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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
Q

How can smoking during pregnancy lead to foetal hypoxia?

A
  • 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
Q

What changes occur to cardiovascular system during pregnancy?

A
  • 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
Q

Why does Total peripheral resistance decrease during pregnancy?

A
  • TPR decreases to avoid a massive increase in blood pressure due to the increase in cardiac ouput
28
Q

How does TPR decrease during pregnancy?

A

Steroids (especially progesterone) cause vasodilation of vessels

29
Q

What condition can develop as a result of failure to reduce TPR during pregnancy?

A
  • Preeclampsia - rise in blood pressure due to failure to decrease TPR in response to increased cardiac output
30
Q

What changes occur to the GI tract during pregnancy?

A

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
Q

Apart from sommoth muscle of GI tract what other area of smooth muscle is affected by steroids and what does this effect cause?

A
  • Steroids lead to relexation of smooth muscle of uterus
  • This decreases uterus contractility allwoing it expand throughout pregnancy
32
Q

Why are folic acid supplements advised to be taken during pregnancy?

A
  • Folic acid involved in DNA production and growth
  • These functions are very useful for placenta, foetus and uterus during pregnancy
33
Q

What changes occur to the urinary system during pregnancy?

A
  • 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
Q

What changes occur to the uterus during pregnancy?

A
  • Huge increase in muscle mass
  • Huge increase in blood flow
  • Lower uterine segment becomes softened/elongated
35
Q

Why is a cesarean performed at the lower uterine segment?

A

Lower uterine segment softer than rest of uterus so less likely to bleed and easy to cut into

36
Q

What changes occur to the cervix during pregnancy?

A
  • Increase in vascularity
  • Tissue softens - preparing for expansion during delivery of baby
  • Glands proliferate and increase secretions
37
Q

Why does removal of placenta after delivery result in dramatic fall in steroid levels in mother?

A
  • Placenta is the organ secreting most steroids/hormones by end of pregnancy so once it’s removed it can’t secrete them anymore
38
Q

What process occurs as a result of decrease in steroid levels after pregnancy?

A

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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