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Physio in pregnancy* Flashcards

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1
Q

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

A

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

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2
Q

what happens at day 1

A

fertilisation occurs in the ampulla of the fallopian tube

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3
Q

what happens during days 3-5

A

transport of blastocyst into the uterus

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4
Q

what happens during days 5-8

what happens to the blastocyte
what happens to the placenta

A

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

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5
Q

how is the blastocysts implanted into the uterus

A

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

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6
Q

what day is the blastocyst completely buried in the uterine lining

A

by day 12

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7
Q

what is the placenta derived from

A

trophoblastic cells (chorion) and decidual tissue

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8
Q

what happens to the trophoblastic cells

A

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

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9
Q

what does the developing embryo send into the synctiotrophoblast projections

A

capillaries

placental villi

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10
Q

what does each villus contain

what does this so

A

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

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11
Q

when is the placenta and foetal heart functional by

A

the 5th week of pregnancy

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12
Q

how is the placenta developed

A

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

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13
Q

what does the placenta work as

A

a physiological arteriovenous shunt

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14
Q

what happens as the placenta develops and why

A

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

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15
Q

blood vessels from the embryo develop where

A

in the villi

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16
Q

cicrculation within the intervillous space acts as what

A

partly as a arteriovenous shunt

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17
Q

what role does the placenta play

what does the exchange take place between

A

fetal lungs

maternal oxygen rich blood and the umbilical blood

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18
Q

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

A

umbilical vein

uterine veins

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19
Q

supply of the fetus with oxygen facilitated by what

A

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

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20
Q

what membrane transport mechanisms lead to placental exchange processes

A 
passive transport
simple diffusion 
osmosis 
simplified transport 
active transport
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21
Q

how does water diffuse into the placenta

does the exchange increase

A

by osmotic gradient

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

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22
Q

electrolytes follow what

and what two things can only go form mother to child

A

follow water

iron and calcium

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23
Q

how is glucose passed to the child

when is high glucose needed

A

passes placenta via simplified transport

3rd trimester

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24
Q

fatty acids reach the child how

A

free diffusion

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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

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