Physiology 2 Flashcards
(93 cards)
1
Q
Weeks of full pregnancy?
A
40 from first day LMP
2
Q
Weeks for viability of baby?
A
~24
3
Q
Weeks for preterm baby?
A
viable - 37 weeks
4
Q
Prenatal Care of?
A
- mother
- fetus
- family
5
Q
Initial Visit for mother?
A
- screening history, physical, labs
- identification of specific “high risk” factors
- anticipate problems
6
Q
Chromosome assessment
A
-age based
7
Q
Early Term
A
37-38
8
Q
Term
A
39-40
9
Q
Late Term
A
41
10
Q
Post Term
A
42
-no one goes this far anymore
11
Q
Progressive Monitoring of Pregnant Mother
A
- weight gain
- bp
- Rh, diabetes, anemia, STD, group B strep carrier
- plan for delivery
12
Q
Nutrition of Pregnant Mom
A
- weight gain - plus
- obesity is a form of malnutrition
- essential amino acids (9)
13
Q
Blood pressure with Pregnant Mom
A
- Pre-existing: medications-contraindicated ACE inhibitors, 50% congential malformation if organogenesis exposure
- Hypertension of pregnancy:
- gestational
- pre-eclampsia
14
Q
Pre-eclampsia
A
- HTN, proteinuria, attributable to being pregnant
- natural history leads to death
- just plain strange syndrome: no good animal models
- one of the major complications of pregnancy
- eclampsia is convulsions
15
Q
Rh
A
- rhesus (monkey) D antigen
- prior pregnancy event
- mom Rh negative, baby positive, possible sensitize mon, develops antibodies “rejects next pregnancy”
- Solution: coat the fetal red cells which may contain Rh antigens using IgG so mom doesn’t “see” antigen
16
Q
Diabetes in Pregnancy
A
- Pre-existing
- Gestational (45-50% dev overt DM later in life)
- Diet Controlled
- Insulin-Dependent (body can’t make type 1, insentitive type 2)
- oral hypoglycemic
- high risk: prior DM in pregnancy, multiple gestation, AMA, obese
17
Q
Eclampsia
A
convulsions
18
Q
hCG - alpha structure
A
- similar to TSH
- similar to insulin
19
Q
Fetus Monotering
A
- gestational age
- one or more
- survey anatomic structural at 18-20 weeks
- routine growth
- well-being
- movement
20
Q
Ultrasound
A
- structure (also where and how many)
- blood flow
- amniotic fluid
21
Q
Fetal Heart Rate Monitoring
A
- strict criteria 110-160 BPM baseline rate
- heart rate “accelerations”
- heart rate “decelerations”
22
Q
Family Issues with Pregnancy
A
- mixing medicinve and sociology
- finances
- work
- other children
- delivery planning
23
Q
Onset of Labor
A
- Contractions
- Bleeding
- Rupture of membranes “water breaks”
24
Q
Labor
A
- regular, phasic contractions sufficient to cause progressive dilation of the cervix
1. Latent Phase - “pre labor” <4cm
2. Active Phase - 1st 4-10cm
3. Pushing - 2nd
4. Delivery placenta 3rd
25
Viability
-ability to live outside the uterus
26
Premature
-fetus is premature, different that preterm
27
What % of pregnancies are normal?
```
75%
"retrospective diagnosis"
-not counting repeat C/S
-Complications of pregnancy:
infection, preterm labor, pre-eclampsia, prior C/S, not vertex
```
28
Contraction
1. start
2. peak
3. end
29
Duration of Latent
no limit
30
Duration of Active
-Friedman curve, actually 1-2cm/hr
31
Duration of 2nd stage
-3 hr primip or 2 hr multip
32
Duration of 3rd stage
-1 hour
33
Vaginal Birth
-regular, normal, usual
34
Delivery of Placenta
- gentle traction: do not avulse cord
- is it intact?
- 3 vessels
- bleeding?
