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Physio II (mine) > Maternal, Fetal, and Neonatal > Flashcards

Maternal, Fetal, and Neonatal Flashcards

1
Q

Name the three hormones important to pregnancy

A
  1. hCG (Human chorionic gonadotropin)
  2. Estrogen
  3. Progesterone
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2
Q

1st Trimester

A

Corpus Luteum: hCG (Human chorionic gonadotropin) increase
Ovarian: Estrogen and Progesterone increase

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3
Q

2nd Trimester

A

Corpus Luteum (regresses): hCG decreased
Placenta: takes over Estrogen and Progesteron production (and increase)

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4
Q

3rd Trimester

A

Placenta:
* hCG plateaus after decrease
* Decrease in Progesterone
* Continued increase in Estrogen

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5
Q

What do “take home” pregnancy tests check for?

A

hCG

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6
Q

Two physiological changes in mom

A

Blood Volume increases (1-2 L or 30%)
* Plasma increases more than RBC’s

Hypercoagulability
* Increased Fibrinogen in plasma

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7
Q

Why does moms blood volume increase?

A

Aldosterone = increase in RAAS
RAAS + Estrogen = increased ADH

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8
Q

Why does mom need more coagulation factors?

A

Body is preparing for blood loss during natural birth
Up to 25% loss

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9
Q

Moms CO increases by ~30%, Why?

A

SV increased due to more volume (RAAS)
slight HR increase

CO=HRxSV

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10
Q

Moms BP(MAP) decreases by 5-7%, why?

A

SVR decreases by 25%
release of Nitric Oxide vasodilates peripherals

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11
Q

Supine Hypotension Syndrome

in 5-10% of women

A

Instead of an increase in SVR to compensate there is a paradoxical parasympathetic response causing hypotension and fetal bradycardia

Treatment: Lay on her left side to decompress IVC

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12
Q

Increased Progesterone changes pulmonary function, how?

A

Increase in Tidal Volume
1. Progesterone= ⬆ CO2 sensitivity
2. ⬆ VO2 = ⬆ CO2 = ⬆ ventilation
3. (MV=RRxTV) no change in RR but ⬆ in TV = ⬆ PaO2 and ⬇ PaCO2

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13
Q

Uterine size changes pulmonary function, how?

A

Uterine size ⬆
Pushes up on diaphram (~4cm)
⬇ in RV and FRC
⬇ ERV and ⬆ in IC

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14
Q

Why does TLC and VC basically remain the same?

A

Increase in abdominal and thoracic dimensions compensate for larger lung expansion (⬆ TV)

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15
Q

⬆GFR in mom, why?

up to 40% and maintanence

A
  1. Nitric Oxide
  2. Relaxin

Both are vasodilators, ⬆ blood flow

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16
Q

Relaxin also does what?

A

Makes the pubic symphysis more compliant for birth

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17
Q

⬇RBF in 3rd trimester, why?

RBF: Renal Blood Flow

A

ANG II

vasoconstrictor

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18
Q

If RBF is ⬇ in the 3rd trimester how does GFR remain elevated?

A

ANG II vasoconstricts after the glomerulus, so bloodflow for filtration does not decrease

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19
Q

Creatinine in mom

A

0.5-0.6 mg/dL
* Normal levels 0.6-1.3

If you see a 1 it is likely pre-eclampsia

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20
Q

Placental hCS in mom

human chorionic somatomammotropin

A

makes mom IR
metabolizes glucose for baby
starts lipolysis (to form FFA) for mom

Gestational Diabetes

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21
Q

Increased Calcitriol and Calcitonin in mom

A

Lower PTH
⬆Ca2+ absorption
⬆PO4- absorption

Not through bone turnover

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22
Q

Thyroid in mom

A

bone turnover
neural development
At risk: cretinism (hypothyroidism)

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23
Q

What else can hCG bind to?

A

TSH receptors

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24
Q

Trophoblastic nutrition is also called what

A

Uterine milk

yuck

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25
Q

Main trophoblastic nutrition hormone?

