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Pregnancy Flashcards

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1
Q

What is the role of progesterone in early pregnancy?

A
  1. Suppress milk secretion
  2. Suppress uterine contractions
  3. Suppress hypothalamus and pituitary
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2
Q

What is the role of oestrogen in early pregnancy?

A
  1. Increase uterine blood flow

2. Increased vessel growth

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3
Q

What occurs to the progesterone:oestrogen ratio in late pregnancy?

A

Stable progesterone with increasing oestrogen

  1. Initiates parturition
  2. Initiates lactation
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4
Q

Give five roles of oestrogen during pregnancy

A
  1. Priming agents, including receptors
  2. Growth of uterus and mammary tissue
  3. Behavioural effects
  4. Feedback on hypothalamus
  5. Increases uterine blood flow
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5
Q

Give five roles of progesterone during pregnancy

A
  1. Growth of endometrium and myometrium
  2. Growth of mammary tissue
  3. Behavioural effects
  4. Negative feedback on hypothalamus
  5. Inhibition of smooth muscle
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6
Q

How does the maternal pituitary gland change during pregnancy?

A

Increases in size by 30-50%

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7
Q

When is increased pituitary size clinically significant?

A
  1. Acromegaly, with an already enlarged pituitary gland, may compress the optic chiasm leading to blindness
  2. Vascular accident during delivery can lead to Sheehan’s syndrome
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8
Q

What is Sheehan’s syndrome?

A
  1. Failure to lactate and resume menstrual cycles

2. Associated with post-partum haemorrhage

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9
Q

What mediates increased calcium uptake?

A

Increase PTH and 1,25DHCC

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10
Q

What mediates increased levels of adrenal cortical hormones?

A

Oestrogen-induced increase in binding globulins

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11
Q

What is the average weight gain in pregnancy?

A

12.5kg

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12
Q

Who tends to gain more weight during pregnancy?

A

Younger, lighter women

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13
Q

What contributes to weight gain during pregnancy?

A

60% water

  1. 3L in fetus
  2. 1L in placenta, uterus and amniotic cavity
  3. 3L in maternal tissue fluid
  4. 25L extra plasma

> 3kg fat deposition

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14
Q

How does blood volume change in pregnancy?

A

40% increase in plasma volume due to upregulation of renin-angiotensin system

Haemodilution as red cell mass increases less than plasma increase

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15
Q

What causes increased red blood cell mass?

A

Increased erythropoiesis

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16
Q

How does clotting change?

A
  1. Platelet count falls

2. Clotting factors increase

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17
Q

How does blood flow change?

A

Increased cardiac output and heart rate

Decreased resistance

Increased flow to kidneys and skin

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18
Q

What is transient high blood pressure?

A

Mild rise in BP during pregnancy or soon after delivery

Not accompanied by oedema or proteinuria

Begins after midpoint of pregnancy

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19
Q

What is pre-eclampsia?

A

Commonest cause of hypertension during pregnancy

ABP of at least 140mmHg/90mmHg

Oedema and proteinuria

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20
Q

Who is most at risk of pre-eclampsia?

A
  1. First time mothers
  2. Younger than 17 or older than 35
  3. Family history of pre-eclampsia
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21
Q

What are the three causes of respiratory changes?

A
  1. Space occupying lesion in abdomen puts upwards pressure on diaphragm
  2. Increased oxygen consumption
  3. Circulating hormone levels
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22
Q

When is breathlessness during pregnancy relieved?

A
  1. Pelvic ligament softening at 36 weeks

2. Fetal head descends into pelvis and engages, relieving pressure

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23
Q

What does pulmonary ventilation increase to?

24
Q

What causes increase in pulmonary ventilation?

