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Embryo Exam II > Lecture 12 - Placental Physiology and Developmental Disorders > Flashcards

Lecture 12 - Placental Physiology and Developmental Disorders Flashcards

(53 cards)

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1
Q

What are the functions of the placenta?

A
  • diffusion of oxygen and carbon dioxide
  • diffusion of food stuffs
  • excretion of waste products
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2
Q

Early Placenta

A
  • thick
  • low permeability
  • small surface area
  • total diffusion conductance is minuscule
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3
Q

Late Placenta

A
  • Thin
  • High Permeability
  • Large Surface Area
  • Large increase in placental diffusion
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4
Q

Oxygen Pressure Gradient Near end of pregnancy

A

PO2 Mom- 50 mm HG

PO2 Fetus- 30 mm HG

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5
Q

Reasons why adequate oxygenation can occur with the low pressure gradient of Mom/Fetus:

A
  • fetal hemoglobin has higher affinity for O2
  • Fetal blood hemoglobin concentration is about 50% higher than maternal
  • Bohr Effect
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6
Q

Bohr Effect

A

Hemoglobin can carry more O2 at a low PCO2

  • fetal blood becomes alkaline —> can carry more O2
  • maternal blood becomes acidic —> decreased O2 affinity
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7
Q

Double Bohr Effect

A

Refers to the double shift in the maternal blood and the fetal blood

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8
Q

Other Placental Functions

A

CO2 diffusion
-PCO2 fetal > maternal

Diffusion of food

  • facilitated diff of glucose via trophoblastic cells
  • slower diffusion of fatty acids into fetal blood

Excretion of Waste Products
-urea, Uris acid, creatinine diffuse from fetus to maternal blood

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9
Q

Human Chorionic Gonadotropin

A

-secreted by syncytial trophoblast into maternal fluids

  • prevents involution of corpus luteum
  • causes CL to increase secretion of progesterone and estrogens
  • increased growth in CL
  • exerts interstitial cell-stimulating effect on testes of male fetus
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10
Q

Estrogens

A

Secreted by syncytiotrophoblast cells of placenta
Converted by trophoblast cells into estradiol, estrone, and estriol

  • uterine enlargement
  • breast enlargement
  • growth of breast ductal structure
  • enlargement of maternal external genitalia
  • relaxation of pelvic ligaments
  • may also affect aspects of fetal development
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11
Q

Progesterone

A

Secreted in small quantities by CL early
Secreted in large quantities by placenta

  • causes decidual cells to develop in the endometrium
  • decreases contractility of pregnancy uterus
  • increases secretions of Fallopian tubes and uterus
  • prepare breasts for lactation (along w estrogen)
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12
Q

Human Chorionic Somatomammotropin

A

Secreted by placenta beginning in the 5th week of pregnancy

  • causes decreased insulin sensitivity and decreased utilization of glucose by mother
  • metabolic hormone
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13
Q

Theories regarding placental immunology

A
  • lack of expression of major histocompatibility antigens
  • decidual immune barrier
  • inactivation of mother’s immune system components by molecules on fetal placental surface
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14
Q

Fetal Alcohol Syndrome

A

(Causes, symptoms)

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15
Q

Erythroblastosis fetalis

A

(Causes, symptoms)

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16
Q

Hydrophobic Fetalis

A

(Causes, symptoms)

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17
Q

Placenta Previa

A

(Causes, symptoms)

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18
Q

Hydatidiform mole

A

(Causes, symptoms)

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19
Q

What is the most common cause of neonatal mortality?

A

Congenital Anomalies

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20
Q

Malformation

A

Primary errors of morphogenesis

Usually multifactorial, involving a number of etiological agents including genetic and environmental factors

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21
Q

Disruptions

A

Disturbances in otherwise normal morphogenetic processes

Eg- amniotic bands

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22
Q

Deformations

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A

Disturbances in otherwise normal morphogenetic processes. These are typically caused by abnormal biochemical forces such as uterine constraints.

Eg- club foot

23
Q

Sequences

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A

Series (cascade) of events triggered by one initiating factor.

Eg- oligohydramnios (decreased amniotic fluid) which leads to fetal compression and other problems

24
Q

Syndromes

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A

Constellations of congenital abnormalities thought to be pathologically related by cannot be explained on the basis of a single loci event. They are often caused by a single event such as oral infection.

