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Reproduction > Physiology- Pregnancy and Lactation > Flashcards

Physiology- Pregnancy and Lactation Flashcards

1
Q

Describe the process from fertilisation to implantation

A 
Fertilisation
Zygote
Morula
Blastocyst
Implantation
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2
Q

How many days after fertilisation does the blastocyst transport into the uterus?

A

3-5 days

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3
Q

How many days after fertilisation does the blastocyst attach to the lining of the uterus?

A

5-8 days

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4
Q

What happens to the inner cells of the blastocyst?

A

Develop into the embryo

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5
Q

What happens to the outer cells of the blastocyst?

A

Burrow into uterine wall and become placenta

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6
Q

What happens when the blastocysts adheres to the endometrial lining?

A

Cords of trophoblastic cells begin to penetrate the endometrium

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7
Q

What is the trophoblast?

A

Surface layer of cells of the blastocyst

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8
Q

What do the cords of trophoblastic cells do after endometrium penetration?

A

Tunnel deeper, carving out a hole for the blastocyst. Boundaries between cells in the advancing trophoblastic tissue disintegrate

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9
Q

Where is the blastocyst when implantation is finished?

A

Completely buried in endometrium

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10
Q

By what day will the blastocyst be buried in the uterine lining?

A

Day 12

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11
Q

What is the placenta derived from?

A

Trophoblast and decidual tissue

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12
Q

Describe how cavities filled with maternal blood are formed from trophoblast cells

A

Cells (chorion) differentiate into multinucleate cells (syncytiotrophoblasts) which invade decidua and break down capillaries to form cavities

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13
Q

Describe what happens to the broken down capillaries in the forming of cavities

A

Developing embryo sends capillaries into the syncytiotrophoblast projections to form placental villi

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14
Q

Describe a placental villus

A

Each contains foetal capillaries separated from maternal blood by a thin layer of tissue- no direct contact between foetal and maternal blood

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15
Q

What type of exchange exists between mother and foetus?

A

2 way exchange of resp gases, nutrients, metabolites etc-largely down diffusion gradient

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16
Q

When are the placenta and foetal heart functional by?

A

5th week of pregnancy

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17
Q

What provides early nutrition to the embryo?

A

Invasion of trophoblastic cells into decidua

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18
Q

What does HCG signal the corpus luteum to continue secreting?

A

Progesterone- stimulates decidual cells to concentrate glycogen, proteins and lipids

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19
Q

Where do placental villi extend into?

A

The uterine wall

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20
Q

What is the purpose of placental villi?

A

Increases contact area between uterus and placenta & more nutrients and waste materials can be exchanged

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21
Q

What does circulation within the intervillous space of the placenta act as?

A

An arteriovenous shunt

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22
Q

What plays the role of the foetal lungs?

A

Placenta

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23
Q

What is contained within umbilical blood?

A

Mix of arterial and venous blood

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24
Q

What does the exchange of CO2 follow from mother to foetus?

A

Reversed gradient to oxygen

Partial pressure elevated in foetal blood

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25
Q

What does foetal, oxygen saturated blood return to the foetus via?

A

The umbilical vein

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26
Q

What does maternal, oxygen poor blood return to the mother via?

A

Uterine veins

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27
Q

What 3 factors facilitate the supply of oxygen to the foetus?

A

Foetal Hb: increased ability to carry O2
Higher Hb concentration in foetal blood (50% more than adults)
Bohr effect: Foetal Hb can carry more oxygen in low pCO2 than higher pCO2

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28
Q

What transport mechanisms do the placental exchange processes occur via?

A 
Passive transport (without energy consumption)
Simple diffusion
Osmosis
Simplified transport
Active transport
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29
Q

Describe water diffusion into placenta

A

Osmotic gradient

Exchange increases during pregnancy up to 35th week (3.5l/day)

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30
Q

Describe electrolyte transport into placenta

A

Follow water

Iron and Ca2+ only go from mother to child

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31
Q

Describe glucose transport into placenta

A

Passes placenta via simplified transport

High quantity needed in 3rd trimester

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32
Q

Describe fatty acid transport into placenta

A

Free diffusion

33
Q

Describe waste products transport into placenta

A

Diffusion along concentration gradient

34
Q

Describe HCG changes in pregnancy

A

Prevents involution of corpus luteum

Effect on testes of male foetus- development of sex organs

35
Q

Describe Human Chorionic Somatomammotropin changes in pregnancy

A

Produced from around week 5
Growth hormone-like effects: protein tissue formation
Decrease insulin sensitivity in mother: more glucose for foetus
Involved in breast development

36
Q

Describe progesterone changes in pregnancy

A

Development of decidual cells
Decrease uterus contractility
Preparation for lactation

37
Q

Describe oestrogens changes in pregnancy

A

Enlargement of uterus
Breast development
Relaxation of ligaments
Estriol level-indicator of foetus viability

38
Q

Describe the trend in production of HCG, HCS, progesterone and oestrogens

A

All but HCG rise from onset at around week 5-6 to birth

HCG starts from week 0, sharply rises to week 10, sharply decreases to week 16 and then tapers down

39
Q

Describe CRH changes from placenta to mother

A

Increased CRH in placenta leads to ACTH in mother
Changes in aldosterone control
Can lead to HT, oedema or insulin resistance (leading to GD)

40
Q

Describe HCG/HC thyrotropin changes from placenta to mother

A

HCG/HCT in placenta, can lead to hyperthyroidism in mother

41
Q

Describe the effects of the increased calcium demand of the placenta on the mother

A

Can lead to hyperparathyroidism

42
Q

Why does the CO increase in pregnancy and from when?

