Physiology of Pregnancy Flashcards Preview

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Flashcards in Physiology of Pregnancy Deck (36):
1

What happens to systemic vascular resistance during pregnancy?

It goes down about 15-20%

2

What part of the placenta is responsible for the remodelling of the local spiral arteries to lower their resistance?

Extravillous trophoblasts-- subgroup of the cytotrophoblast

3

Extravillous trophoblasts invade intravascularly to change the spiral arteries into high bloodflow low resistance arteries

ok

4

When, during pregnancy, does this spiral artery remodelling start?

4 weeks

5

Spiral artery remodelling is complete when?

20 weeks

6

Reduced total vascular resistance is due to what?

1) Reduced vasomotor tone
2) remodelling of arteries (even peripheral arteries are remodelled by matrix metalloproteinases)

7

In a mother with pre-eclampsia, what will VEGF receptor 1 levels be compared to a normal pregnancy?

High

8

cGMP is important to what process

vessel relaxation...should be higher in normal pregnancy

9

Increased large artery compliance in combination with lower peripheral vascular resistance means what for afterload?

Afterload (pressure against which teh ventricular walls contract....pressure against cardiac output.....will be decreased

10

We know that plasma volume increases during pregnancy. What happens when plasma volume doesn't increase by a great enough amount

IUGR of the fetus

11

What happens to hematocrit (RBC concentration) in pregnancy?

It falls. This is because blood volume goes up and erythrogenesis (red blood cell creation) cannot increase at a high enough rate

12

Preload during pregnancy

goes up

13

Cardiac output during pregnancy?

goes up

14

Ventricular remodelling during pregnancy results in left ventricular hyperplasia

ok. This same kind of hyperplasia is seen in athletes

15

Increased Med 13

increased energy expenditure, low fat storage

16

Deletion of Med 13

increased susceptibility to diet induced obesity, increased glucose intolerance and incidence of fatty liver

17

What happens to GFR during pregnancy>

Increases by about 50%

18

Serum creatinine during pregnancy?

Decreased because of increased GFR. serum creatinine levels that are normally seen in an unpregnant woman present in a pregnanct woman may mean there is underlying kidney disease

19

Remember, a level of hydronephrosis during pregnancy is normal because of the smooth muscle relaxation in the ureters and compression of the ureters by the growing fetus.

This hydronephrosis is more prominent on the right side

20

Effect of pregnancy on the diaphragm?

Raises it by about 4cm

21

Rib cage during pregnancy

raises and widens

22

Abdominal muscle tone during pregnancy?

lost

23

This loss of abdominal muscle tone means that they are a less active part of respiration and that respiration during pregnancy is driven by the diaphragm.

ok

24

Inspiratory capacity during pregnancy?

Increases, due to increased tidal volume and smaller residual capacity

25

Alveolar ventilation?

Increases

26

Maternal hyperventilation is a protective measure in what way?

It prevents the fetus from being overexposed to CO2

27

What does leptin do during pregnancy?

goes up

28

Where does the majority of leptin come from during pregnancy

the placenta

29

Usually increased leptin increases satiety and suppresses appetite

during pregnancy, we are letpin resistant....just like in obesity.

30

Cortisol levels during pregnancy

rise...apparently the placenta secretes CRH

31

What enzyme is responsible for converting maternal cortisol (active glucocorticoids) to fetal corticosterone (inert)

11 Beta HSD2....KNOW!!!

32

Deficiency in 11 beta HSD2 means

higher levels of cortisol get to the fetus. Causes low birthweight, altered HPA axis, long term neuro-psychic sequelae.

33

11 Beta HSD2 in pre-eclampsia?

Decreased

34

11 Beta HSD2 is very important for protection from maternal cortisol

ok

35

Four mechanisms of maternofetal transfer

- Endocytosis, exocytosis: uptake from maternal blood by ENDOCYTOSIS, transport across cytosol via VESICULAR TRANS, released into fetal circulation via EXOCYTOSIS
- Lipophillic diffusion
- Paracellular Diffusion
- Protein Mediated Transport

36

Placental tissue uptakes what type of fatty acid preferentially

Long chain polyunsaturated