A

Progesterone

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26
Q

Three phases to placental development

A
  1. Adhesion
  2. Invasion (two steps)
  3. Implantation
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27
Q

Adhesion Phase

A

Trophoblasts stick to endometrial tissue

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28
Q

Invasion Phase

A

Trophoblasts differentiate into two cell types
1. Cytotrophoblasts
2. Syncytiotrophoblasts
Sync cells form lacuna which digests moms blood vessels
Sync cells directly exposed to moms blood
Sync cells produce placental hormones (mostly hCG and some hCS)

hCG: Human chorionic gonadotropin and hCS: human chorionic somatomammotropin

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29
Q

Growth Factors

3

A
  1. IGF (Insulin like)
  2. TGF (transforming)
  3. EGF (epidermal)
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30
Q

Cytotrophoblasts

A

Inner layer of the trophoblast

This anchors the blastocyst to the uterine wall

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31
Q

Syncytiotrophoblast

A
  • Fused cytotrophoblasts create this
  • they extend outward to blood and glands
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32
Q

Implantation Phase

A

Cytotrophoblasts makeup the chorionic cilli
-Fetal capillary network
-serves as the border between maternal and fetal blood

33
Q

What is Pre-eclampsia

usually in older / diabetic / and obese women

A

Trophoblasts can not invade deeply into tissues
-Growth restrictions

34
Q

What is placenta accreta

A

Attachment extends into muscle layer (myometrium)
-results in continued placental bleeding after birth

35
Q

What are the functions of the placenta

G-LIKE

A

Acts as the:
* Gut
* Lungs
* Immune modulator
* Kidneys
* Endocrine glands

36
Q

Increased transfer of drugs across placenta are:

4 things

A
  1. Low molecular weight
  2. Lipid soluable
  3. Non-charged
  4. Non-protein binding
37
Q

What drugs can cross the placenta?

MOVABLE-II

A

Most Anticholinergics (Atropine)
Opioids
Vasopressors
Antihypertensives
Benzos
Local anesthetics
Ethanol
Induction agents
Inhalation anesthetics

38
Q

What drugs cross poorly?

A

Heparin (Large and charged)
Insulin (Large)
Muscle relaxants (Ionized and not lipid soluable)

39
Q

1st & 2nd Trimester; which hormone is more important

A

Progesterone

40
Q

3rd Trimester; which hormone is more important

A

Estrogen

41
Q

Prostaglandins in the uterus?

A

These help create contractions

42
Q

What does Progesterone do?

4 things

A

Decrease gap junctions
decrease oxytocin receptors
inhibits prostaglandins
creates a more negative resting membrane potential

Basically makes any contraction (aka labor) less likely to occur

43
Q

What does Estrogen do?

4 things

A

Increases gap junctions
increases oxytocin receptors
increases prostoglandin receptors
creates a more positive resting membrane potential (enchancing contractions)

44
Q

Braxton hicks contractions?

A

Flase Labor contractions
Does not increase in rate or strength

45
Q

what two things trigger birth?

A

hormone factors: increase E2:P ratio, prostaglandins and oxytocin

mechanical factor: Ferguson reflex

46
Q

what are the phases of birth?

A

0 - quiescence
1 - myometrial activation
2 - stimulation
3- involution

47
Q

what happens in quiescence?

A

trimesters 1-2
progesterone and NO high
decrease in intracell calc = relax

48
Q

what happens in myometrial activation?

A

last 6-8 wks
increases E:P ratio, PG, relaxin, oxy receptors, gap junc
braxton hicks

49
Q

what happens in stimulation?

A

oxytocin, PG, stretch, uterine contraction

50
Q

what happens in involution

A

ocytocin, PG
decrease post bleed
increase uterine repair

51
Q

how much is full dilation?

