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Reproduction > Physiology- Pregnancy and Lactation > Flashcards

Physiology- Pregnancy and Lactation Flashcards

(78 cards)

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1
Q

Describe the process from fertilisation to implantation

A 
Fertilisation
Zygote
Morula
Blastocyst
Implantation
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2
Q

How many days after fertilisation does the blastocyst transport into the uterus?

A

3-5 days

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3
Q

How many days after fertilisation does the blastocyst attach to the lining of the uterus?

A

5-8 days

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4
Q

What happens to the inner cells of the blastocyst?

A

Develop into the embryo

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5
Q

What happens to the outer cells of the blastocyst?

A

Burrow into uterine wall and become placenta

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6
Q

What happens when the blastocysts adheres to the endometrial lining?

A

Cords of trophoblastic cells begin to penetrate the endometrium

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7
Q

What is the trophoblast?

A

Surface layer of cells of the blastocyst

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8
Q

What do the cords of trophoblastic cells do after endometrium penetration?

A

Tunnel deeper, carving out a hole for the blastocyst. Boundaries between cells in the advancing trophoblastic tissue disintegrate

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9
Q

Where is the blastocyst when implantation is finished?

A

Completely buried in endometrium

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10
Q

By what day will the blastocyst be buried in the uterine lining?

A

Day 12

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11
Q

What is the placenta derived from?

A

Trophoblast and decidual tissue

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12
Q

Describe how cavities filled with maternal blood are formed from trophoblast cells

A

Cells (chorion) differentiate into multinucleate cells (syncytiotrophoblasts) which invade decidua and break down capillaries to form cavities

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13
Q

Describe what happens to the broken down capillaries in the forming of cavities

A

Developing embryo sends capillaries into the syncytiotrophoblast projections to form placental villi

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14
Q

Describe a placental villus

A

Each contains 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 type of exchange exists between mother and foetus?

A

2 way exchange of resp gases, nutrients, metabolites etc-largely down diffusion gradient

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16
Q

When are the placenta and foetal heart functional by?

A

5th week of pregnancy

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17
Q

What provides early nutrition to the embryo?

A

Invasion of trophoblastic cells into decidua

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18
Q

What does HCG signal the corpus luteum to continue secreting?

A

Progesterone- stimulates decidual cells to concentrate glycogen, proteins and lipids

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19
Q

Where do placental villi extend into?

A

The uterine wall

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20
Q

What is the purpose of placental villi?

A

Increases contact area between uterus and placenta & more nutrients and waste materials can be exchanged

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21
Q

What does circulation within the intervillous space of the placenta act as?

A

An arteriovenous shunt

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22
Q

What plays the role of the foetal lungs?

A

Placenta

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23
Q

What is contained within umbilical blood?

A

Mix of arterial and venous blood

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24
Q

What does the exchange of CO2 follow from mother to foetus?

