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Pregnancy Physiology Flashcards

(84 cards)

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1
Q

What days is the two cell stage present?

A

First 3 days of development

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2
Q

Define Morula

A

Solid mass of blastomere cells

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3
Q

When does a morula appear?

A

Day 4

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4
Q

What day does the morula become a blastocyst?

A

Day 5

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5
Q

What is the outer layer of the blastocyst consist of?

A

Trophoblast

Placenta & fetal membranes

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6
Q

What is the inner layer of the blastocyst consist of?

A

Cell mass to become the embryo & fluid

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7
Q

What surrounds the blastocyst?

A

Zona pellucida

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8
Q

When does implantation occur?

A

Day 6-7

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9
Q

What is the stem cell of the placenta?

A

Progenitor cytotrophoblast cell

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10
Q

2 Differentiation of Progenitor Cytotrophoblast Cells

A 
Extravillous cytotrophoblast (inner)
Villous cytotrophoblast (outer)
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11
Q

Extravillous Cytotrophoblast (Inner) Cells

A

“Invasive” into decide & myometrium
“Invasive” into the spiral arteries (form uteroplacental arteries)
Form core of villi

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12
Q

Villous Cytotrophoblast (Outer) Cells

A

Forms placental villi with base of cytotrophoblast cells

Forms umbilical arteries & vein

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13
Q

Function of Villous Cytotrophoblast (Outer) Cells

A

Transport of gases
Nutrient & wastes
Synthesis of peptide & steroid hormones that influence placental, fetal, & maternal systems

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14
Q

Dicidua

A

Influence by progesterone & later with the invasion of trophoblasts

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15
Q

What forms the basal plate of the placenta?

A

Decidual cells

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16
Q

Define Trophoblast

A

Layer of trophoblast cells always separate the embryonic circulation from maternal blood & decidua

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17
Q

Define Nitabuch’s Layer

A

Layer of fibrin between the boundary zone of compact endometrium & the cytotrophoblastic shell in the placenta

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18
Q

Functions of the Placenta

A 
Extra brain
Interface between mom & baby
Prevents rejection of fetal allograft
Enables respiratory gas exchange
Transports nutrients
Eliminates fetal waste products
Secretes peptide & steroid hormones
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19
Q

Metabolic Functions of the Placenta

A

Glycogen synthesis
Cholesterol synthesis
Removal of lactate
Protein metabolism

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20
Q

Function of Cholesterol Synthesis

A

Precursor for production of progesterone & estrogen

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21
Q

Define Lactate

A

Waste product of placental metabolism

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22
Q

Placental Peptide Hormones

A

Human chorionic gonadotropin (hCG)
Human placental lactogen (hPL)
Placental corticotropin-releasing hormone (CRH)
Insulin-like growth factor (IGF)
Vascular endothelial growth factor (VEGF)
Placental growth factor

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23
Q

Function of Human Chorionic Gonadotropin (hCG)

A

Maintains corpus luteum production of progesterone until placenta takes over at 6-8 weeks
Regulates placental steroid production

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24
Q

Function of Human Placental Lactogen (hPL)

