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OBGYN > I. Maternal Physiology > Flashcards

I. Maternal Physiology Flashcards

1
Q

By the end of 12 weeks, the enlarged uterus extends out of the pelvis. With this, it comes in contact with the anterior abdominal wall and displaces the intestines ____ and ____ (ant, superior, medial etc?) and ultimately reaches almost to the liver.

A

laterally and superiorly

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2
Q

hormones that augement NO synthase

A

VEGF, Estrogen, Progesterone, PGF, Activin

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3
Q

Greater vascularity and hyperemia in the skin and muscles of perineum, vulva, vagina and cervix resulting in violet color characteristic

A

Chadwick sign

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4
Q

Endocervical gland hyperplasia and hypersecretory appearance which is difficult to differentiate from atypical glandular cells

A

Arias-Stell reaction

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5
Q

seen on a glass slide, as a result of amniotic fluid leakage which is an arborization of ice- crystals

A

Ferning

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6
Q

seen when cervical mucus, in most pregnant women, as a result of progesterone, shows poor crystallization

A

Beading

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7
Q

Slightly elevated clear or red patches that bleed easily seen on and just beneath the ovarian surface.
Arise from subcoelomic mesenchyme or endometriotic lesions stimulated by progesterone

A

decidual reaction

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8
Q
  • Protein hormone secreted by corpus luteum, the decidua, placenta, brain, heart, and kidney
  • Aids in remodelling of reproductive tract connective tissue to accommodate labor
A

Relaxin

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9
Q

Exaggerated physiological follicle stimulation. Usually bilateral, moderately to massively enlarged cystic ovaries due to markedly elevated serum hCG

A

theca lutein cyst

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10
Q

CARBOHYDRATE METABOLISM
• Normal pregnancy characterized by:
o Mild fasting _______________ oPostprandial _________
o_______insulinemia

A

hypoglycemia
hyperglycemia
hyper

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11
Q

factors responsible for insulin resistance

A 
PPPCTL
Progesterone
PDGF
Prolactin
Cortisol
TNF
Leptin
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12
Q

• Secreted by adipose tissue
• Important for implantation, cell proliferation
& angiogenesis.
• Important for development of pancreas,
kidney, heart & brain.
• Lower levels are linked to fetal-growth
restriction

A

Leptin

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13
Q

Maternal blood volume grows most rapidly during the ___ trimester.

A

2nd trimester

Maternal blood volume grows most rapidly during the 2nd trimester, rises at a slower rate during the 3rd trimester and reaches a plateau in the last few weeks of pregnancy.

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14
Q

During pregnancy, hemoglobin and hematocrit ___ and whole blood viscosity ____
(increases/decreases)

A

Because of great plasma augmentation, both hemoglobin and hematocrit decline slightly during pregnancy. As a result, whole blood viscosity decreases.

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15
Q

An important anti-inflammatory component of pregnancy involves the suppression of ___ and ___ which lower secretion of IL-2, IF-𝛼 and TNF.

A

TH1 and T-cytotoxic cells

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16
Q

With suppression of TH1 cells, there is upregulation of TH2 cells to increase secretion of IL-__, IL-__, and IL-__.

A

TH2 cells to increase secretion of IL-4, IL-10, and IL-13.

These promote humoral or antibody-based immunity. Hence, autoimmune diseases mediated mainly by autoantibodies, (e.g. SLE) may flare if the disease is already active in early pregnancy.

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17
Q

In cervical mucus, Ig_ and Ig_ are significantly higher during pregnancy.

A

IgG and IgA

18
Q

Ig_ is transferred to the developing fetus in the __ trimester as a form of passive immunity in anticipation of birth.

A

IgG, 3rd

19
Q

Concentrations of ___ increase at the end of the 3rd trimester and through the first few postpartum days.
These levels rise with severe bacterial infections but remain low in viral infections and non-specific inflammatory disease.

A

Procalcitonin

20
Q

increased concentrations of all clotting factors EXCEPT Factors __ and __

A

Factor XI and XIII

21
Q

net result is that pregnancy is a (pro or anti)-coagulant state.

A

Pregnancy is a pro-coagulant state hence, there will be increased fibrinogen, factor VII, factor X, plasminogen while there is a decrease in tPA, antithrombin III, protein C, protein S, platelet count

22
Q

Arterial pressure usually declines to a nadir at ___ weeks AOG and rises thereafter. (Systolic or Diastolic) pressure (increases or decreases) more than systolic.

