Physiology of Pregnancy: Schlabritz-Lutsevich Flashcards Preview

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Flashcards in Physiology of Pregnancy: Schlabritz-Lutsevich Deck (70):
1

What increases in CV during pregnancy?

BV
CO
SV
HR

2

What does not change in CV during pregnancy?

Veinous pressure
Mean arterial BP:
Although systolic and diastolic both go down

3

What goes down in CV during pregnancy?

TPR
Osmotic pressure
Hemoglobin

4

What is the name of the cells in the cytotrophoblast that cause drop from arterial to venous?

Extravillous trophoblast: invade spiral arteries of endometrium to form invasive cell columns

This drop in pressure keeps things from exploding... allows ex

5

What do decimalized cells look like at 4 weeks?

Large pale cells

6

What is the timeline of vascular remodeling?

4 weeks, it begins
5 weeks, heart beats for first time

7

What happens in vessel changes during remodeling?

Small size to large, high resistance to low resistance

0 Unmodified: 0 weeks
4 Vessel priming
8 Trophoblast invasion, loss of EC and VSMC
12 TC plugs dissolve
16 TC infiltration ceases
20 remodeling complete

8

When is local spiral artery remodeling complete?

20 wks

9

When is systemic artery remodeling complete?

24-28 weeks

10

What happens to arteries in pregnancy?

Less resistance, (maybe larger diameters?)

11

The remodeling of the spiral done when? systemic?

20-spiral
24-28-systemic

12

What happens to TPR in gestation at 5 weeks?

20-25% deducting by 5 weeks

13

What is the reduced TVR due to?

Reduced vasomotor tone
Remodelling of resistant size arteries (MMP9/3)

14

What are changes in vessels due to, broadly?

Angiogenic and antigenic factor balance

15

What placental growth factor a analogue for?

VEGF: angiogenesis

16

What percent of maternal blood goes to fetus eventually?

35%

17

If we have imbalance in angiogenic/antiangiogenic factors, what happens?

Pre-ecclampsia

18

Remember what anti-angiogenic factors?

Soluble VEGF-Receptor 1
S-Fleet

19

TPR is decreased due to what?

NO
PGI2 from COX1 and 2
cGMP (decreases Ca+2)

20

What is emphasized as important to keep vessel relaxed and TPR low?

cGMP

21

What is cause of relaxation in regard to K channels?

Hyperpolarization

22

Placental casues and increase in?

ATII??

23

What is increased compliance?

distensibility (by blood volume)

24

What does increased compliance do to after load of heart?

Decreased after load

25

What happens first, increased BV or decreased TPR?

We don't know... she thinks vascular remodeling

26

What is an important mechanism to allow fetal growth?

Increased plasma volume, erythrocyte volume

27

What happens to the HCT in pregnancy?

Decreases

28

Does erythrogenesis match plasma volume increase?

No, thus HCT is low

29

When does BV return to normal after delivery?

by 6 weeks

30

What happens to heart chambers in pregnancy?

Left ventricular hypertrophy (same as athletes!)

31

What is the difference between the physiological and pathological heart hypertrophy?

Fibrosis and elasticity!

Patho: fibroblasts increase, walls thicken too much
Phys: myocytes increase, walls proportionate thick

32

What increases with heart wall stretching?

ANP
BNP
cGMP**emphacized
*feedback to decrease BP in kidneys and adrenals

33

What is the role of microRNA?

MiR208 is heart specific microRNA

34

Animals treated with miR208 are resistant to what?

high fat diet

35

What does miR208 inhibit?

MED13, an inhibitor of mediators of fat storage

36

Deletion of MED13 causes what?

Obesity

37

How does the heart regulate fat storage?

Thorugh miR208 and MED13

38

What are the changes in kidney in pregnancy?

GFR increases up to 50%

39

What happens to creatinine in pregnancy?

0.4 mg/dl increase on average (0.9 to 1.3)

40

What happens to the collecting system of the kidneys?

physiological hydronephrosis due to increased progesterone relaxation of ureters and fetal compression

41

Which side has more hydronephrosis in pregnant kidneys?

Right side

42

What is the respiratory changes in pregnancy?

Diaphragm elevation
widened rib cage (2cm diameter, 6 cm circumference)
Bigger chest (5-7cm)
Subcostal angle from 68 to 103 degrees

43

Is respiratory muscle function effected by pregnancy?

NO! no change in reap. muscles

44

What happens to abdominal muslces in pregnancy?

Less tone
Less active
Respiration is diaphragmatic

45

What is the change in the subcostal angel?

68 to 103 degrees

46

What is the change in tidal volume?

increase 35-50%

47

What is the change in total lung capacity?

4-5% reduction by elevation of diaphragm

48

What happens to functional residual capacity, residual volume, respiratory reserve volume?

Decrease about 20%

49

What causes increase in alveolar ventilation in pregnancy?

Larger tidal volume
Smaller residual volume

50

What happens to inspiratory capacity?

increase 5-10%

51

What percent of oxygen is taken by placenta?

40%!!!

52

Vital capacity is what?

Almost the SAME

53

Overall what happens in respiratory pregnancy?

More efficient gas exchange

54

What are the increases in hormones in pregnancy?

Increase:
Estrogen/Progesterone Ratio
Prolactin
Placental GH
TNF-a
Leptin
Free cortisol

55

What are the decreases in hormones in pregnancy?

Decrease:
Pituitary GH
Adiponectin

56

What do the changes in hormones in pregnancy compare to?

Obesity! We need to deposit fat... insulin resistance and available glucose.

57

Our babies are what?

Fat!

58

What hormonal adaptations lead to fat babies?

Increased TNF-a
Leptin
Cortisol
Deacrease Adiponectin

59

Majority of Leptin comes from where in pregnancy?

Placenta! 10 fold increase

60

What is the pregnancy response to leptin?

Leptin resistant state, like obesity

61

What is the overview of gut micro biome and metabolic change in pregnancy?

Weight gain
Insulin desensitization
Altered microbiota: transplant makes fatter mouse

62

What happens to fat in pregnancy?

Shunt to fetus?

63

What acts as a barrier to active glucocorticoids (cortisol) in placenta?What does it do to them?

11 beta hydroxysteroid dehydrogenase type 2 in placenta

Converst to cotisone

64

What happens if 11 BHSD2 is low in placenta?

Cortisol gets across
Growth retardation

65

What deactivates cortisol in placenta?

11bHSD2

66

What can happen to molecules from mother in placenta?

Metabolism
Transport
No transport

67

What protects barrier of blood-blood barrier placenta?

Syncytiotrophoblast:
Vasculosyncyntial membrane

68

What GLUT gets glucose in in placenta?

GLUT 1

69

What may interfere with amino acid transport in placenta?

Glucose
Lipid metabolism

70

What type of fats does placenta prefer?

Long chaing polyunsaturated fatty acids (LC-PUFAs)
Building blocks for fetal brain
(cholesterol not quite known yet)