Physiology of Pregnancy and Lactation Flashcards

(86 cards)

1
Q

What part of the blastocyst develops into the placenta?

A

Trophoblast = accomplishes implantation and develops into foetal portions of placenta

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2
Q

What happens to the fertilised ovum as it moves from the site of fertilisation to the site of implantation?

A

Progressively divides and differentiates into a blastocyst

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3
Q

Where does fertilisation occur?

A

In the ampulla of the fallopian tube

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4
Q

What happens to the blastocyst between days 3-5?

A

Transported into uterus

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5
Q

When does the blastocyst attach to the lining of the uterus?

A

From days 5-8

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6
Q

What do the different cells of the blastocyst develop into?

A

Inner cells = embryo

Outer cells = burrow into uterine wall and become placenta

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7
Q

What happens when the blastocyst adheres to the endometrial lining?

A

Cords of trophoblastic cells begin to penetrate the endometrium

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8
Q

What carves a hole in the endometrium for the blastocyst to adhere to?

A

Advancing cords of trophoblastic cells = tunnel deeper into endometrium

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9
Q

What happens to the boundaries between cells in advancing trophoblastic tissue?

A

The boundaries disintegrate

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10
Q

What is the fate of the blastocyst at the end of implantation?

A

It is completely buried in the endometrium = occurs by day 12

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11
Q

What is the placenta derived from?

A

Trophoblastic and decidual tissue

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12
Q

What do trophoblastic chorion cells differentiate into?

A

Multinucleate cells called syncytotrophoblasts = invade decidua and break down capillaries to form cavities filled with maternal blood

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13
Q

How are placental villi formed?

A

Developing embryo sends capillaries into the syncytotrophoblast projections

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14
Q

What does each placental villi contain?

A

Foetal capillaries separated from maternal blood by a thin layer of tissue = no direct contact between foetal and maternal blood

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15
Q

What kind of exchange exists between the mother and foetus?

A

2 way exchange = largely down diffusion gradient

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16
Q

When are the placenta and foetal heart functional from?

A

By the fifth week of pregnancy

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17
Q

What does HCG signal the corpus luteum to do?

A

Continue secreting progesterone = stimulates decidual cells to concentrate glycogen, proteins and lipids

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18
Q

What is the purpose of the placental villi?

A

Increase contact between uterus and placenta = more nutrients and waste products cane be exchanged

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19
Q

Where do blood vessels from the embryo develop?

A

In the placental villi = thin membrane separates embryonic villous blood from maternal blood in intervillous space

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20
Q

What does the circulation within the intervillous space act as?

A

An AV shunt

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21
Q

How does the placenta act as the foetal lungs?

A

Respiratory function makes supply of oxygen and removal of carbon dioxide possible

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22
Q

Where does exchange of oxygen take place in the placenta?

A

Between maternal oxygen-rich blood and umbilical oxygen-poor blood

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23
Q

What direction does oxygen move in during placental exchange?

A

From maternal into foetal circulation system = carbon dioxide moves in the opposite direction

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24
Q

What happens to blood once oxygen exchange has occurred within the placenta?

A

Foetal oxygen-enriched blood returns to foetus via umbilical vein
Maternal oxygen-depleted blood flows back into uterine veins

