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Human development block > Hormonal changes& the maternal adaptation to pregnancy > Flashcards

Hormonal changes& the maternal adaptation to pregnancy Flashcards

1
Q

What is gestational diabetes?

A
  • High blood sugar that develops during pregnancy& usually disappears after giving birth
  • Too much insulin resistance
  • Happens because they are already insulin resistant because they’re pregnant( as hormones stimulate this change) because it increases the maternal glucose then facilitates transfer across the placenta
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2
Q

Describe what happens to the maternal RBCs in pregnancy

A
  • Synthesis increases( stimulated by erythropoietin)
  • Number increases but apparent anaemia due to dilution
  • Haematocrit falls from approx 40% to 32%
  • Approx 30% increase in intracellular 2-3 DPG facilitates offload of o2 release to fetus
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3
Q

What biochemical parameter in maternak blood has the most significant increase in % compared to non -pregnant women

A

-Triglycerides ( produces a lot during pregnancy)

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4
Q

Which B vitamins are needed for DNA synthesis

A

Folate( vitamin B9) and vitamin B12

-Lack of folate may cause neural tube defetcs

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5
Q

Where is progesterone produced during pregnancy?

A
  • produced by the corpus luteum at the beginning of pregnancy
  • Then the placenta takes over as the corpus luteum dies down
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6
Q

What is the role of estrogens in pregnancy?

A
  • Stimulate synthesis of liver FAs & cholesterol
  • cardiovascular adaptation to pregnancy
  • Growth of uterus
  • ‘priming’ of uterus for labour
  • weak anti-insulin activity( via enhanced cortisol)
  • Onset of labour-relative rise v fall in progesterone
  • Cervical ripening ( infiltration of leukocytes into the cervix; leads to collagen fibres breaking down, cervix ripens and this facilitates delivery)
  • Stimulates renin-angiotensin-aldosterone axis
  • When you want to deliver the baby, the uterus acts as a synctium; you get electrical connectivity& coordinated contraction- Estrogen is responsible for this
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7
Q

What is a significant difference in the renin-angiontensin-aldosterone axis

A
  • Angiontensin II has little effect on the aldosterone axis

- The RAAS is predominantly a sodium losing system

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8
Q

What are Braxton-Hicks contractions?

A

-Spontaneous contractions over the uterus

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9
Q

What is the role of progesterone in pregnancy

A
  • Prepares and maintains the endometrium to allow implantation
  • produced initially by CL up to day 50-60 then placenta
  • May have a role in suppressing the maternal immunologic response to fetal antigens thereby preventing maternal rejection of the trophoblast
  • role in parturition
  • Serves as a substrate for fetal adrenal gland production of glucocorticoids& mineralocorticoids
  • Growth of mammary glands
  • Maintenance of pregnancy( inhibition of uterine contraction& prevention of ripening of cervix)
  • Induces overbreathing& lowering of maternal co2
  • Stimulates the renin-angiotensin axis
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10
Q

What is Human chorionic gonadotrophin( hCG)

A
  • the basis of the pregnancy test
  • Rescue& maintenance of function of the CL( continued progesterone production)
  • About the 8th day after ovulation or 1 day after implantation- hCG takes over for the corpus luteum
  • Continued survival of the CL is totally dependant on hCG
  • Survival of the pregnancy is dependent on CL progesterone until the 7th week of pregnancy
  • Progesterone luteal synthesis begins to decline at about 6 weeks despite continued & increasing hCG production
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11
Q

What are the biological functions of hCG

A
  • Stimulation of maternal thyroid activity
  • hCG binds to the TSH receptors of thyroid cells
  • LH-hCG receptor is expressed in the thyroid
  • Possibly, hCG stimulates thyroid activity via the LH-hCG receptor and by the TSH receptor
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12
Q