A

Week 6-24 (30-50% increased)

Due to placental circulation, increased metabolism, thermoregulation and renal circulation changes

43
Q

What cardiac changes are all normal in pregnancy?

A 
ECH changes
Functional murmurs
Heart sounds
HR increase up to 90
BP drops during 2nd trimester
44
Q

When does the CO increase in pregnancy?

A

Decreases in last 8 weeks (becomes sensitive to body position, uterus compresses vena cava)
Increases 30% during labour

45
Q

Why does the BP drop during 2T?

A

Uteroplacental circulation expands & peripheral resistance decreases

46
Q

What happens to the CO with twins?

A

Increases more, BP drops more

47
Q

What haematologic changes occur in pregnancy?

A

PV increases proportionally with CO (50%)
Erythropoesis (RBC) increases (25%)
Thus Hb decreased by dilution (decreasing blood viscosity)
Iron requirements increase (6-7mg/day in 2nd half pregnancy: iron supplements needed)

48
Q

What respiratory changes occur in pregnancy?

A

Lung function changes due to progesterone increases and enlarging uterus interferes
Progesterone signals brain to lower CO2 levels (increases CO2 sensitivity in resp centres)
O2 consumption increases (20%)

49
Q

What is done to lower CO2 levels in pregnancy?

A

RR increases
Tidal and minute volume increases (50%)
pCO2 decreases slightly
Vital capacity and pO2 don’t change

50
Q

What urinary system changes occur in pregnancy?

A

GFR and renal plasma flow increase (30-50%, peaks 16-24wks)
Increased re-absorption of ions and water: placental steroids, aldosterone
Slight increase in urine formation

51
Q

How do postural changes affect renal function?

A

Upright position decreases
Supine increases
Lateral position during sleep increases greatly

52
Q

What is pre-eclampsia?

A

Pregnancy induced HT + proteinuria

53
Q

What happens in pre-eclampsia?

A

Increasing BP since 20th week
Kidney function declines-salt and water retention (oedema, esp hands and face)
Renal blood flow and GFR decrease

54
Q

In what women is pre-eclampsia more common in?

A 
Pre-existing hypertension
DM
AI disease (eg lupus)
Renal disease
FHx of pre-eclampsia
Obesity
Multiple gestation
55
Q

What is the most significant risk of having pre-eclampsia?

A

History of pre-eclampsia

56
Q

What causes pre-eclampsia?

A

Extensive secretion of placental hormones
Immune respose to foetus
Insufficient blood supply to placenta- ischaemia

57
Q

What is eclampsia?

A

Extreme pre-eclampsia (fatal unless treated)

58
Q

How does eclampsia present?

A

Vascular spasms
Extreme HT
Chronic seizures and coma

59
Q

How is eclampsia treated?

A

Vasodilators

C-section

60
Q

What is the average weight gain in pregnancy?

A

24lbs, can be up to 75bs

61
Q

Where does the extra weight in pregnancy come from?

A 
Foetus - 7lbs
Extra-embryonic fluid/tissues – 4 lbs
Uterus – 2 lbs
Breasts – 2 lbs
Body fluid – 6 lbs
Fat accumulation – 3 lbs
62
Q

How many extra kcal/day should be ingested by mother and for what?

A

250-300 extra

85% foetal metabolism, 15% stored as maternal fat

63
Q

How much extra protein should be ingested during pregnancy?

A

30g/day

64
Q

What is the glucose need at end of pregnancy?

A

Foetal need 5mg/kg/min

Mother 2.5mg/kg/min

65
Q

Describe the 1st-20th week in terms of metabolism?

A

Mother’s anabolic phase

Small nutrional demands of conceptus

66
Q

Describe the 21st-40th week in terms of metabolism?

A

Esp last trimester
High metabolic demands of foetus
Accelerated starvation of mother

67
Q

What happens during the mother’s anabolic phase?

A

Normal or increased sensitivity to insulin
Lower plasmatic glucose level
Lipogenesis, glycogen stores increases
Growth of breasts, uterus,weight gain

68
Q

What happens during the catabolic phase (accelerated starvation)?

A

Maternal insulin resistance
Increased transport of nutrients through placental membrane
Lipolysis

69
Q

What causes the insulin resistance in pregnancy?

A

HCS
Cortisol
GH

70
Q

What are the special nutritional needs in pregnancy?

A

High protein diet, higher energy uptake
Iron supplements - 300mg ferrous sulfate
B - vitamins - erythropoesis
Folic acid (folate) - reduces risk of neural tube defects
Vitamin D3 + Ca2+ supplements
Before parturition - K vitamin (prevention of intracranial bleeding during labour)

71
Q

What happens to the oestrogen:progesterone ratio at parturition?

A

Alters increasing excitability: progesterone inhibits contractility, oestrogen vice versa

72
Q

What does oxytocin do during parturition?

A

Increases contractions and excitability

73
Q

What do the foetal hormones oxytocin, adrenal gland hormones, and prostaglandins do during parturition?

A

Control timing of labour

74
Q

What does cervical stretch cause the further release of?

A

Oxytocin

75
Q

What is oestrogen’s role in lactation?

A

Growth of ductile system

Inhibit milk production (level drops at birth)

76
Q

What is progesterone’s role in lactation?

A

Development of lobule-alveolar system

Inhibit milk production (level drops at birth

77
Q

What is prolactin’s role in lactation?

A

Stimulates milk production (rise in levels week 5 to birth)
1-7 days after birth, prolactin induces high milk production
Stimulates colostrum (low volume, no fat)

78
Q

What do the sucking stimulus and oxytocin do in lactation?

A

Initiate ‘milk let-down’ reflex

Reproduction (40 decks)

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