A

24-26 weeks AOG

Diastolic pressure decreases more than systolic.

23
Q

RAAS for BP control is via __ and __ balance

A

Na and H2O

24
Q

___ is increased in severe preeclampsia
___ is increased in preeclampsia
___ is decreased in preeclampsia

(endothelin-1, prostacyclin, BPN)

A

BNP
Endothelin-1
Prostacyclin

Nitric oxide: Abnormal synthesis linked to preeclampsia development

25
Q

2 things secreted in response to chamber-wall stretching.

• Regulate blood volume by natriuresis, diuresis & vascular smooth- muscle relaxation.

A

ANP and BNP

26
Q
  • Principal prostaglandin of endothelium;
  • increases in late pregnancy
  • Regulates blood pressure & platelet function
  • Maintain vasodilation;
A

prostacyclin (PGI2)

27
Q

Endothelin 1

  • stimulates secretion of __, __ & __.
  • Produced in endothelial & vascular smooth muscle;
  • production is stimulated by ATII, AVP & thrombin
A

Stimulate secretion of ANP, aldosterone & catecholamines.

28
Q
  • Potent vasodilator
  • Released by endothelial cells
  • Mediator of placental vascular tone & development.
A

NO

29
Q

RESPIRATORY CHANGES

The elevation of the diaphragm, at around 4cm, during the third trimester results to the reduction of the ___ and its components (__ and __) as well as increase in __ and ___.

A

The elevation of the diaphragm, at around 4cm, during the third trimester results to the reduction of the functional residual capacity and its components (ERV and RV) as well as increase in inspiratory capacity and tidal volume.

30
Q

RESPIRATORY CHANGES

INCREASED OR DECREASED OR UNCHANGED

total pulmonary resistance
peak expiratory flow rate lung compliance
airway conductance

A

decreased
increased
unchanged
increased

31
Q

URINARY SYSTEM

INCREASED OR DECREASED OR UNCHANGED

Tests of renal function
o Serum creatinine
o Creatinine clearance

protein, AA, and glucose excretion: _____.

A

Tests of renal function

o Serum creatinine – DECREASED.

o Creatinine clearance – INCREASED about 30%

protein, AA, and glucose excretion all increase.

32
Q

Albumin excretion is minimal and ranges from ___mg/day

A

5 to 30 mg/day

33
Q

GI

INCREASED OR DECREASED OR UNCHANGED

albumin, alkaline phosphatase, ALT, leucine aminopeptidase, AST, GGT, bilirubin, globulin, gallbladder contractility

A 
albumin increased
alkaline phosphatase increased
ALT decreased
leucine aminopeptidase
AST decreased
GGT decreased
bilirubin decreased
globulin increased
gallbladder contractility decreased
34
Q

Initiates DNA synthesis and mitosis of glandular epithelial cells and presecretory alveolar cells of breast

A

Prolactin

35
Q

Increase in pituitary size (~__%) is d/t _____-stimulated hypertrophy (what hormone);
hyperplasia of lactotrophs.
May compress optic chiasma & reduce visual fields

A

135%; estrogen

36
Q

ENDOCRINE

From 10 weeks to 28 weeks. Fetal growth progresses even in its
complete absence.

A

Maternal GH

37
Q
  • Secreted by syncytiotrophoblasts

* Upregulates insulin-like GF (IGF-1) for fetal growth.

A

Placental GH

38
Q

GH sources for 1st trimester mostly are from: ____

then at ~__ weeks AOG, it is the ___ that becomes the principal source of GH

A

maternal pituitary glands

39
Q

Fetal thyroid changes:
o __ wks: begin to concentrate iodine
o ___: synthesis/secretion of thyroid hormone by fetal
pituitary

A

10-12 wks

20 wks

40
Q

___ in the principal glucocorticoid. This is elevated in response to elevated __ to maintain homeostasis.

A

Cortisol

Progesterone

41
Q

Modulates trophoblast growth & placental

size. 2 hormones

A

Cortisol and aldosterone

42
Q

Protects against natriuretic effect of progesterone and ANP.

A

aldosterone

OBGYN (3 decks)

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