35
Assess for Damage
- cervical laceration
- vaginal wall laceration
- perineum laceration
- vulvar laceration
36
Perineum Lacerations
1st degree-skin only
2nd-defect of underlying tissue but not through anal sphincter (must repair)
3rd-into or through sphincter (repair)
4th-defect of rectum (repair)
37
Assisted Vaginal Delivery
- forceps
| - vacuum (no only if have to, or if don't want mom to push)
38
Cesarean Delivery
- abdominal delivery
- vaginal bypass operation
- C/S, CSD
- Tocolytic (toco-childbirth cutting, really means stopping preterm birth)
39
Cesarean Rate
- the C/S rate is too high or too low
- US: low 30% (20% for primigravidas)
- Puerto Rico is 70%
40
Vaginal Birth after Cesarean Section
- uterine scar: ruptured uterus with subsequent labor
- repeat C/S
- if many more children are desired, trial of labor
- vaginal birth after C/S
41
Risk of C/S
1. increased bleeding
2. increased risk of infection
3. increased risk of intraabdominal scarring
4. increased risk of uterine rupture with each additional C/S
5. Increased risk of placenta accreta, next pregnancy
42
Maternal Mortality: Statistics
- 250,000-343,000 deaths worldwide
- 99% in economically disadvantaged countries
- nearly linearly associated with illiteracy rate, education, poverty
- morbidity is 20x mortality
43
Maternal Mortality
-death occurring during pregnancy, or within 6 weeks of delivery, excluding accidents or if the pregnancy is incidental to cause of death
44
MMR
-maternal mortality ratio: # deaths/100,000 live births in one year
(ratio)
45
Maternal Mortality Rate
deaths/ # women of reproductive age
46
How many maternal deaths in US are preventabe?
50% - 27%
47
Problems that lead to ectopic pregnancy?
1. damage to cilia
| 2. blind pouch
48
Why recient rise in mortality?
- obesity
- immigration
- increased C/S rates
- IVF: twins
- High unintended pregnancy
- no pre pregnancy counseling
- domestic abuse rates are high in US
49
Racial Disparity in Pregnancy
- african american: white 4:1
- education not independent risk factor
- income not independent risk factor
50
Extremely Preterm
<28 weeks
51
Very Preterm
28 to <32 weeks
52
Moderate to late Preterm
32 to <37 weeks
53
Cardiovascular Adaptation During Pregnancy
```
#1-systemic vascular resistance goes down (dec. 20-25% in early pregnancy, reached by 5 weeks)
#2-blood volume goes up 30%, need to supply baby
-bp & heme decrease
```
54
What group of cells remodel the spiral arteries?
-cytrtrophoblasts (extravascular trophoblast)
55
Remodeled Vessels are??
high-flow
| low-resistance
56
When does remodlin start?
at 4 weeks of pregnancy
57
Invasive Trophoblasts
- uterine spiral artery containing maternal blood
- maternal endometrium has become decidualized meaning that the stromal cells have been transformed into large pail cells
- infiltrating b/w these decidual cells are trophoblasts
58
hCG levels level off when?
-at 20 weeks (baby grows by deposition of fat)
59
What causes total vascular resistance to decrease?
-reduced vasomotor tone and remodelling of resistance-sized arteries (because of remodin & ADAM 12)
60
Women with preeclampsia have higher and lower what?
Higher: conc. of sVEGRF-1 and sENG
Lower: conc. P1GF
-have imbalance of angiogenic/antioangiogenic factors
61
Regulation of Cardiac Output during Pregnancy?
- maternal vasodilation
- decreased ventricular afterload (1st trimester)
- increase in cardiac output & relative arterial underfilling
- increased preload
- decreased afterload
- increased compliance
62
Physiologic anemia of pregnancy?
-increase in plasma volume is faster than increase in erythrocyte volume (give iron)
63
Timing of Plasma Volume change?
- happens in 4-8 weeks
| - returns to normal 6 weeks after delivery
64
What happens if plasma volume doesn't increase enough?
-related to not enough fetal growth
65
Does the heart change in pregnancy?
- yes, ventricular remodeling
- apical four chamber views showing the normal heart remodelling with eccentric hypertrophy in a normal third trimester pregnant women
- increased myocyte volume without fibrosis, increased heart elasticity to comply with increased volume
- increased injection fraction, stroke volume, cardiac output
66
Renal Adaptation in Pregnancy
- GFR increases by up to 50% above baseline (b/c elevations in cardiac output & kidney blood flow)
- decrease in serum creatine concentration (0.4mg/dL)-normal levels 0.9 may indicate kidney disease
- hydronephrosis (more on right)
67
Why do pregnant women have hydronephrosis?
