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FHB Block 4 > Reproduction 5: Pregnancy > Flashcards

Reproduction 5: Pregnancy Flashcards

1
Q

What is the first hormone secreted by the syncytiorophoblasts?

A

hCG

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2
Q

Whatdoes hCG bind to, and what does it do?

A

bind to LH receptors on corpus luteum and keeps it viable (rescues)

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3
Q

What do pregnancy tests detect?

A

hCG

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4
Q

What other cells does hCG act on?

A

fetal leydig cells and adrenal cortex

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5
Q

What are the feedback actions of hCG?

A

negative feedback on maternal HPG axis

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6
Q

What is hPL?

A

human placental lactogen

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7
Q

What is hPL also called?

A

hCS- human chorionic somatomammotropin

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8
Q

what other two hormones is hPL like?

A

GH and prolactin

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9
Q

How is hPL like GH?

A

counter-regulatory to insulin (anabolic in the fetus, lipolytic in mom)

mobilizes glucose for fetal use

stimulates fetal IGF-1

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10
Q

How is hPL like prolactin?

A

stimulates mammary gland development

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11
Q

What is the insulin state during pregnancy?

A

pregnancy is an insulin-resistant state

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12
Q

What is the result of being in an insulin resistant state?

A

decreased glucose use by mom allows fetal use

lipolysis and proteolysis provides fatty acids for mom and AA for fetus

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13
Q

What is gestational diabetes caused by?

A

anti-insulin effects of hPL, progesterone, prolactin, and cortisol

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14
Q

What are the functions of the placenta?

A

supportive: provides nutrients for fetal growth
immune: prevents rejection of fetus by mother
endocrine: synthesizes hormones

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15
Q

What organs does the placenta perform the functions of?

A

gut: supplies nutrients
lung: gas exchange
kidney: regulates fluid volume and waste disposal

endocrine

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16
Q

What can’t the placenta make on its own?

A

cholesterol, must get it from mom - can then convert to progesterone

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17
Q

Why is the placenta considered an incomplete endocrine organ?

A

can’t complete steroid biosynthesis - gets stuck at progesterone

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18
Q

What is unique in steroid biosynthesis in the syncytiotrophoblast?

A

StAR independent

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19
Q

What are the sources of cortisol to the syncytiotrophoblasts?

A

mother and fetal adrenal cortex

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20
Q

What is highly upregulated in the syncytiotrophoblasts, and why

A

11beta-HSD2, converts cortisol to cortisone, protecting the fetus from too much cortisol

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21
Q

What is relaxin?

A

inhibits myometrial contractions early in pregnancy

relaxes pelvic bones, ligaments, and softens cervix

involved in reversible hypertrophy of heart?

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22
Q

What produces relaxin?

A

corpus luteum in response to hCG and by the placenta

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23
Q

What is prolactin?

A

stimulates lactogenic apparatus during pregnancy

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24
Q

What is prolactin from?

A

not from placenta, but from maternal pituitary

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25
Q

What i prolactin essential for?

A

mammotrophic effects of estrogen and progesterone

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26
Q

What is significant lactation inhibited by?

A

high levels of estrogen and progesterone

27
Q

What are the cardiovascular changes during pregnancy?

A

increased stroke volume and heart rate resulting in increased CO

catecholamines mediate chronotropic and ionotropic increases

mild cardiomegaly

28
Q

What is the change in the MAP during pregnancy?

A

decreases - TPR decreases more than CO increases

29
Q

What is the change in pulmonary pressures?

A

stays the same - decrease in volume offset by decrease in resistance

30
Q

What is the change in venous pressure during pregnancy?

A

increases

31
Q

What are the changes in regional blood flow during pregnancy?

A

uterus receives up to 30% of CO

skin blood flow increases to maintain body temp

kidney blood flow increases and GFR increases

32
Q

What are the changes in blood during pregnancy?

A

increase in blood volume - up to 50% during second trimester - mediated by progesterone

plasma and RBC increase with a net decrease in Hct

33
Q

What are the respiratory changes during pregnancy?

A

40% reduction in expiratory reserve due to elevation of diaphragm

increase in tidal volume with no increase in frequency

increased tidal volume results in increased alveolar ventilation - functional alkalosis

34
Q

What are the GI changes during pregnancy?

A

additional 30g/day of protein required

decreased mobility which increases nutrient absorption but can result in constipation

decreased LES tone resulting in reflux

35
Q

What are the endocrine changes during pregnancy?

