Physio in pregnancy* Flashcards Preview

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Flashcards in Physio in pregnancy* Deck (62):
1

what happens to the fertilised ovum first and what does it form
when does this happen

divides and differentiates into a blastocysts
as it moves from the site of fertilisation in the upper oviduct to the site of implantation in the uterus

2

what happens at day 1

fertilisation occurs in the ampulla of the fallopian tube

3

what happens during days 3-5

transport of blastocyst into the uterus

4

what happens during days 5-8

what happens to the blastocyte
what happens to the placenta

blastocysts attached to the lining of the uterus

inner cells form embryo and outer cells burrow into uterine wall and become placenta

produces hormones to maintain pregnancy

5

how is the blastocysts implanted into the uterus

free floating blastocyst attaches to the endometrial lining
cords of the trophoblastic cells begin to penetrate the endometrium and tunnel deeper carving a hole for the blastocyst

boundaries between cells int eh advancing trophoblastic tissue disintegrate

6

what day is the blastocyst completely buried in the uterine lining

by day 12

7

what is the placenta derived from

trophoblastic cells (chorion) and decidual tissue

8

what happens to the trophoblastic cells

they differentiate into multinucleate cells called syncytiotrophoblasts which invade the decide and break down capillaries to form cavities form maternal blood

9

what does the developing embryo send into the synctiotrophoblast projections

capillaries
placental villi

10

what does each villus contain
what does this so

foetal capillaries separated from maternal blood by a thin layer of tissue in the intervillous space

2 way exchange of rep gases, nutrients, metabolites between mother and foetus down a diffusion gradient

11

when is the placenta and foetal heart functional by

the 5th week of pregnancy

12

how is the placenta developed

HCG singles the CL to continue secreting prog which stimulates the decidual cells to concentrate glycogen, proteins and lipids

13

what does the placenta work as

a physiological arteriovenous shunt

14

what happens as the placenta develops and why

it extends hair like projections (villi) into uterine wall
this increases contact area between the uterus and the placenta and more nutrients and waste materials can be exchanged

15

blood vessels from the embryo develop where

in the villi

16

cicrculation within the intervillous space acts as what

partly as a arteriovenous shunt

17

what role does the placenta play
what does the exchange take place between

fetal lungs

maternal oxygen rich blood and the umbilical blood

18

what does fatal oxygen saturated blood return to the fetus in and what does the maternal oxygen poor blood flow back in

umbilical vein

uterine veins

19

supply of the fetus with oxygen facilitated by what

fetal Hb - increased ability to carry oxygen
higher Hb - concentration in fatal blood - 50% more than adults
Bohr effect - fatal Hb can carry more oxygen in low CO2 than in high CO2

20

what membrane transport mechanisms lead to placental exchange processes

passive transport
simple diffusion
osmosis
simplified transport
active transport

21

how does water diffuse into the placenta
does the exchange increase

by osmotic gradient
increases during pregnancy up tot he 35th week - 3.5l/day

22

electrolytes follow what
and what two things can only go form mother to child

follow water

iron and calcium

23

how is glucose passed to the child
when is high glucose needed

passes placenta via simplified transport

3rd trimester

24

fatty acids reach the child how

free diffusion

25

waste products leave the fetus how

concentration gradient

26

what drugs can cross placental barrier

thalidomide, carbamazepine, coumarins, tetracycline

alcohol, nicotine, heroin, cocaine, caffeine

27

What does HCG do

prevent involution of the CL

effect on the tests of the male fetus - development of the sex organs

28

what does HCS - produced?
what does it do

produced from week 5 of pregnancy

growth hormone like effects - protein tissue formation
decreases insulin sensitivity in mother - more glucose for the fetus
involved in breast development

29

what does progesterone do

development of decidual cells
decreases uterus contractility
prepares for lactation

30

what does oestrogen's do

enlargement of uterus
breast development
relaxation of ligaments
estriol level - indicator of vitality of fetus

31

what changes in CO during pregnancy

it increases due to demand of the uteroplacental circulation

32

how much does the CO increase and when
when does it peak
what does it lead to

30-50% above normal - begins week 6 and peaks at week 24

placental circulation, increased metabolism, thermoregulation, renal circulation

33

when does the CO decrease and what happens during labour

in the last 8 weeks - become sensitive to body position - uterus compresses vena cava

increases 30% during labour

34

what happens to the heart rate during preg

increases up to 90bpm to increase CO

35

what happens to blood pressure during preg

drops during the 2nd trim as uteroplacantal circulation expands and peripheral resistance decreases

