle of GI tract what other area of smooth muscle is affected by steroids and what does this effect cause?
* Steroids lead to relexation of smooth muscle of uterus * This decreases uterus contractility allwoing it expand throughout pregnancy
32
Why are folic acid supplements advised to be taken during pregnancy?
* Folic acid involved in DNA production and growth * These functions are very useful for placenta, foetus and uterus during pregnancy
33
What changes occur to the urinary system during pregnancy?
* Urinary tract relaxes and dilates - this increases chances of UTI * Increased clearance of creatinine and urea due to increased glomerular filtration rate which is due to increase in cardiac output
34
What changes occur to the uterus during pregnancy?
* Huge increase in muscle mass * Huge increase in blood flow * Lower uterine segment becomes softened/elongated
35
Why is a cesarean performed at the lower uterine segment?
Lower uterine segment softer than rest of uterus so less likely to bleed and easy to cut into
36
What changes occur to the cervix during pregnancy?
* Increase in vascularity * Tissue softens - preparing for expansion during delivery of baby * Glands proliferate and increase secretions
37
Why does removal of placenta after delivery result in dramatic fall in steroid levels in mother?
* Placenta is the organ secreting most steroids/hormones by end of pregnancy so once it's removed it can't secrete them anymore
38
What process occurs as a result of decrease in steroid levels after pregnancy?
Increases level of prolactin within mother which will act on her breasts to increase production of milk

Physiology 2 (29 decks)

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