Pregnancy Flashcards by Esme Cosham

What are the 3 stages of implantation?

The blastocyst contacts the implantation site of the endometrium (apposition)
Trophoblasts of the blastocyst attach to the receptive endometrial epithelium (adhesion)
Invasive trophoblasts cross the endometrial membrane (invasion)

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As the trophoblasts migrate across the endometrial tissue, what do they come across?

NK cells (these NK cells only appear in this area around this period of implantation)

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What are villous trophoblasts?

Villous trophoblasts cover the chorionic villi and are involved in the exchange of gas and nutriments between the mother and the fetus.

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What are extravillous trophoblasts?

Invasive

Only class I human leucocyte antigens (Cw, G, E; A&B not expressed)
Less attractive to cytotoxic T-cells
Enables binding to NK cells

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What does the blastocyst then release into the endometrium?

hCG

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What is hCG produced by?

Trophoblast cells

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What type of molecule is hCG?

Glycoprotein

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What effect does hCG have?

Luteotrophic: continues to stimulate the corpus luteum - progesterone (vital for fetal survival)

Production is autonomous - independent of hypothalamus and pituitary

Thought to be the cause of “morning sickness”

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What do pregnancy tests detect?

Levels of hCG

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How are miscarriages managed medically?

Progesterone receptor antagonist (mifepristone) in combination with a prostaglandin analogue (misoprostol)

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How does the blood volume change during pregnancy?

40% increase (Increase in total body water content and plasma volume)

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How does red cell mass change during pregnancy?

Red cell mass increases (increased erythropoietin) – but not as much as blood volume –> ‘physiological anaemia’

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How does oestrogen affect RAAS?

Oestrogen stimulation of renin-angiotensin-aldosterone leads to water and sodium retention

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How does cardiac output change during pregnancy?

Increases 30-50% in pregnancy

rise in stroke volume (30%) and heart rate (10%

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What is pre-eclampsia?

Condition that affects some pregnant women, usually during the second half of pregnancy (from around 20 weeks) or soon after their baby is delivered.

One of leading causes of maternal death globally.

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What are the indications of pre-eclampsia?

Persistently high BP
Proteinuria
Peripheral oedema

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What are other clinical signs of pregnancy due to changes in cardiovascular?

Fainting
Haemorrhoids
Varicose veins

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What happens to coagulation during pregnancy? What can this lead to?

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Increased clot formation
Decreased clot lysis

Increased risk for thromboembolism

Why is there increased clot formation?

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Increased factors I, V, VII, VIII, IX, X, XII

Why is there decreased clot lysis?

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Increased plasminogen activator inhibitors (placenta)

Activated protein C resistance

Reduced protein S levels

How does O2 consumption change during pregnancy?

How does respiratory system compensate for this?

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Increase in O2 consumption to meet needs of developing fetus

Increase in tidal volume
Vital capacity unchanged
Increase in alveolar ventilation

How is this respiration increased?

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Change in central control of respiration:

altered chemoreceptor PaCO2 sensitivity,
triggers increase respiration

What is the clinical consequence of increased respiration?

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Disproportionate sense of dyspnoea on exertion

How does renal blood flow change during pregnancy?

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Increase in renal blood flow:

Rise in plasma volume and CO
Fall in renal vascular resistance/increase in renal vasodilatory prostaglandins (PGI2; PGE2)

How is GFR affected?

Increase in GDR

How does this increase in GFR affect urea and creatinine?

Urea and creatinine fall as no change in production | Renal threshold to glucose also diminished

How does pregnancy affect bladder?

- Bladder capacity decreases | - Increased tendency to UTIs

How does pregnancy affect stomach?

- Decrease in motility | - Lower oesophageal pressure and incompetence of cardia (nausea and heartburn)

What are consequences of decrease in stomach motility?

Prolongation of gastric emptying; prolongation of transit time, increase in water reabsorption Constipation: transition time extended, greater water reabsorption

How does pregnancy affect breasts?

- Increase size - Heaviness - Tingling - Fullness - Darkening of nipple - Thin watery secretion

How does pregnancy affect respiratory system?

- Increased tidal volume - Increased O2 consumption - Elevated diaphragm (due to growing baby) - Nasal stuffiness - Epistaxis (nose bleeds due to vasodilation)

How does pregnancy affect GI system?

- Pregnancy gingivitis (swelling of gums) - Increased saliva - Decreased gastric acidity - Nausea and vomiting - Decreased tone and motility of smooth muscles (reflux and constipation) - Haemorrhoids and constipation - Decreased emptying of gall bladder

How does pregnancy affect vagina?

- Oestrogen influence - Hypertrophy - Hyperplasia of lining - Increased thick white secretions

How does pregnancy affect integumentary system?

- Increased skin pigmentation - Facial mask - Acne vulgaris - Dermatitis (skin irritation) - Vascular spider nevi (an enlarged blood vessel in the skin from which smaller blood vessels extend) - Stretch marks (linea nigra --> 'pregnancy line')

How does pregnancy affect nutrition?

- Normal weight gain 20-30 lbs - Balanced diet (increased folic acid and iron, increased caloric intake by 300 cal/day) - Increased need for H20

How does pregnancy affect muscoskeletal system?

- Increased lumbosacral curve - Altered centre of gravity - Duck waddling gait

How does pregnancy affect CV system?

- Increased blood volume - Increased heart rate - Increased cardiac palpitations - Heart enlargement - Murmurs - Pseudoanaemia (pale skin but without blood changes, due to excess water)

How does pregnancy affect urinary-renal system?

- Increased urine frequency - Decreased bladder tone - Decreased renal threshold for sugar - Increased glomerular filtration - Decreased BUN (blood urea nitrogen), creatinine, uric acid

How does pregnancy affect uterus?

- Increased size and weight - Increased fibrous connective tissue - Braxton Hicks (false labour pains) - Cervical softening - Mucus plug

How does pregnancy affect endocrine system?

Placenta: - Produces hCG and hPL Thyroid: - Increases in size and activity - Increased basal metabolic rate - Increased parathyroid activity Pituitary: - Enlarges 9th month - Produces FSH, LH, thyrotropin, adrenotropin, prolactin

When is 1st stage of labour?

4-10 cm dilation of cervix

When is 2nd stage of labour?

10cm to birth Typically 2-3 hours

When is 3rd stage of labour?

Birth of baby to birth of placenta Typically 1 hour

What vessels does umbilical cord contain?

- 2 arteries (deoxy blood) | - 1 vein (oxy blood)

Pregnancy Flashcards

(44 cards)