A

HPG axis suppressed due to high concentrations of placental sex steroids

growth of pituitary lactotrophs and an increase in PRL secretion (GnRH suppression)

Ant. Pituitary increases in size by 30%

36
Q

What are the metabolic changes during pregnancy?

A

first half of pregnancy mother is in anabolic state, second half in state of accelerated starvation

anabolic state: normal or increased sensitivity to insulin, increased fat deposition, glycogen stores, breast growth, nutrient stockpiling

accelerated starvation: mediated by hPL, increased plasma glucose and FA levels

37
Q

What is accelerated starvation?

A

catabolic state characterized by insulin resistance

38
Q

What is the first stage of labor?

A

activation of the uterus

39
Q

What does activation of the uterus entail?

A

release from inhibitory actions of progesterone

Ferguson reflex

fetal HPA axis activated - CRH levels peak

40
Q

What is the ferguson reflex?

A

stretch of the cervix from the fetus stimulates release of oxytocin

41
Q

What are the hormones involved in the initiation and maintenance of labor and uterine evacuation?

A

progesterone, E2, relaxin, cortisol, oxytocin, CRH, prostaglandins, catecholamines

42
Q

What is the most important hormone relationship in the initiation and maintenance of labor?

A

decrease in progesterone and an increase in estrogen

43
Q

Where is oxytocin released from?

A

posterior pituitary

44
Q

What does oxytocin binding to its receptor result in?

A

PLC cascade results in increased IP3, and an increase in Ca which activates calmodulin

increases uterine smooth muscle contractions

45
Q

How does E2 influence the response to OT?

A

E2 increases the number of receptors to OT during pregnancy, increasing the potency of OT

uterus insensitive to OT until 29 wks, then gradually increases 200 fold in early labor

46
Q

What is used to induce labor?

A

Pitocin - synthetic OT

47
Q

What is OT important for in lactation?

A

not important in formation of milk, but rather for the release/ejection of milk

48
Q

is maternal OT considered the signal that initiates labor?

A

No! levels do not increase prior to labor, but rather is released in bursts once labor begins, with increased frequency as labor continues

49
Q

What is the signal that initiates labor?

A

Decrease in progesterone/E2 ratio leads to increased prostaglandins which results in increased myometrium Ca leading to more forceful contractions

50
Q

What does OT stimulate release of?

A

prostaglandins (also stimulates contractions)

51
Q

What stimulates lactation?

A

initiated after delivery by decreased progesterone and E2

52
Q

What sustains milk secretion?

A

repeated transient hyperprolactinemia

53
Q

What does suckling do?

A

stimulates prolactin release

54
Q

What does prolactin do?

A

stimulates maternal behavior during pregnancy and after parturition

suppresses reproductive function (inhibits GnRH)

55
Q

What is the fundamental secretory unit of the breast-alveolus?

A

contractile myoepithelial cells, adipose cells

56
Q

What is the colostrum?

A

first milk produced, contains very little fat

57
Q

What is essential for continued milk production?

A

prolactin, cortisol, insulin

58
Q

What is oxytocin released in response to?

A

neural input to NTS (mother response to infant crying) via circulation to the breast

59
Q

What does it mean that prolactin is a lactogenic hormone?

A

mammogenic effects: breast development

galactogenic effects: milk production

60
Q

How does the pill work?

A

Acts on CNS and urogenital tract to inhibit reproductive function

Pituitary and Hypothalamus – prevents LH surge and ovulation

Basal gonadotropin levels are decreased

Ovary - follicular growth is inhibited

Fallopian tube motility is decreased (in vitro observation)

Glandular atrophy in uterine endometrium – why it is good for controlling heavy menstruation

Inhibits implantation of blastocyst

Causes thick cervical mucus – inhibits sperm motility and migration

61
Q

What does the progestational drug in the pill do?

A

prevents LH secretion (including LH surge)

62
Q

What does the estrogenic drug in the pill do?

A

inhibits FSH release

63
Q

What are some non-contraceptive benefits to the pill?

A

Treatment of excessive menstrual bleeding

Protection for pelvic inflammatory disease

Dysmenorrhea

Hormone replacement therapy in postmenopausal women

64
Q

What are some risks and side effects of the pill?

A

Contraindicated in heavy smokers over 35 and those with a history of estrogen-dependent breast carcinomas

Hypertension, myocardial infarction, stroke

Blood clots

Depression

Decreased libido

FHB Block 4 (13 decks)

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