What are the metabolic actions of hPL

A
  • Maternal lipolysis and increase in maternal plasma free fatty acids (NEFAs)-providing a source of energy for maternal metabolism & fetal nutrition
  • Anti-insulin or ‘diabetogenic’ action- increase in maternal insulin- favoring provision or mobilizable AAs and fetal protein synthesis as well as glucose for transport to the fetus
  • Potent angiogenic hormone- may play an important role in the formation of fetal vasculature
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13
Q

List the different placental proteins

A
  • human placental lactogen
  • pregnancy- associated plasma protein-A( PAPP-A, part of the quadraple test)
  • Vascular endothelial growth factor( VEGF)
  • Placenta growth factor (PLGF)
  • human chorionic gonadotrophin
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14
Q

What is the function of leptin in pregnancy& early development?

A
  • Secreted by both cytotrophoblast cells& synctiotrophoblast; maternal levels are significantly higher than in non pregnant women& that in the fetal circulation
  • stimulates placental AA/FA transport
  • Fetal leptin levels: positive correlation with fetal birth weight
  • Probably plays an important role in fetal development& growth
  • Women respond by becoming leptin resistant, allows them to keep eating as normal, and this helps the baby grow
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15
Q

What is the quadraple test used for?

A
  • screens for downsyndrome, Patau’s, Edwards and neural tube defects e.g spina bifida
  • Done in the second trimester (usually between 15-20 weeks)
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16
Q

Describe the normal cardiovascular adaptation to pregnancy

A
  • HR increases
  • CO(aortic) increases then levels off
  • TPVR decreases
17
Q

What causes peripheral resistance to fall in pregnancy

A
  • Increased NO synthesis
  • Increased prostacyclin synthesis
  • Relaxin possibly
  • Increased compliance of vessels due to structural changes
18
Q

What causes the increase in CO in pregnancy?

A
  • Oestrogen—>ALL-renin-aldosterone increases
  • Progesterone—-> aldosterone increases
  • Vasodilatory PGs—-> aldosterone increases
  • ‘shunting’ of blood to uterine circulation stimulates sympathetic activity—> increased renin
  • Renal Na loss due to increased GFR leading to increased renin
  • hcG —> increased renin
19
Q

Outline skin blood flow in pregnancy

A
  • predominantly increases in hands& feet
  • Leads to: increased skin temp;increased nail growth;increased % of hairs actually growing
  • Disappearance of Raynaud’s syndrome
  • nose bleeds, nose stuffiness, snoring
20
Q

What is Raynaud’s syndrome?

A
  • A medical condition in which a spasm of arteries cause episodes of reduced blood flow; typically the fingers& less commonly the toes. are involved
21
Q

Outline renal function in pregnancy

A
  • Plasma concentrations of renal function i.e urea and creatinine decrease
  • Glycosuria
  • Calcicuria
  • Urinary frequency increases
  • Urinary stasis due to dilatation of collecting system
  • Decreased osmotic threshold for AVP
22
Q

What other physiological/anatomical changes occur during pregnancy?

A
  • Rib cages gets pushed up

- Maternal oxygen consumption increases

23
Q

Outline pulmonary function in pregnancy

A
  • Tidal volume increases
  • Deep breathing stimulated by progesterone
  • RR unchanged
  • Expiratory reserve reduced
  • pCO2 decreases, po2 increases, pH unchanged( HCO3 falls)
  • Costal margin& diaphragm altered
24
Q

Describe coagulation& fibrinolysis in pregnancy

A
  • Changes occur to induce low grade increase in coagulability- this is advantageous at delivery
  • increase in Factors VII, VIII & X
  • increase in plasma fibrinogen leads to increased ESR
  • decreased fibrinolytic activity
25
Q

What changes occur to the GI tract in pregnancy

A 
Reduced smooth muscle tone leads to:
-Decreased cardiac sphincter tone
-Decreased motility and mobility 
associated with:
-biliary stasis 
-Increased gastric reflux ( heart burn)
-Increased nutrient absorption 
-Increased water reabsorption

Human development block (35 decks)

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