-progesterone-induced ureteral smooth muscle relaxation and ureteral compression secondary to the enlarging fetus results in dilatation of the urinary collecting system
68
Respiratory System in Pregnancy
-uterus enlarges, diaphragm is elevated (4cm), doesn't impede movement
-rib cage is displaced upward & widens, increasing the lower throacic diameter by 2cm and thoracic circumference by 6cm
-chest circumference expands 5-7cm
-subcostal angle increases from 68-103 deg
-respiratory muscle function is not affected
-abdominal muscles have less tone, less active
MORE DIAPHRAGMATIC
69
In pregnancy, what happens to dead volume?
-increases to relaxation of the musculature of the conducting airways
70
Pregnancy: Tidal Volume
-increases gradually (35-50%) as pregnancy progresses
71
Pregnancy: Total Lung Capacity
-reduced (4-5%) by elevation of the diaphragm
72
Pregnancy: Functional Residual Capacity, Residual Volume, Respiratory Reserve Volume
-dec. by 20%
73
Pregnancy: Residual Volume, Tidal Volume
Residual Volume smaller & Tidal Volume Larger caused by increased alveolar ventilation (about 65%) during pregnancy
74
Pregnancy: Inspiratory Capacity
-increases 5-10%
75
Pregnancy: Alveolar Oxygen Tension
-in normal limits, lowers maternal blood CO2 tension
76
Maternal Hyperventilation
-considered a protective measure that prevents that fetus from the exposure to excessive levels of CO2
77
Gas Exchange in Pregnancy
-hyperventilation leads to decreased PCO2
-increases CO2 gradient b/w fetus and mother
-chronic respiratory alkalosis
-compensatory metabolic acidosis
-20-40% increased in maternal oxygen consumption
-normal arterial blood gas values pH-7.4-7.45
PCO2 = 28-32 PO2=101-106 HCO3=18-21
78
Hormone Changes in Pregnancy
- pregnancy increases estrogen/progesterone
- increase prolactin
- decrease pituitary growth hormone b/c placental GH takes over
- adiponecin decreases
79
Pregnancy looks hormonally similar to?
Obesity
80
How is pregnancy like obesity?
- insulin resistance
- leptin resistance (need increased fat content for babies brain), made by placents (10x)
- high cortisol level
81
Does bacteria change in pregnancy?
-yes, causes increased insulin resistance
82
Pregnancy HPA axis?
- placental CRH stimulates both the maternal pituitary and adrenal, leading to increased cortisol producing
- rising cortisol stimulates placental CRH production
83
Passage of cortisol through placenta?
- partially inhibited by placental HSD2
| - if to much gets to baby, bad effects
84
What happens if mother has stress or 11beta-HSDw is decreased?
-baby gets more cortisol in its blood
85
Mechanisms of Materno-Fetal Transfer
1. transported intact
2. partially consumed by placenta
3. metabolized by placenta (cortisol)
4. not transported
86
What are stem cells of the placenta?
-cytotropyoblasts
87
Endocytosis/Exocytosis
-uptake form maternal blood by endocytosis transport across cytosol via vesicular transport released into fetal circulation via exocytosis (immunoglobulins)
88
Lipophillic Diffusion
-hydrophobic molecules soluble in plasma membrane (respiratory gases)
89
Paracellular Diffusion
-hydorphillic molecules exchanged via water filled channels/pores, driven by electrochemical driving forces (small solutes, sodium, calcium, K)
90
Protein Mediated Transport
-hydrophillic molecules, mediated via specific proteins in maternal and fetal facing plasma membranes (ions, amino acids, glucose)
91
What is the primary barrier for transfer of nutrients from mother to fetus?
-syncytiotrophoblast
92
What type of transports are increased towards the end of pregnancy?
-fat transporters
93
-What type of fatty acids does placental tissue preferentially take up?
-long-chain polyunsaturated fatty acids (LC-PUFAs)
