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Repro / GU > SM_208b: Normal Pregnancy > Flashcards

SM_208b: Normal Pregnancy Flashcards

1
Q

Describe physiological changes in the uterus during pregnancy

A

Physiological changes in the uterus during pregnancy

  • Progressive increase in uteroplacental blood flow as gestation progresses
  • Uterine weight increases as well
  • Estrogen-mediated hypertrophy
  • Progesterone-mediated relaxation
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2
Q

Describe physiological changes in the cervix / vagina during pregnancy

A

Physiological changes in the cervix / vagina during pregnancy

  • Chadwick sign
  • Hypertrophy and hyperplasia of cervical glands -> eversion of proliferating columnar endocervical glands
  • Increasing mucosal thickness and loosening of connective tissue in vagina
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3
Q

Chadwick sign is ____

A

Chadwick sign is bluish discoloration of the cervix and vagina caused by increased blood flow

  • Observed as early as 6-8 weeks after conception
  • Early sign of pregnancy
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4
Q

Describe physiological changes in the ovaries during pregnancy

A

Physiological changes in the ovaries during pregnancy

  • Corpus luteum functions until 7 weeks gestation
  • Decidual reaction
  • Theca lutein cells: associated with high hCG levels, bilateral cystic ovaries, maternal virilization occurs in 25%
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5
Q

Theca lutein cysts in the ovaries are ____, ____, and ____

A

Theca lutein cysts in the ovaries are associated with high hCG levels, bilateral cystic ovaries, and maternal virilization occurs in 25%

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6
Q

Decidual reaction in ovaries is ____

A

Decidual reaction in ovaries is an increase in secretory functions of the endometrium at the area of implantation and edematous surrounding stroma

  • Seen in very early pregnancy in generalized area where blastocyst contacts endometrial decidua
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7
Q

In pregnancy, cardiovascular changes include ____, ____, and ____

A

In pregnancy, cardiovascular changes include enlarged cardiac silhouette due to elevation of diaphragm, increase in HR, and increase in CO

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8
Q

MAP is lowest in ____ of pregnancy

A

MAP is lowest in middle of pregnancy

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9
Q

In pregnancy, elevation of diaphragm ____ respiratory function

A

In pregnancy, elevation of diaphragm changes respiratory function

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10
Q

Describe maternal GI tract physiology in pregnancy

A

Maternal GI tract physiology in pregnancy

  • High B-hCG contributes to nausea / vomiting in first trimester
  • Increasing smooth muscle relaxation secondary to progesterone: GERD, constipation, decreased gallbladder motility
  • Gastric emptying time itself unchanged in pregnancy but increases during labor
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11
Q

Describe maternal hepatic physiology during pregnancy

A

Maternal hepatic physiology during pregnancy

  • Increased hepatic blood flow
  • Labs: D-dimer increases, alk phos increases, albumin decreases
  • Anatomic changes: appendix location
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12
Q

Pregnancy effect on hepatic labs

  • D-dimer: ____
  • Alk phos: ____
  • Albumin: ____
A

Pregnancy effect on hepatic labs

  • D-dimer: increases
  • Alk phos: increases
  • Albumin: decreases
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13
Q

Describe maternal renal / urinary physiology during pregnancy

A

Maternal renal / urinary physiology during pregnancy

  • GFR increases by ≤ 50% by mid-pregnancy
  • RPF increases more than GFR
  • Serum Cr decreases
  • Uterine displacement of ureters (R>L): hydronephrosis, slight increase in size of kidneys
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14
Q

Maternal blood volume ___ during pregnancy

A

Maternal blood volume increases during pregnancy

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15
Q

Describe maternal hematologic physiology during pregnancy

A

Maternal hematologic physiology during pregnancy

  • Leukocytosis in pregnancy
  • Increased granulocytes and CD8 lymphocytes
  • Decreased CD4 lymphocytes and monocytes
  • Coagulation / fibrinolysis: both augmented but remain balanced for homeostasis
  • Clotting factors increase, tPA increase, protein S decreases, activated protein C decreases
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16
Q

Pregnancy effect on coagulation labs

  • Clotting factors (including fibrinogens): ____
  • tPA: ____
  • Protein S: ____
  • Activated protein C: ____
A

Pregnancy effect on coagulation labs

  • Clotting factors (including fibrinogens): increase (except factors XI and XIII)
  • tPA: increase
  • Protein S: decrease
  • Activated protein C: decrease
17
Q

