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Fetus > Maternal adaptation to pregancy > Flashcards

Maternal adaptation to pregancy Flashcards

1
Q

What are the maternal adaptions to pregnacy

A

Gastrointestinal, metabolic, renal, haematological, immune, respiratory, cadiovascular, endocrine

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2
Q

Explain how maternal adaptations are proactive not reactive

A

Body rehearses for pregnancy each menstrual cycle, then blastocyst hCG prevents luteal progression

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3
Q

What facilitates maternal adaptations

A

Two way communication between maternal and fetal tissues

Pregnancy hormones- placental hormones that have subsequent effect on maternal endocrinology

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4
Q

Why are maternal adaptations to pregnancy important

A

To supply nutrients to fetus
To support amniotic fluid production
To clear fetal waste products
To meet fetal demands for glucose, amino acids + oxygen
Adapt in preparation for labour- protect mother from cardiovascular insult
Adaptations are in excess of fetal requirement

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5
Q

What are the pregnancy hormones

A

hCG, progestins, oestrogens, human placental lactogen, placental coricotropin releasing hormone, relaxin, oxytocin, prolactin

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6
Q

What is hCG

A

Produced by syncytiotrophoblast
Rises in first trimester then declines
Signals presence of blastocyst to mother
Maintains corpus luteum

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7
Q

What are progestins

A 
Produced by corpus luteum then placenta
Increase until just before labour
Cause smooth muscle relaxation
Inhibit oxytocin receptor expression
Promote glucose deposition in fat stores
Raises body temperature
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8
Q

What are oestrogens

A 
Produced by corpus luteum then placenta
Increase until just before labour
Breast and nipple growth
Uterine blood flow
Myometrial growth
Promote cardiovascular changes
Water retention
Alter carbohydrate metabolism
Increase oxytocin receptors
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9
Q

What is human placental lactogen

A

Also known as somatomammotropin
Increases throughout pregnancy proportional to size of placenta
Converts mammary gland into milk-secreting tissue
Mobilises glucose from fat reserves to promote lipolysis
Reduces inuslin sensitivity

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10
Q

What is placental corticotropin releasing hormone

A

Produced by placenta
Increases throughout pregnancy
Timing of parturition
Interacts with fetal + maternal HPA systems

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11
Q

What is relaxin

A

Produced by corpus luteum, decidua + placenta

Facilitates remodelling of connective tissue of reproductive tract in preparation for labour

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12
Q

What is oxytocin

A 
Produced by posterior pituitary and placenta
Acts on uterus and breasts
Contraction of smooth muscle
Prostaglandin production
Milk ejection reflex
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13
Q

What is prolactin

A

Produced in anterior pituitary
Milk production but only when oestrogen and progesterone have declined postpartum
Increases throughout pregnancy

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14
Q

How does the uterus adapt to pregancy

A

Mass increases 10-20x
Volume increase from 10ml to 5000ml
Composition: smooth muscle hyperplasia + hypertrophy then stretch effect
Increased supportive fibrous tissue
Orientation- straightens and dextrorotates
Immunology- uNK cells appear

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15
Q

How does the cervix adapt to pregnancy

A

Increased vascularity and oedema
Softening due to oestrogen and progesterone
Increased cervical glands, production of mucous plug
Hyperplasia of endovervical epithelium

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16
Q

How does the vagina adapt to pregnancy

A

Venous congestion

Oestrogen causes increased glycogen deposition which increases lactic acid which is protective

17
Q

How does the breast adapt to pregnancy

A 
Lactiferous ducts + alveoli proliferate due to oestrogen + progesterone
Breast + nipple size increase
Skin pigmentation changes
Colostrum produced from 16 weeks
Lactation
18
Q

What are the cardiovascular changes during pregnancy

A 
Heart rate increases 20%
Stroke volume increases
Cardiac output increases by 30-50%
Total peripheral resistance decreases
Blood pressure decreases
Plasma volume increases 30-50%
19
Q

What thoracic changes occur during pregnancy

A

Diaphragm elevated 4cm
Heart displaced up, left, apex moved laterally
Increased pulmonary blood flow
Increased ventricular muscle mass
Increased size of left ventricle + atrium

20
Q

What problems does increased demands on overstretched system cause

A 
Valve disease
Pulmonary hypertension
Connective tissue diseases
Cardiomyopathies
Ischaemic heart disease
21
Q

What is aortocaval compression syndrome

A

From 20 weeks gravid uterus big enough to compress abdominal aorta + inferior vena cava
Supine position causes 30-50% reduction in cardiac output
Asymptomatic or cause hypertension
Reduces uteroplacental perfusion causing fetal distress, IUGR, stillbirth

22
Q

Describe uterine blood flow during pregnancy

A

10% of cardiac output at term
500-800ml/min
Increased venous return, increased cardiac output

23
Q

What are the mechanisms for changes in the respiratory system

A 
Increased oxygen consumption
Increased carbon dioxide production
Increased tidal volume
Increased ventilation
Decreased partial pressure of CO2
24
Q

What are the mechanical changes in the respiratory system

A

Uterus expands, lower ribs flare, ligaments relax.
Diameter of chest increases due to increase in subcostal angle
Diaphragm raised
Chest wall compliance decreases

25
Q

What are the respiratory adaptations to pregnancy

A 
Tidal vol increased 3-40%
Total lung capacity decreased 5%
Vital capacity no change
Inspiratory capacity increased 15%
Expiratory reserve volume decreased 25%
Residual volume decreased 15%
Functional residual capacity decreased 20%
Respiratory rate no change
26
Q

What is the relevance of respiratory changes

A

Maternal pCO2 reduced compared to fetal pCO2, facilitates gas exchange- also affects acid base chemistry
Physiological breathlessness of pregnancy
Relevant to anaesthetists

27
Q

What are the haematological adaptations to pregnancy

A 
Blood vol increases 45%
White cell count increased
T + B lymphocyte counts stable but decreased function- increased susceptibility to infection
Platelet count unchanged
Dilutional anaemia
Hypercoagulable
28
Q

What is dilutional anaemia of pregnancy

A 
Increased red blood cell number and size
Decreased haemoglobin
Increased iron requirements
Decreased haematocrit
Occurs as plasma volume increase is greater than red cell increase
29
Q

What is the hypercoagulable state in pregnancy

A

Procoagulatory clotting factors increase- 7, 8, 10
Inhibitory clotting factors decrease- antithrombin 3
Highest risk for thromboembolism in postnatal period

30
Q

What are the structural renal adaptations to pregnancy

A

Increased blood flow
Increase 1cm length
Increased progesterone increases size of collecting system
Decreased tone, uterine can back up
Compression of ureter from gravid uterus causes physiological hydronephrosis
Overall effect- mild obstruction/urinary stasis

31
Q

What are the functional adaptations to pregnancy

A

Increased renal flow 35-60%
Increased glomerular filtration rate 40-50%
Glycosuria common
Resistance to angiotensin II
RAAS generally activated
Increase in extracellular water + sodium/water retention

32
Q

What are the gastrointestinal adaptations to pregnancy

A

Progesterone causes relaxed lower oesophageal sphincter, decreased gastric/intestinal motility
Increases gut transit time- enhanced nutrient uptake but increased constipation
Gall bladder increases in size but empties slower

Fetus (18 decks)

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