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Pregnancy complications, fatal morbidity and assisted reproduction EAR7 > Maternal physiological adaptations to pregnancy > Flashcards

Maternal physiological adaptations to pregnancy Flashcards

(53 cards)

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1
Q

What are the pregnancy hormones

A 
Progesterone 
Oestrogen 
Placental prolactin 
Placental lactogens 
Corticotropin-releasing hormone (CRH)
Aldosterone 
EPO
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2
Q

What produces progesterone in pregnancy

A

Corpus lute and then placenta

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3
Q

What produces oestrogen in pregnancy

A

Placenta and fetes

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4
Q

How does fetus protect itself from secreted hormones

A

Placental polarity/barrier

Fetus can conjugate steroids to sulphates making them biologically inactive

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5
Q

What does placental prolactin do

A

Breast chances, behavioural changes

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6
Q

What do placental lactogens do

A

For maternal insulin and glucose metabolism, lipolysis, EPO

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7
Q

What does cirticotropin releasing hormone do

  • where is it released from
  • What are the risks of increased levels
A

Leads to increased secretion of cortisol from mother- its a stress response

Released from placenta

Increased levels can affect nutrient transfer and the placental clock. Risks can be pre-term labour, early parturition signals

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8
Q

What does aldosterone affect

A

Plasma volume

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9
Q

What does EPO affect

A

Red blood cells

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10
Q

What cytokines are released in pregnancy

A

Pro-inflammatory interleukins, TGF-beta

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11
Q

What vasodilatory mediators are released in pregnancy and use

A

VEGF, NO (for vasodilation and angiogenesis)

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12
Q

how does uterus change in pregnancy

A

Expands and increases in weight

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13
Q

How does uterine musculature change in pregnancy

A

Hypertrophy. Needed for expulsion of fetus at parturition

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14
Q

What happens to heart during pregnancy

A

Apex of heart moved to anterior and to the left (pushed up and rotated forwards)

Left ventricular hypertrophy to cope with increased maternal cardiac output

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15
Q

What happens to calcium concentrations in pregnancy

A

Increased intestinal calcium absorption, maternal bone loss may occur in last trimester and lactation. Reversible

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16
Q

What happens to blood volume in pregnancy and how does this occur

A

Increase (over 40%)

Stimulation of RAAs- aldosterone leads to increased sodium and water retention so increased plasma volume

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17
Q

What happens to red cell mass during pregnancy and why

A

Increases linearly

Increased renal EPO increases red cell mass

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18
Q

What happens to hematocrit and haemoglobin during pregnancy and why

advantage of this

A

Fall. Because plasma volume increases more than cell mass

Advantage- decreased viscosity leads to reduced resistance in flow so better placental perfusion

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19
Q

What happens to haemoglobin during pregnancy and why is this beneficial

A

50% higher. Useful protection against any blood loss at delivery

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20
Q

What will help restore haemoglobin levels in pregnant women

A

Iron and folic acid

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21
Q

What relaxes smooth muscle cells of arteries

A

VEGF
PLGF
NO
Progesterone

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22
Q

What do angiogenic, permeability and vasoactive factors do to vasculature

What is the consequence of this

Study These Flashcards
A

Vascular dilatation and relaxation of peripheral vascular tone

Establishment of the new vascular beds, including the utero-placental circulation

Lowers blood pressure (contributes to increased blood volume)

-Reduction in peripheral vascular resistance which reduces by about 40% in mid pregnancy, rising slowly to term

23
Q

What happens to stroke volume in pregnancy and why

Study These Flashcards
A

Increase

-Because of increase in blood volume which means more blood enters heart (preload) and decrease in peripheral resistance due to vasodilation leads to reduced after load