25
Why are developmental insults during the first three weeks of development unlikely to result in defective development?
See book
26
Why are major structural anomalies unlikely to occur after the eighth week of pregnancy?
See book.
27
What are the three main groups of congenital anomaly causes?
Genetic Environmental Multifactorial
28
Preeclampsia
^^^ BP Proteinuria Weight gain Edema
29
Pregnancy induced hypertension
Persistent elevated BP (140/190) that develops after 20 wks gestation and returns to normal after birth
30
Eclampsia
Extremely serious condition Extremely high BP Grand mal seizures or coma
31
Nonimmune Hydrops
Major causes: - cardiovascular defects such as congenital defects and arrhythmias - chromosomal abnormalities - Turner syndrome and trisomy 21 or 18 - generally due to cardiac structure aberrations that accompany these anomalies
32
Immune Hydrops
Caused by blood group incompatibility between mother and fetus - fetal RBC reach maternal stream during last trimester or during childbirth - major factor is D antigen of Rh group - ABO incompatibility is generally not a problem with the 1st pregnancy CONSEQUENCES OF RH DISEASE
33
Kernicturus
SEE BOOK
34
Fetal Hydrops
Accumulation of edema fluid in the fetus during intrauterine growth Until recently the most common cause was hemolytic anemia caused by blood group incompatibility Causes: - immune Hydrops - nonimmune Hydrops
35
Neonatal Resp Distress Syndrome
Related to immature lungs —> premature birth Incidence is inversely proportional to gestational age Fundamental deficiency is lack of pulmonary surfactant
36
Additional Developmental Problems
Prematurity and growth restrictions Neonatal resp distress syndrome Hydrops Eclampsia
37
Major risk factors of prematurity
- preterm premature rupture of placental membranes - intrauterine infections - uterine, cervical, and placental structural abnormalities - multiple gestation
38
Hazards of prematurity
- hyaline membrane disease - necrotizing enterocolitis - sepsis - interventricular hemorrhage - long-term complications including developmental delay
39
Fetal Factors resulting in fetal growth restriction
- chromosome disorders - congenital anomalies - congenital infections
40
Placental factors resulting in fetal growth restrictions
- umbilical/placental vascular anomalies - placenta previa - placental thrombosis and infarction - multiple gestation - placental genetic mosaicism
41
Maternal factors resulting in fetal growth restriction
- Preeclampsia - Chronic hypertension - Maternal use of drugs, narcotics, alcohol, nicotine - Maternal malnutrition
42
Gene Mutations
Include inborn errors of metabolism (rare). Inherited most commonly as autosomal recessive or X-linked disease. A few are dominant. Often affect enzymes and biochemical pathways. Eg- phenylketonuria, galactosemia, cystic fibrosis
43
Phenylketonuria
Congenital deficiency Causes inadequate formation of L-tyrosine, elevation of L-phenylalanine, excretion of phenylpyruvic acid, and accumulation of phenylalanine
44
Galactosemia
Congenital deficiency Results in accumulation of galactose-1-phosphate
45
Cystic Fibrosis
Inherited disorder (autosomal recessive) that affects mostly the lungs but also pancreas, liver, kidneys, and intestine. Cystic fibrosis transmembrane conductance regulator (CFTR) gene CFTR is a membrane pt chloride channel/transporter
46
Chromosomal rearrangements
Deletions, duplications, inversions, translocation
47
Changes in chromosome number Aneuploidy
Changes in chromosome # from 2N state. 80-90% die in uterine in earliest stages of gestation Trisomy 21, 13, Turner Sydrome, Poly-X syndrome
48
Turner Syndrome
XO 1/3000 - Female with underdeveloped sex characteristics - Low hairline - Broad chest - Folds on neck - Usually sterile - Normal intelligence
49
Poly-X Syndrome
XXX 1/1000 - Usually tall and thin - Often fertile - Normal intelligence
50
Changes in chromosome number Euploidy
Addition of a complete set of chromosomes in addition to diploid 2N stage Often result of retention of a polar body of by fertilization by more than one sperm Typically results in early spontaneous abortion
51
Environmental Factors
Infection Radiation Maternal diabetes Drugs and other chemicals
52
Infections
Protozoans, bacteria Viruses: Rubella, herpes, varicella, influenza, mumps
53
Drugs and other chemicals
Thalidomide Alcohol Retinoic Acid Folic Acid

Embryo Exam II (8 decks)

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