Most circulating hormones are ____ in pregnancy as a result of the fetus and placenta

A

Most circulating hormones are increased in pregnancy as a result of the fetus and placenta

18
Q

Describe maternal endocrine physiology during pregnancy

A

Maternal endocrine physiology during pregnancy

19
Q

Describe effect of pregnancy on thyroid hormone

A

Effect of pregnancy on thyroid hormone

  • TBG: increased
  • T4 and T3: increased
  • TSH: stable / slightly decreases

(fetus dependent on maternal thyroid hormone until at least 10 weeks gestation)

20
Q

Describe maternal metabolic physiology during pregnancy

A

Maternal metabolic physiology during pregnancy

  • Basal metabolic rate increases 10-20%
  • Weight gain: 25-35 lbs if normal pre-pregnancy weight, maximal additional caloric intake is 300 kcal / day
  • Carbohydrate metabolism: hyperplasia of insulin-secreting pancreatic beta cells, increased insulin secretion, progressive insulin resistance -> mild fasting hypoglycemia and postprandial hyperglycemia
  • Protein metabolism: nitrogen balance increases with GA
  • Fat metabolism: increased lipids / lipoproteins / apolipoproteins, fat storage occurs primarily mid-pregnancy and tends to be deposited more centrally
21
Q

Maternal metabolism during pregnancy is characterized by ____ and ____

A

Maternal metabolism during pregnancy is characterized by mild fasting hypoglycemia and postprandial hyperglycemia

22
Q

___ is the structural unit of each fetal cotyledon

A

Main stem villus is the structural unit of each fetal cotyledon

  • Many cotyledons make up the placenta
  • Main stem villus responsible for fetal circulation
23
Q

Describe regulation of placental transfer

A

Regulation of placental transfer

  • Mode of transport (e.g. simple diffusion vs active transport)
  • Concentration of substance within maternal plasma: also dependent upon amount bound to carrier proteins
  • Rate of maternal blood flow through intervillous space
  • Rate of fetal blood flow
  • Area available for exchange across villous trophoblast epithelium
  • Amount of substance metabolized by placenta
  • Area for exchange across fetal capillaries
24
Q

Describe circulatory changes at birth

A

Circulatory changes at birth

  • Alveolar expansion -> increased alveolar capillary O2 -> induces marked decrease in pulmonary vascular resistance -> decreased RA pressure and RV afterload
  • Backflow of oxygenated blood into ductus arteriosus -> alters ductal production of prostaglandins -> localized vasoconstriction -> closure of ductus arteriorosus
  • Closure of foramen ovale
  • Collapse of ductus venosus and umbilical vessels
25
Q

Describe fetal respiratory physiology

A

Fetal respiratory physiology

  • Fetal breathing movements begin at age 16-22 weeks

Anatomical maturation

  • Pseudoglandular stage (5-16 weeks)
  • Canalicular stage (16-25 weeks)
  • Terminal sac / alveolar stage (25 weeks - 8 years of life)
26
Q

Describe fetal GI and renal / GU physiology

A

Fetal GI and renal / GU physiology

  • GI: swallowing begins at 10-12 weeks
  • Renal / GU: fetal kidneys produce urine and accounts for majority of amniotic fluid volume after 16 weeks
27
Q

Fetal hemoglobin has ____ affinity for oxygen

A

Fetal hemoglobin has greater affinity for oxygen

28
Q

Describe fetal endocrine physiology

A

Fetal endocrine physiology

  • Thyroid hormones critical for normal development
  • Fetal thyroid begins synthesizing thyroid hormone at 10-12 weeks
  • Fetus dependent on maternal thyroid prior to this time
29
Q

Describe fetal adrenal physiology

A

Fetal adrenal physiology

  • Fetal adrenals at term weigh as much as adult adrenals (large fetal zone)
  • Fetal adrenals account for a large amount of pregnancy steroidogenesis: precursor is cholesterol (maternal LDL)
30
Q

Mechanisms resulting in parturition (childbirth) are ____ and ____

A

Mechanisms resulting in parturition (childbirth) are CRH and myometrial contractility

31
Q

Describe stages of labor

A

Stages of labor

  • Stage 1: interval between onset of labor and full cervical dilation: latent phase and active phase
  • Stage 2: interval between full cervical dilation and delivery of fetus
  • Stage 3: interval between delivery of neonate to delivery of placenta

Repro / GU (46 decks)

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