A

10 cm

52
Q

labor and delivery stages (stimulation phase)

A

dilation stage (6-12 hr) contrac to full dilation
expulsion stage (20m-2hr) full dilation to baby out
placental phase (15m) baby out to placenta out

53
Q

describe ferguson reflex

A

baby head stretches cervix and positive feedback for oxy and increased contraction at fundus pushes baby down

54
Q

what things would result in decreased contraction?

A

beta adrenergic, cAMP or NO, if you increase cAMP or cGMP that inhibits contraction

55
Q

what things would result in increased contractions?

A

Prostaglandin (PGE2 & PF2a)
Oxytocin activation of IP3 and DAG
IP3 and DAG increase intercellular calc = more muscle contraction

56
Q

what is the APGAR?

A

10 pt scale of baby
check at 1min and 5 min
<7 you need to be concerned

57
Q

what does APGAR stand for?

A

appearance (blue?)
pulse (>100)
grimace (crys and pulls away)
activity (active mvmt)
respiration (strong cry)
2-1-0 pts

Less than 7 is bad

58
Q

Twins can be?

2 types of twins

A
  1. Monozygotic: identical
  2. Dizygotic: fraternal
59
Q

Dichorionic diamnionic

A

Own Sac
Own placenta

Twin with*

60
Q

Monochorionic diamniotic

A

Own sac
One placenta

Twin with*

61
Q

Monochorionic monoamniotic

A

One Sac
One Placenta

Twin with*

62
Q

Monochorionic monoamniotic: conjoined twins

A

One Sac
One Placenta
the two fetus’ are joined

63
Q

how does crying/suckling relay information to the CNS?

A

sensory afferents

64
Q

regulation of lactation summary

A

stimulated by decrease in E2 and P after birth
sensory information inhibits PIH (dopamine)
stimulates oxytocin and Prolactin to be released
prolactin causes milk secretions
oxytocin causes muscle contraction in breast

65
Q

lactational amenorrhea

A

prolactin inhibition of FSH and LH

Temporary infertility that accompanies breastfeeding and is marked by the absence of monthly periods

66
Q

what is bilirubin?

A

yellow compound made when the liver is breaking down Hb

67
Q

what do neonates do after birth with their Hb?

A

they try to replace HbF with HbAdult

68
Q

what are the 4 shunts in fetal circulation?

A

placenta shunt: umbilical vein to liver
ductus venosus: umbilical vein to IVC
ductus arteriosus: PA to Aorta
foramen ovale: opening between LA and RA

69
Q

what are the 6 circulatory changes with fetal vs neonate?

A

1- loss of placental BF (2x increase in SVR)
2- PVR decreases (lung expand and oxygen)
3- disintegration of umbilical cord (umb vein repaced with round ligament; umbilical artery is now iliac artery)
4- closure of ductus venosus (1-3 hr) blood flows to portal vein
5- ductus arteriosus closes at birth
6- foramen ovale closes at birth

70
Q

what types of mothers/birth would you see low surfactant

A

premature

diabetic

71
Q

fetus vs neonate lungs

A

fetus- amniotic fluid and movements of breaths

neonate- ENaC pump moves water out of lungs

72
Q

transient tachypnea

A

abnormal fast breathing starts after 4-6 hr from birth

give oxygen and wait 1-2 days

73
Q

respiratory distress syndrome

A

lack of surfactant

give surfactant and cpap/vent

74
Q

what are the 3 neonatal respiratory triggers

A

sensory (being born)
mechanical (birth, squeezes lung)
chemical stimulation (cut umbilical = acidosis (increased CO2)

75
Q

what are the 3 challenges a neonate faces at birth

A

hypoxia
hypoglycemia
hypothermia

76
Q

what things in a neonate cause hypoxia

A

anesthestic depression
Hb phenotype
nasal breather
soft tissue obstruction
ETT may be difficult

77
Q

why is hypoglycemia a problem in neonates?

A

limited gluconeogensis

glucose dependent brain

78
Q

what are the threats for hypothermia for neonates?

A

radiation
conduction
convection
evaporation

Physio II (mine) (6 decks)

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