24
Q

What happens to maternal heart rate in pregnancy

25
What happens to cardiac output during pregnancy and why is this needed
Increase -AN extra 30-50ml of oxygen is consumed per minute during pregnancy
26
What can happen to women with valvular heart disease during pregnancy and why
Pulmonary oedema Have difficulty accommodating raised CO
27
What is systolic and diastolic bp like during pregnancy
Systolic- remains stable | Diastolic- early, falls and reaches plateau at around 20 weeks and rises to normal values by term
28
IN mid-pregnancy what can happen if a woman lays supine
Enlarging uterus compresses both the inferior vena cava and the abdominal aorta. Vena Cana: This reduces venous return to the heart so fall in pre-load and cardiac output. Resultant fall in BP may be severe enough for the mother to lose consciousness Aorta: reduction in uteroplacental and renal blood flow. During last trimester, maternal kidney function is markedly lower in the supine than in the lateral position
29
What is maternal oxygen consumption like to all tissues throughout pregnancy
Increased
30
What are the structural changes in the respiratory system to accommodate for increased o2 consumption
Increased chest expansion, displaced diaphragm, increased vascularisation of upper respiratory tract
31
What are the ventilatory changes in the respiratory system to accommodate for increased o2 consumption
Progesterone-mediated hypersensitivity to CO2 increases the respiratory rate Tidal volume increases Alveolar ventilation is higher Therefore there is a fall in arterial and alveolar CO2 tensions. PaO2 increases
32
What is the consequence of a fall in arterial and alveolar CO2 tensions and an increase in PaO2 to the baby
The higher PaO2 on the maternal side of the placenta facilitates oxygen transfer to fetus, whilst the lower PaCO2 facilitates transfer of CO2 in the reverse side
33
Anatomical changes to maternal kidneys
Kidneys enlarge due to increased vasculature, vascular dilatation and interstitial space increases Renal parenchymal volumes increase in pregnancy, glomerular diameters are greater Dilatation of the calyces, renal pelvis and ureter. Increased chances of urinary tract infection Bladder loses tone: increased urinary frequency, urgency
34
Physiological changes to renal function
Increase in renal plasma flow, decrease in renal vascular resistance Changes in GFR and glomerular filtration fraction Changes in tubular re-absorption
35
What happens to filtration fraction in early pregnancy
Declines in early pregnancy
36
Formula for amount of glucose in urine
Amount of glucose filtered through the glomerulus minus the amount reabsorbed by the proximal tubules
37
What may be present in a pregnant woman's urine What is a consequence of this
Glucose (glycosuria) because filtered load of glucose rises in pregnancy and exceeds maximal rate of reabsorption. Increases chances of UTI
38
Where does fetus get its glucose from
Mother
39
What happens to glucose levels in mother during pregnancy
Fasting hypoglycaemia in first trimester, the decrease in glucose levels reach their plateau about 12 weeks gestation. Then it reverts to normal in second and third trimester
40
What do progesterone and insulin do
Progesterone increases maternal appetite and stimulates deposition of glucose in fat stores Increase in insulin secretion favours lipogenesis and storage of fat
41
What is absorption like mid pregnancy onwards
Increased absorption
42
What is gluconeogeneis like mid pregnancy onwards
Increased
43
What happens to free fatty acids and lipolysis from mid pregnancy onwards
Mobilised
44
What does enhanced lipolysis mean
Increases free fatty acid oxidation and ketones. It is an alternative fuel and can be used by mother so reduces her need for glucose which can be spared for fetus
45
After 20 weeks of pregnancy, what happens to plasma glucose levels
Revert to normal
46
What is the duration of postprandial hyperglycaemia in pregnancy
Prolonged
47
What is postprandial hyperinsulinimea
During last trimester: - Higher glucose peak leads to higher insulin secretion - Insulin reaches its peak after 1h - Declines slowly but not back to basal levels in pregnancy
48
When is insulin resistance higher
Gestational diabetes and maternal obesity
49
How does fetus avoid maternal rejection
Placenta is a structural barrier stopping direct contact of maternal blood with fetus Syncytial structure of the syncytiotrophoblast means maternal immune cells cannot cross to the fetus without going through the cytoplasm and being degraded. If they do manage to transcytose to the placental storm, fetal macrophages will phagocytose maternal immune cells
50
Which immune cells present in endometrium
Dendritic cells (APC) Helper T cells T regulatory cells Uterine natural killer cells
51
What happens to T helper cells under the influence of pregnancy hormones
Decline relative to the suppressor cells or T regulatory cells in the endometrium (these decrease immune function so maintain materno-fetal tolerance)
52
What can be used to suppress immune reactions
Extra- villous trophoblast cells
53
What may soluble factors provide
Local immunoprotection of the fetus

Pregnancy complications, fatal morbidity and assisted reproduction EAR7 (8 decks)

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