Study These Flashcards
A

Increased tidal volume

25
What occurs to arterial pCO2 during pregnancy?
Decreases due to increased alveolar ventilation
26
What are the gastrointestinal changes that occur in pregnancy?
1. Decreased salivary pH causes caries 2. Increased abdominal pressure causes heartburn 3. Reduced gastric tone and motility causes nausea 4. Piles
27
What are the renal changes that occur in pregnancy?
1. Increased GFR due to increased plasma flow 2. Increased aldosterone 3. Sodium retention for fetal growth and volume expansion 4. Increased erythropoietin production
28
Which hormones induce metabolic changes in pregnancy?
1. Sex steroids 2. Human placental lactogen 3. Cortisol
29
How does maternal glucose regulation change?
1. Insulin resistance 2. Glucose diverted to fetus 3. Proliferation of pancreatic beta cells to compensate for insulin resistance 4. Can lead to gestational diabetes
30
What are the early behavioural changes in pregnancy?
Relate to food acquisition Increased thirst and appetite, cravings and aversions, nausea and vomiting
31
What are the late behavioural changes in pregnancy?
Sense of fatigue Reduced food intake Nesting/restlessness
32
What is the proxy measure of intrauterine growth?
Birth weight
33
What are the three causes of a small birth weight?
1. Genes 2. Prematurity 3. Intrauterine growth restriction
34
What are the five maternal factors influencing intrauterine growth?
1. Uterine size 2. Nutrition 3. Parity 4. Socioeconomic and other environmental factors 5. Diseases
35
What is the evidence for the effect of uterine size on intrauterine growth?
Reciprocal crosses between Shire and Shetland ponies Multiple pregnancies
36
What are the most important fetal endocrine factors for influencing intrauterine growth?
1. Insulin | 2. Thyroid hormones
37
What is the effect of fetal insulin on fetal growth?
1. Decreased bodyweight | 2. Increased fat deposition
38
What is the effect of thyroid hormones on fetal growth?
1. Increased bodyweight | 2. Muscle, CNS, bones, wool
39
What is the effect of glucocorticoids on fetal growth?
1. Decreased bodyweight | 2. Maturational effects on liver, lungs and gut
40
What does IGF-1 contribute to the development of?
1. Liver | 2. Bones
41
What does growth hormone contribute to the development of?
Fat deposition
42
What are the properties of fetal haemoglobin?
1. Greater intrinsic oxygen affinity | 2. Reduced 2,3DPG affinity
43
What are the two shunts in the fetal heart?
1. Foramen ovale | 2. Ductus arteriosus
44
How does the fetal circulation differ from adult circulation?
1. Supplies placenta (55%) 2. CO is 4x greater 3. Two sides act in parallel rather than in series 4. Bypasses lungs
45
What are the changes in fetal lungs in preparation for birth?
1. Breathing movements that facilitate normal lung development 2. Development of surfactant and elastin in the lungs
46
What are the changes in fetal nutritional activity in preparation for birth?
1. Capacity for hepatic gluconeogenesis 2. Morphology and digestive capacity of the gut 3. Hepatic glycogen deposition 4. Hepatic gluconeogenic enzyme activities 5. Activities for gut digestive enzymes
47
What are the prepartum effects of cortisol on the liver?
Increased glycogen deposition
48
What does the maturation of lung, liver, kidney and gut rely on before birth?
Increase in glucocorticoid secretion from the fetal adrenal
49
Why are premature infants at risk of neonatal hypoglycaemia?
They have not had enough time to develop glycogen stores as they have not had enough cortisol
50
How does cortisol affect fetal concentrations of other hormones?
Increases tri-iodothyronine Increases adrenaline
51
What are trio-iodothyronine and adrenaline important for?
Maturation or functional activation of key tissues essential for neonatal survival
52
What does the maturation of lung, liver, kidney and gut rely on before birth?
Increase in glucocorticoid secretion from the fetal adrenal
53
Why are premature infants at risk of neonatal hypoglycaemia?
They have not had enough time to develop glycogen stores as they have not had enough cortisol
54
How does cortisol affect fetal concentrations of other hormones?
Increases tri-iodothyronine Increases adrenaline
55
What are trio-iodothyronine and adrenaline important for?
Maturation or functional activation of key tissues essential for neonatal survival

Human Reproduction (17 decks)

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