36

what happens to cardiovascular changes during in pregnancy with twins

CO increases more and BP drops more

37

what haematological changes occur during pregnancy and why

plasma volume increases proportional to CO (50%)

RBC increases -25%

Hb is decreased by dilution - decreases blood viscosity

iron requirements increase 6-7mg/day in 2nd half of preg
iron supplement needed

38

respiratory changes during preg
why
what

progesterone signals brain to lower Co2 levels

O2 consumption increases (20% above normal)

growing uterus interferes with lung action

SO

resp rate increases
tida and minute volume increases by 50%
pco2 decreases slightly
vital capacity and pO2 don't change

39

changes in the urinary system during pregnancy

glomerular filtration rate and renal plasma flow increase up to 30-50% and oaks at 16-24 weeks

increased re absorption of ions and water
- placental steroids, aldosterone

slight increase of urine formation

postural changes affect renal functions
upright position decreases
supine position increases
lateral positions during sleep increases

40

what is pre eclampsia

pregnancy induced hypertension and proteinuria

41

what are the signs of pre eclampsia

increasing BP since the 20th week
kidney function declines - salt and water retention - oedema formation esp in hands and face
RBF and GFR decreases

42

who is pre eclampsia more common in
single most significant risk is what

pre existing ht, DM, autoimmune disease, renal disease, FH, obesity, multiple gestation

had pre eclampsia previously

43

what causes pre eclampsia

extensive secretion of placental hormones
immune response to fetus
insufficient blood supply to placenta

44

what is eclampsia
symptoms
treatment

extreme pre eclampsia

vascular spasms, extreme hypertension, chronic seizures and coma

vasodilators and C sec

45

maternal average weight gain total

fetus
fluid/tissue
uterus
breasts
body fluid
fat accumulation

24

7
4
2
2
6
3

46

how much extra calories have to be taken in by the mother during pregnancy and what happens to it

250-300 kcal/day
85% fetal metabolism and 15% stored as maternal fat

47

how much extra protein intake does the mother have to take
how much glucose does the fetus need

30g/day

by the end of the pregnancy 5mg/kg/min

48

what are the two phases of the pregnancy in relation to maternal-feral metabolism

1-20 weeks mother anabolic phase
anabolic metabolism of the mother
small nutritional demands of the conceptus

21-40 weeks esp in the last trimester - catabolic phase
hig metabolic demands of the fetus
accelerated starvation of the mother

49

what is the anabolic phase

normal of increases sensitivity to insulin
lower plasmatic glucose level
lipogenesis, glycogen stored increases
growth of breasts, uterus, weight gain

50

what is the catabolic phase

accelerated starvation

maternal insulin resistance
increases transport of nutrients through the placental membrane
lipolysis

51

why is insulin resistant caused by and which phase is it in

HCS, cortisol and GH

catabolic phase

52

what is the special nutritional need in pregnancy

higher protein and energy intake
iron supplenments - 300mg ferrous sulfate
B vitamine - erythopoesis
Folic acid
Vit D3 and calcium suppléments
K vitamins before parturition to prevent intracranial bleeding during labour

53

why is folic acid given

reduces risk of neural tube defects

54

what happens to the uterus towards the end of the pregnancy and why

becomes more excitable

estrogen: prog ratio alters leading to excitedness
prog inhibits contractility and oestrogen increases it

55

what does oxytocin do at the time of birth

from mother pit gland
increases contractions and excitability

56

what are the fatal hormones and what do they do

oxytocin, adrenal gland, prostaglandin
control timing of labour

57

what part do muscles and the cervix play in birth

mechanical stretch of uterine muscles increase contractility
stretch of cervix also stimulate uterine contractions

58

what happens during the onset of labour

braxton hicks contractions
stretch of cervix by head increases contractility - pos feedback
cervical stretching - further oxytocin release
strong contraction and pain causes neurogenic reflexes from spinal cord that induce strong abdominal muscle contractions

59

1st stage of labour
2nd
3rd

cervical dilation (8-24 hours)
passage through birth canal (few mins to 30)
expulsion of placenta

60

what causes growth of ductile system
what causes development of lobule-alveolar system
what inhibits milk production and what happen to these at birth

estrogen
prog
E and P - drop in them

61

what stimulates milk production

prolactin - steady rise in week5-birth
1-7 days after birth 0 high levels of prolcatin
stimulates colostrum (low volume, no fat)

62

whats a stimulus for lactation and what does oxytocin do

suckling
milk let down reflex