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FHB Block 4 > Reproduction 5: Pregnancy > Flashcards

Reproduction 5: Pregnancy Flashcards

(64 cards)

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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
What i prolactin essential for?
mammotrophic effects of estrogen and progesterone
26
What is significant lactation inhibited by?
high levels of estrogen and progesterone
27
What are the cardiovascular changes during pregnancy?
increased stroke volume and heart rate resulting in increased CO catecholamines mediate chronotropic and ionotropic increases mild cardiomegaly
28
What is the change in the MAP during pregnancy?
decreases - TPR decreases more than CO increases
29
What is the change in pulmonary pressures?
stays the same - decrease in volume offset by decrease in resistance
30
What is the change in venous pressure during pregnancy?
increases
31
What are the changes in regional blood flow during pregnancy?
uterus receives up to 30% of CO skin blood flow increases to maintain body temp kidney blood flow increases and GFR increases
32
What are the changes in blood during pregnancy?
increase in blood volume - up to 50% during second trimester - mediated by progesterone plasma and RBC increase with a net decrease in Hct
33
What are the respiratory changes during pregnancy?
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
What are the GI changes during pregnancy?
additional 30g/day of protein required decreased mobility which increases nutrient absorption but can result in constipation decreased LES tone resulting in reflux
35
What are the endocrine changes during pregnancy?
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
What are the metabolic changes during pregnancy?
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
What is accelerated starvation?
catabolic state characterized by insulin resistance
38
What is the first stage of labor?
activation of the uterus
39
What does activation of the uterus entail?
release from inhibitory actions of progesterone Ferguson reflex fetal HPA axis activated - CRH levels peak
40
What is the ferguson reflex?
stretch of the cervix from the fetus stimulates release of oxytocin
41
What are the hormones involved in the initiation and maintenance of labor and uterine evacuation?
progesterone, E2, relaxin, cortisol, oxytocin, CRH, prostaglandins, catecholamines
42
What is the most important hormone relationship in the initiation and maintenance of labor?
decrease in progesterone and an increase in estrogen
43
Where is oxytocin released from?
posterior pituitary
44
What does oxytocin binding to its receptor result in?
PLC cascade results in increased IP3, and an increase in Ca which activates calmodulin increases uterine smooth muscle contractions
45
How does E2 influence the response to OT?
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
What is used to induce labor?
Pitocin - synthetic OT
47
What is OT important for in lactation?
not important in formation of milk, but rather for the release/ejection of milk
48
is maternal OT considered the signal that initiates labor?
No! levels do not increase prior to labor, but rather is released in bursts once labor begins, with increased frequency as labor continues
49
What is the signal that initiates labor?
Decrease in progesterone/E2 ratio leads to increased prostaglandins which results in increased myometrium Ca leading to more forceful contractions
50
What does OT stimulate release of?
prostaglandins (also stimulates contractions)
51
What stimulates lactation?
initiated after delivery by decreased progesterone and E2
52
What sustains milk secretion?
repeated transient hyperprolactinemia
53
What does suckling do?
stimulates prolactin release
54
What does prolactin do?
stimulates maternal behavior during pregnancy and after parturition suppresses reproductive function (inhibits GnRH)
55
What is the fundamental secretory unit of the breast-alveolus?
contractile myoepithelial cells, adipose cells
56
What is the colostrum?
first milk produced, contains very little fat
57
What is essential for continued milk production?
prolactin, cortisol, insulin
58
What is oxytocin released in response to?
neural input to NTS (mother response to infant crying) via circulation to the breast
59
What does it mean that prolactin is a lactogenic hormone?
mammogenic effects: breast development galactogenic effects: milk production
60
How does the pill work?
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
What does the progestational drug in the pill do?
prevents LH secretion (including LH surge)
62
What does the estrogenic drug in the pill do?
inhibits FSH release
63
What are some non-contraceptive benefits to the pill?
Treatment of excessive menstrual bleeding Protection for pelvic inflammatory disease Dysmenorrhea Hormone replacement therapy in postmenopausal women
64
What are some risks and side effects of the pill?
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

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