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Reproduction & Sexual Health > Physiology of Pregnancy > Flashcards

Physiology of Pregnancy Flashcards

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1
Q

Where does fertilisation occur?

A

Ampulla

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2
Q

After fertilisation what happens?

A

Fertilised ovum progressively divides and differentiates into a blastocyst as it moves from site of fertilisation in the upper oviduct to the site of implantation in the uterus

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3
Q

At what gestational age is the blastocyst transported to the uterus?

A

3-5 days

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4
Q

What happens to the blastocyst at 5-8 days?

A

Blastocyst attaches to the lining of the uterus and the inner cells develop into an embryo and outer cells burrow into the uterine wall

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5
Q

What do the cells that burrow into the uterine wall become?

A

Placenta

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6
Q

Describe how the placenta forms

A
  1. Cords of trophoblastic cells penetrate into the endometrium
  2. Maternal capillaries respond to form the decidual layer and placental bed
  3. Boundaries between the trophoblastic tissue disintegrate
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7
Q

When is implantation complete?

A

Day 12

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8
Q

Is there any contact between maternal and foetal blood?

A

No - thin layer of tissue

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9
Q

When is the placenta functional?

A

Week 5

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10
Q

What hormone keeps the placenta alive?

A

hCG - signals the corpus luteum to continue secreting progesterone which in turn stimulates decidual cells to concentrate glycogen, proteins and lipids

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11
Q

What increases the contact area of the placenta?

A

Villi

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12
Q

What acts as a shunt in the placenta?

A

Circulation in the intervillous space

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13
Q

State the factors that allow oxygen transportation to the baby

A
  1. Foetal Hb has increased ability to carry oxygen
  2. Higher Hb concentration in foetus (50% more than adults)
  3. Bohr effect
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14
Q

What is the bohr effect?

A

Foetal Hb can carry more oxygen in low pCO2 than high pCO2

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15
Q

State four mechanisms by which nutrients and waste can be exchanged between mum and baby

A

Passive/active transport
Simple diffusion
Osmosis
Simplified transport

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16
Q

What is the main energy source to the foetus?

A

Glucose - simplified transport

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17
Q

Define teratogens

A

Drugs that can cross the placental barrier and are detrimental to the foetus

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18
Q

Name some teratogens

A 
Thalidomide 
Carbamazepine 
Tetracycline 
Alcohol 
Nicotine 
Caffeine
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19
Q

Which ions can only go from mother to child?

A

Iron and calcium

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20
Q

When does water exchange stop increasing?

A

35 weeks

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21
Q

State the purpose of hCG

A

Prevents involution of the corpus luteum in the first 12 weeks of pregnancy (stimulates progesterone and oestrogen)

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22
Q

Describe the normal trend of hCG

A

Levels double every 48 hours

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23
Q

In pathology what happens to hCG

A

Ectopic - static
Failing - falls usually >50%
Molar - extremely high

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24
Q

What are the side effects of hCG?

A

Nausea and vomiting

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25
When does hCG levels start to fall?
12-14 weeks
26
State the purpose of HPL
Growth hormone like effects - protein tissue formation Decreases insulin sensitivity (increase glucose to foetus) Breast development
27
When is HPL produced?
From week 5 when the placenta and foetal heart develop
28
Describe the role of progesterone in pregnancy
Rises throughout Development of decidual cells Decreases uterine contraction Prepares breast for lactation
29
Describe the role of oestrogen in pregnancy
Oestradiol rises throughout pregnancy Enlargement of uterus Breast development Relaxation of ligaments for labour
30
What pathology can hCG/HPL cause in the mum?
Hyperthyroidism
31
What pathology can calcium demands cause in the mum?
Hyperparathyroidism
32
What pathology can corticotrophin releasing hormone cause in the mum?
Increase ACTH causes increased aldosterone and cortisol which can cause - hypertension - oedema - insulin resistance (gestational diabetes)
33
What happens to cardiac output in pregnancy?
Increases due to demands of uteroplacental circulation
34
In the last 8 weeks of pregnancy what does cardiac output depend on?
Body position
35
At what gestational age does increase in cardiac output peak?
24 weeks
36
What are the signs of physiological cardiovascular changes in pregnancy?
ECG changes Functional/flow murmurs Heart sounds
37
What will happen to heart rate during pregnancy?
Increases up to 90bpm
38
What happens to blood pressure in pregnancy?
Drops in the 2nd trimester as uteroplacental circulation expands and peripheral resistance decreases
39
Why do pregnant women often need iron supplement?
Erythropoesis increases as plasma volume increases so Hb is decreased by dilution and iron requirements increase
40
How much iron is required in the second trimester?
6-7mg/day
41
State the values for anaemia in first and 2nd/3rd trimester?
Outwith pregnancy 120-160g/L First - <110g/L Second/third <105g/L
42
What effect does progesterone have on respiration?
Signals the brain to lower CO2 and there is an increase in CO2 sensitivity
43
What factors causes lower levels of carbon dioxide?
Progesterone Oxygen consumption increase Growing uterus
44
Describe the effect of lower carbon dioxide levels
- Increased respiratory rate - tidal and minute volume increase - pCO2 decreases - vital capacity and pO2 do not change
45
What renal changes occur in pregnancy?
GFR and renal plasma flow increases Increased re-absorption of ions and water Increased urine formation
46
What substance drives the re-absorption of ions and water?
Steroids and aldosterone
47
What external factor impacts renal function?
Posture - upright reduces, supine increases and lateral lying significantly increases
48
In general how do pregnancy values compare to normal values for renal/liver function?
Lower
49
How can pregnancy be describe haematologically?
Hypercoaguable state - helps to reduce risk of haemorrhage
50
What contribute to maternal weight gain?
``` Foetus Amniotic fluid Uterus Breasts Plasma volume Fat accumulation ```
51
How many extra calories a day should a pregnant lady eat?
200
52
Describe phase 1 of pregnancy metabolism
Anabolic Phase week 1-20 | Small nutritional demands from the foetus
53
What factors contribute to phase one maternal metabolism?
Normal/increased insulin sensitivity Lower plasma glucose Increased lipogenesis Growth of breast and uterus
54
Describe phase 2 of pregnancy metabolism
Higher metabolic demand and accelerated starvation of the mother if intake is not regular
55
What factors contribute to phase 2 maternal metabolism
Maternal insulin resistance Increased transport of nutrients through placental membrane Lipolysis
56
State five nutritional needs of women during pregnancy
- folic acid - vitamin D - high protein diet - iron supplements - B vitamins
57
Define lactation
Producing and releasing milk
58
How do oestrogen and progesterone impact lactation?
Oestrogen - growth of ductile system Progesterone - development of lobular-alveolar system Both inhibit lactation so decrease after birth
59
Describe the role of prolactin in lactation
Stimulates milk production, steady rise in levels from week 5. 1-7 days after birth prolactin induces high milk production and stimulates colostrum
60
What is the let-down reflex?
1. Receptors in nipple stimulated 2. Impulses propagated to spinal cord 3. Stimulation of hypothalamic nuclei 4. Oxytocin released 5. Milk ejected
61
What is colostrum?
High protein and immunoglobulins but no fat and low in volume

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