A

Antagonizes maternal secretion of insulin to increase fetal glucose supply

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25
Function of Placental Corticotropin-Releasing Hormone (CRH)
Stimulates fetal ACTH resulting in fetal adrenal making DHEA-S as precursor to placental estrogen
26
Placental Steroid Hormones
Progesterone Estrogens Enzymes to degrade maternal glucocorticoids
27
Function of Progesterone
Maintains non-contractile uterus | Anti-inflammatory & immunosuppressive to protect fetus
28
Function of Estrogens
Stimulated by placental HCG | Maternal & fetal blood supply DHEAS
29
Enzymes to Degrade Maternal Glucocorticoids
Placenta regulates exposure of fetus to glucocorticoids | Regulating fetal organ development & maturation
30
Placental Transfer/Transport
``` CO2 & O2 exchange Glucose Amino acid Fatty acids Immunoglobulin G Drugs ```
31
Function of Estrogen (Maternal Physiology)
``` Enlargement of uterus Breast enlargement & growth of ductal structure Enlargement of the external genitalia Relaxation of pelvic ligaments Affects fetal development ```
32
Function of Progesterone (Maternal Physiology)
Induces endometrial secretory cells to decidual cells Contributes to development of the conceptus before implantation Inhibits myometrial contractions May be involved with immune tolerance of fetus Influences breasts for lactation Helps develop thick mucus plug Changes cervix, vagina, & vulva to allow stretching for delivery
33
Ophthalmic Changes with Pregnancy
``` Cornea thickens Decrease in intraocular pressure Visual field changes or double vision (abnormal) Diabetic retinopathy Secondary retinal detachments ```
34
Dental Changes in Pregnancy
Gingivitis: bleeding or inflammation Epulis: hyperplastic, granulomatous lesions
35
GI Changes in Pregnancy
``` Relaxation of LES Decreased PUD Incomplete emptying of the gallbladder Delayed gastric emptying, slowed small bowel transit & decreased large bowel peristalsis Increased portal venous pressure N/V Hyperemesis gravidarum ```
36
What does a relaxation of the LES increase the incidence of?
GERD
37
Why is there decreased PUD in pregnancy?
Increased mucus | Decreased gastric secretion
38
A decrease of gallbladder emptying increased the risk of what?
Gallstones
39
Treatment of Nausea & Vomiting
Vitamin B6
40
Symptoms of Hyperemesis Gravidarum
Persistent & severe N/V Weight loss Dehydration Electrolyte imbalances
41
Treatment of Hyperemesis Gravidarum
IV fluids Anti-emetics TPN (rarely)
42
Renal & Urinary Changes in Pregnancy
Relaxes bladder wall & reduces ureteral tone & peristalsis Hydroureter of pregnancy (R>L) Hydronephrosis (R>L) Predisposes to UTI's & pyelonephritis
43
Urinary Bladder in Pregnancy
Flattens bladder Decreases capacity Associated with incontinence Asymptomatic bacteruria
44
Asymptomatic Bacteruria
Acute pyelonephritis Preterm labor Low birth weight
45
Renal Function in Pregnancy
Kidneys increase in size Renal blood flow & GFR increase by mid-trimester Hyperventilation Extracellular volume increases
46
Cardiovascular Changes in Pregnancy
``` Increase in stroke volume Increase HR Increases cardiac output Decreased systolic vascular resistance Decreased mean BP Increased oxygen consumption Uterine blood flow- 700 mL/min Placental blood flow 500 mL/min Increased heart muscle mass Heart shifted to left Apical pulse moves to 4th intercostal space Louder heart sounds Wide split S1 & S2 ```
47
Physiologic Anemia of Pregnancy
Increased plasma volume Increased red cell mass Increased blood volume
48
Nutritional Supplements in Pregnancy
Folic acid Oral iron Magnesium (opposite of iron)
49
Coagulation Changes in Pregnancy
Increase in fibrinogen Increase in clotting factors II, VII, VIII, X, IX, XII, & XIII Decrease in protein S levels & inhibition of fibrinolysis
50
Respiratory Tract Changes in Pregnancy
Increased nasopharyngeal blood flow Increased phagocytic activity in the upper respiratory tract Decreased residual lung capacity
51
Progesterone Effects on Respiratory Tract Changes
``` Stimulates respiratory drive Minute ventilation increases Tidal volume increases Oxygen consumption increases PaO2: 100-110 mmHg PaCO2 decreases: 27-32 mmHg ```
52
Musculoskeletal Changes in Pregnancy