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25
What facilitates foetal oxygen supply?
Foetal Hb = increased ability to carry oxygen Higher Hb concentration = 50% higher than adults Bohr effect
26
How does the Bohr effect facilitate foetal oxygen supply?
Foetal Hb can carry more oxygen in low pCo2 than in high pCO2
27
How is water transported in the placenta?
Diffuses into placenta along osmotic gradient = exchange increases during pregnancy up to 35th week (3.5L/day)
28
How are electrolytes transported in the placenta?
Follow water = iron and calcium only go from mother to child
29
How does glucose pass into the placenta?
By simplified transport = high demand in third trimester
30
How do fatty acids move in the placenta?
Via diffusion
31
What is diffusion of waste products based on?
Concentration gradient
32
How much are drugs (other than alcohol) implicated in congenital malformations?
Responsible for 3% of all congenital malformations
33
What is the function of HCG?
Peaks at 10 weeks gestation = prevents involution of corpus luteum, causes development of male sexual organs
34
What is the function of human placental lactogen (HPL)?
Produced from 5th week and increases as pregnancy goes on = GH-like effect causing protein tissue formation, decreases insulin sensitivity in mother, involved in breast development
35
What is the function of progesterone?
Increases as pregnancy goes on = development of decidual cells, decreases uterine contractility, preparation for lactation
36
What are the functions of oestrogens?
Enlargement of uterus, breast development, relaxation of ligaments
37
How do HCG levels change in a singleton early pregnancy?
Serum levels double every 48hrs
38
What conditions can HCG levels be useful for diagnosis?
Ectopic pregnancy = static or slow rising levels Failing pregnancy = falling levels Ongoing viable pregnancy = doubling/>60% rise
39
What are the side effects of HCG?
Nausea and vomiting
40
When may high levels of HCG occur?
In multiple or molar pregnancies
41
When do HCG levels begin to fall?
From 12-14 weeks gestation
42
Why does cardiac output increase during pregnancy?
Due to the demands of the uteroplacental circulation
43
How does the cardiac output change during pregnancy?
Increases to 30-50% above normal = begins in week 6 and peaks at week 24 Decreases in last 8 weeks = uterus compresses IVC Increases 30% more during labour
44
What are some normal CV changes that occur during pregnancy?
ECG changes, functional murmurs and heart sounds
45
What happens to maternal heart rate during pregnancy?
Increases up to 90 beats per minute
46
How does blood pressure change during pregnancy?
Drops during 2nd trimester = uteroplacental circulation expands and peripheral resistance decreases
47
What are the CV changes that occur during a multiple pregnancy?
Cardiac output increases by more and BP drops by more than would occur during a singleton pregnancy
48
What haematologic changes occur during pregnancy?
Plasma volume increases proportionally with cardiac output (50% increase) Erythropoesis increases by 25%
49
What effect do the haematologic changes that occur during pregnancy have on haemoglobin?
Decreases Hb by dilution = decreases blood viscosity
50
How do iron requirements change during pregnancy?
Increase = 6-7 mg/day needed in second half of pregnancy = may need iron supplements
51
What causes lung changes during pregnancy?
Increases in progesterone and the enlarging uterus interfering with lung function
52
How does progesterone affect CO2 level?
Signals brain to lower CO2 levels
53
Why does oxygen consumption increase during pregnancy?
Increases up to 20% above normal to meet metabolic needs of mother, foetus and placenta
54
What changes occur to lower CO2 levels?
Respiratory rate increases, tidal and minute volumes increase, pCO2 increases slightly
55
What changes occur in the urinary system during pregnancy?
GFR and renal plasma flow increase by up to 30-50% = peaks at 16-24 weeks gestation Increased reabsorption of ions and water Slight increase in urine formation
56
How do postural changes during pregnancy affect renal function?
Decrease in function if upright Increase in function if supine Significant increase in function when in lateral position during sleep
57
What is pre-eclampsia?
Pregnancy induced hypertension and proteinuria
58
What are some signs of pre-eclampsia?
Increasing BP since 20 weeks gestation Decrease in renal blood flow and GFR Oedema = salt and water retention
59
What causes oedema in pre-eclampsia?
Decline in renal function
60
What are the risk factors for pre-eclampsia?
Pre-existing hypertension, diabetes, autoimmune disease, renal disease, family history, obesity, twins/multiple births
61
What are the features of eclampsia?
Lethal without treatment = vascular spasms, extreme hypertension, chronic seizures, coma
62
How is eclampsia treated?
C-section and vasodilators
63
What is the usual maternal weight gain during pregnancy?
Average is 11kg = can be as much as 30kg
64
What contributes to maternal weight gain during pregnancy?
``` Foetus = 3.5kg Extra-embryonic fluid and tissues = 2kg Uterus = 1kg Breasts = 1kg Body fluid = 2.5kg Fat accumulation = 1kg ```
65
How much should calorie intake increase by during pregnancy?
200 extra kcal/day = 85% for foetal metabolism, 15% stored as maternal fat
66
How does protein intake need to change during pregnancy?
Extra protein intake required = 30g/day
67
When is the anabolic phase of pregnancy?
Weeks 1-20 = anabolic metabolism of mother, quite small nutritional demands of conceptus
68
When is the catabolic phase of pregnancy?
Weeks 21-40 = especially high during 3rd trimester, high metabolic needs of foetus, accelerated starvation of mother
69
What changes occur during the anabolic phase of pregnancy?
Normal/increased sensitivity to insulin Lower plasma glucose level Lipogenesis and increased glycogen stores Growth of breasts and uterus, and weight gain
70
What changes occur during the catabolic phase of pregnancy?
Maternal insulin resistance Increased transport of nutrients through placental membrane Lipolysis
71
What causes insulin resistance?
HPL, cortisol and GH
72
What are the special nutritional needs of pregnancy?
Folic acid = reduces risk of neural tube defects High protein diet Vitamin D and iron supplements B vitamins = erythropoesis
73
What happens to the uterus towards the end of pregnancy?
Becomes progressively more excitable
74
What causes increased uterine excitability?
Alteration of oestrogen:progesterone ratio | Oxytocin = also increases contractions
75
How do foetal hormones influence labour?
Control timing of labour
76
What effect does stretch of pelvic organs during labour have?
Mechanical stretch of uterine muscles increases contractility Stretch of cervix stimulates uterine contractions
77
When do Braxton Hicks contractions occur?
Increase towards end of pregnancy
78
How does positive feedback influence onset of labour?
Stretch of cervix by foetal head increases contractility and causes further oxytocin release
79
What effect do string uterine contractions and pain from birth canal during labour have?
Cause neurogenic reflexes from spinal cord that induce abdominal muscle contractions
80
What are the stages of labour?
1st stage = cervical dilation (8-24hrs) 2nd stage = passes through birth canal (up to 120mins) 3rd stage = expulsion of placenta
81
How do oestrogen and progesterone aid lactation?
``` Oestrogen = growth of ductile system Progesterone = development of lobule-alveolar system ```
82
What effect do oestrogen and progesterone have on milk production?
Inhibit milk production = drop suddenly at birth
83
What hormone stimulates milk production?
Prolactin = steady rise in levels from week 5 to birth
84
When does prolactin induce high milk production?
1-7 days after birth = also stimulates colostrum (low volume, no fat)
85
What are the components of the milk let-down reflex?
Sucking stimulus and oxytocin
86
What occurs in the milk let-down reflex?
Receptors in nipples stimulated Impulses propagated to spinal cord Stimulation of hypothalamic nuclei Oxytocin released and milk ejected