A

Reversed gradient to oxygen

Partial pressure elevated in foetal blood

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25
What does foetal, oxygen saturated blood return to the foetus via?
The umbilical vein
26
What does maternal, oxygen poor blood return to the mother via?
Uterine veins
27
What 3 factors facilitate the supply of oxygen to the foetus?
Foetal Hb: increased ability to carry O2 Higher Hb concentration in foetal blood (50% more than adults) Bohr effect: Foetal Hb can carry more oxygen in low pCO2 than higher pCO2
28
What transport mechanisms do the placental exchange processes occur via?
``` Passive transport (without energy consumption) Simple diffusion Osmosis Simplified transport Active transport ```
29
Describe water diffusion into placenta
Osmotic gradient | Exchange increases during pregnancy up to 35th week (3.5l/day)
30
Describe electrolyte transport into placenta
Follow water | Iron and Ca2+ only go from mother to child
31
Describe glucose transport into placenta
Passes placenta via simplified transport | High quantity needed in 3rd trimester
32
Describe fatty acid transport into placenta
Free diffusion
33
Describe waste products transport into placenta
Diffusion along concentration gradient
34
Describe HCG changes in pregnancy
Prevents involution of corpus luteum | Effect on testes of male foetus- development of sex organs
35
Describe Human Chorionic Somatomammotropin changes in pregnancy
Produced from around week 5 Growth hormone-like effects: protein tissue formation Decrease insulin sensitivity in mother: more glucose for foetus Involved in breast development
36
Describe progesterone changes in pregnancy
Development of decidual cells Decrease uterus contractility Preparation for lactation
37
Describe oestrogens changes in pregnancy
Enlargement of uterus Breast development Relaxation of ligaments Estriol level-indicator of foetus viability
38
Describe the trend in production of HCG, HCS, progesterone and oestrogens
All but HCG rise from onset at around week 5-6 to birth | HCG starts from week 0, sharply rises to week 10, sharply decreases to week 16 and then tapers down
39
Describe CRH changes from placenta to mother
Increased CRH in placenta leads to ACTH in mother Changes in aldosterone control Can lead to HT, oedema or insulin resistance (leading to GD)
40
Describe HCG/HC thyrotropin changes from placenta to mother
HCG/HCT in placenta, can lead to hyperthyroidism in mother
41
Describe the effects of the increased calcium demand of the placenta on the mother
Can lead to hyperparathyroidism
42
Why does the CO increase in pregnancy and from when?
Week 6-24 (30-50% increased) | Due to placental circulation, increased metabolism, thermoregulation and renal circulation changes
43
What cardiac changes are all normal in pregnancy?
``` ECH changes Functional murmurs Heart sounds HR increase up to 90 BP drops during 2nd trimester ```
44
When does the CO increase in pregnancy?
Decreases in last 8 weeks (becomes sensitive to body position, uterus compresses vena cava) Increases 30% during labour
45
Why does the BP drop during 2T?
Uteroplacental circulation expands & peripheral resistance decreases
46
What happens to the CO with twins?
Increases more, BP drops more
47
What haematologic changes occur in pregnancy?
PV increases proportionally with CO (50%) Erythropoesis (RBC) increases (25%) Thus Hb decreased by dilution (decreasing blood viscosity) Iron requirements increase (6-7mg/day in 2nd half pregnancy: iron supplements needed)
48
What respiratory changes occur in pregnancy?
Lung function changes due to progesterone increases and enlarging uterus interferes Progesterone signals brain to lower CO2 levels (increases CO2 sensitivity in resp centres) O2 consumption increases (20%)
49
What is done to lower CO2 levels in pregnancy?
RR increases Tidal and minute volume increases (50%) pCO2 decreases slightly Vital capacity and pO2 don't change
50
What urinary system changes occur in pregnancy?
GFR and renal plasma flow increase (30-50%, peaks 16-24wks) Increased re-absorption of ions and water: placental steroids, aldosterone Slight increase in urine formation
51
How do postural changes affect renal function?
Upright position decreases Supine increases Lateral position during sleep increases greatly
52
What is pre-eclampsia?
Pregnancy induced HT + proteinuria
53
What happens in pre-eclampsia?
Increasing BP since 20th week Kidney function declines-salt and water retention (oedema, esp hands and face) Renal blood flow and GFR decrease
54
In what women is pre-eclampsia more common in?
``` Pre-existing hypertension DM AI disease (eg lupus) Renal disease FHx of pre-eclampsia Obesity Multiple gestation ```
55
What is the most significant risk of having pre-eclampsia?
History of pre-eclampsia
56
What causes pre-eclampsia?
Extensive secretion of placental hormones Immune respose to foetus Insufficient blood supply to placenta- ischaemia
57
What is eclampsia?
Extreme pre-eclampsia (fatal unless treated)
58
How does eclampsia present?
Vascular spasms Extreme HT Chronic seizures and coma
59
How is eclampsia treated?
Vasodilators | C-section
60
What is the average weight gain in pregnancy?
24lbs, can be up to 75bs
61
Where does the extra weight in pregnancy come from?
``` Foetus - 7lbs Extra-embryonic fluid/tissues – 4 lbs Uterus – 2 lbs Breasts – 2 lbs Body fluid – 6 lbs Fat accumulation – 3 lbs ```
62
How many extra kcal/day should be ingested by mother and for what?
250-300 extra | 85% foetal metabolism, 15% stored as maternal fat
63
How much extra protein should be ingested during pregnancy?
30g/day
64
What is the glucose need at end of pregnancy?
Foetal need 5mg/kg/min | Mother 2.5mg/kg/min
65
Describe the 1st-20th week in terms of metabolism?
Mother's anabolic phase | Small nutrional demands of conceptus
66
Describe the 21st-40th week in terms of metabolism?
Esp last trimester High metabolic demands of foetus Accelerated starvation of mother
67
What happens during the mother's anabolic phase?
Normal or increased sensitivity to insulin Lower plasmatic glucose level Lipogenesis, glycogen stores increases Growth of breasts, uterus,weight gain
68
What happens during the catabolic phase (accelerated starvation)?
Maternal insulin resistance Increased transport of nutrients through placental membrane Lipolysis
69
What causes the insulin resistance in pregnancy?
HCS Cortisol GH
70
What are the special nutritional needs in pregnancy?
High protein diet, higher energy uptake Iron supplements - 300mg ferrous sulfate B - vitamins - erythropoesis Folic acid (folate) - reduces risk of neural tube defects Vitamin D3 + Ca2+ supplements Before parturition - K vitamin (prevention of intracranial bleeding during labour)
71
What happens to the oestrogen:progesterone ratio at parturition?
Alters increasing excitability: progesterone inhibits contractility, oestrogen vice versa
72
What does oxytocin do during parturition?
Increases contractions and excitability
73
What do the foetal hormones oxytocin, adrenal gland hormones, and prostaglandins do during parturition?
Control timing of labour
74
What does cervical stretch cause the further release of?
Oxytocin
75
What is oestrogen's role in lactation?
Growth of ductile system | Inhibit milk production (level drops at birth)
76
What is progesterone's role in lactation?
Development of lobule-alveolar system | Inhibit milk production (level drops at birth
77
What is prolactin's role in lactation?
Stimulates milk production (rise in levels week 5 to birth) 1-7 days after birth, prolactin induces high milk production Stimulates colostrum (low volume, no fat)
78
What do the sucking stimulus and oxytocin do in lactation?
Initiate 'milk let-down' reflex

Reproduction (40 decks)

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