Joint laxity of lumbar spine Separation & stretching of abdominal muscles SI joints & pubic symphysis widen (increased mobility) Pelvis tilted anteriorly Carpal tunnel syndrome Sciatic nerve pain
53
Why carpal tunnel syndrome in pregnancy?
Inflammation, fluid retention, and swelling
54
Why sciatic nerve pain in pregnancy?
Extra weight & pressure causes compression of sciatic nerve
55
Endocrine Adaptations in Pregnancy
``` Interactions of fetal-placental-maternal unit Hypothalamus Pituitary Parathyroid Thyroid Adrenal glands ```
56
Hypothalamic Hormones in Pregnancy
Gonadotropin-releasing hormone (GnRH) | Corticotropin-releasing hormone (CRH)
57
What does placental CRH drive?
Maternal & fetal pituitary
58
Anterior Pituitary Gland in Pregnancy
Decline in circulating gonatotropins due to high estradiol & progesterone levels Growth hormone (GH) declines Increase in ACTH Thyrotropin (TSH) reduced in 1st trimester; modestly elevated at term Prolactin levels increased
59
Intermediate Lobe of Pituitary in Pregnancy
Increase in volume | Melanocyte-stimulating hormone (MSH) elevated
60
Posterior Pituitary Hormones in Pregnancy
``` Antidiuretic hormone (ADH) Oxytocin ```
61
Effects of ADH in Pregnancy
Women less sensitive to ADH
62
Effects of Oxytocin in Pregnancy
Involved in onset of labor | Involved in milk "let down"
63
Parathyroid Glands & Pregnancy
PTH increases
64
Function of PTH in Pregnancy
Facilitates transfer of calcium across the placenta Mobilizes calcium from maternal skeleton Intake requirement increases
65
Thyroid Glands in Pregnancy
Increased thyroxine-binding globulin (TBG) Increased TSH Increased maternal iodine needs
66
Adrenal Glands in Pregnancy
Cortisol affected by CRH | Decreased vascular responsiveness to angiotensin II
67
Glucose Metabolism in Pregnancy
Develops insulin- resistant state Diabetogenic hormones: GH, CRH, chorionic somatomammotropin, & progestrone Maternal hyperglycemia & DM (possible birth defects) Hyperplasia of pancreatic beta cells Increased insulin secretion Fasting levels decreased Relative insulin resistence & hypoglycemia with increasing lypolysis Minimizes protein catabolism
68
Lipid Metabolism in Pregnancy
Serum triglycerides & cholesterol levels rise Triglycerides provide maternal fuel Elevated LDL 2nd trimester: fat accumulation 3rd trimester: maternal consumption of stored fat Leptin
69
Define Leptin
Hormone secreted by adipose tissue & placenta plays key role in fat metabolism
70
Other Metabolic Changes
Protein: increased needs Water: 3 L/day; edema
71
Changes in Reproductive ORgans in Pregnancy
``` Uterine enlargement 20% of cardiac output to uterus Increased blood supply to cervix, vagina, & vulva Vulvar varicosities Vulvar condylomata ```
72
Skin Changes in Pregnancy
Striaegravidarum (stretch marks) | Rosacea worsens
73
Hair & Skin Changes in Pregnancy
Increase or decrease growth rate Some degree of hirsutism Delivery may initiate shedding cycle Nails grow faster
74
Vascular Changes in Pregnancy
Spider telangiectasias Palmar erythema Saphenous, vulvar, hemorrhoidal varicosities
75
Pruritis Uritcarial Papules & Plaques (PUPP) of Pregnancy
Associated rash with intense pruritis 3rd trimester First on the abdomen Common in 1st pregnancies & multiples
76
Treatment for Prurits Uritcarial Papules & Plaques (PUPP)
Antihistamines | Topical corticosteroids
77
Immunologic Changes in Pregnancy
Promote maintenance of antigenic fetus Suppression of T-cell-mediated immunity Depression of most cytokines
78
Breast Changes in Pregnancy
Stimulated by estrogen & progesterone Increase in size Nipples & areola increase in size & pigmentation Colostrum secretion after delivery
79
Early Breast Changes in Pregnancy
``` Influence by hCG Increase in size Tenderness Tingle with temperature changes Secretory glands develop ```
80
Breast Changes in Late Pregnancy
Proliferation of new acini reduced Lumen become distended Parturition after delivery
81
Define Parturition
Mitotic activity & further growth & differentiation with milk secretion
82
Lactogenesis Stages
Secretory initiation | Secretory activation
83
Describe Secretory Initiation
2nd half of pregnancy | Women able to express colostrum
84
Describe Secretory Activation
Copious milk production after delivery | This due to decline in progesterone & elevation in prolactin, cortisol, & insulin

OB/GYN (12 decks)

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