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51 Cards in this Set

  • Front
  • Back
outline physical changes to woman
uterine enlargement
cervical plug
breast tissue
decidualisatin
bone content
muscle added to ventricular wall
weight gain
describe uterine enlargement in pregnancy?
20 x size
pear shaped to globular to ovoid
what seals the cervix?
mucus plug
what happens to the heart, physically, in pregnancy?
increased muscle mass on ventricular wall
what is responsible for maternal weight gain?
extra blood volume, uterus, baby
what changes occur in maternal bones?
changes in calcium concentration
outline cardiovascular changes in mother?
heart rate increase from 70 to 85
stroke volume incrase from 63 to 71
cardiac output increase from 4 - 6 then to 8 in labour
what happens to venous return?
uterus falls back on IVC
decreased venous return, decreases cardiac output in last trimester
what happens to cardiac output in last trimestr
decreases due to decreased venous return
how much cardiac output does the placenta take?
25%
what happens to plasma volume in pregnancyy?
increases by up to 50%
babies weight proportional to it?
what happens to blood pressure during pregnancy
falls at mid term rises to full term
what happens to total peripheral resistance in pregancy and why?
falls at mid term by 40% then rises again at full term
due to increased vascular bed / relaxation of vascular tone
possibly due to low grade inflammatory state
what are the respiratory changes?
total lung capacity falls
minute ventilation increases from 6 - 10
funcitonal residual capacity decreaases
tidal volume increases
hyperventilation
what are the changes to blood oxygen carrying capacity?
increaes by 20%
what are the changes to oxygen consumption?
increases by 15%
what are the changes to haematocrti?
falls
what are the changes to total Hb content of blood?
increases
how much more iron does pregnant woman need?
700-1400mg /day
childbirth = 250mg or iron
what percentage of women have low ferritin stores in pregnancy?
40%
discuss iron absopritpn / use in pregnancy?
increased iron absorption in GI tract
crosses placenta by transferrrin receptor
what are B12 and B9 needed for?
DNA and RNA syntheiss
synthesis of methionine synthase which recylcles methionine from homocysteine
describe basic renal changes in pregnany?
expansion of calyces, pelvis, ureters
RPF and GFR rate increase
natiuresis
glucose loss
increased creatinine clearance
what happens to normal ranges in pregnancy?
often change
eg creatinne clearance increaes so chnages from being 60 - 120 to less than 75
why does GFR and RPF decrease in pregnancy
decreased renal vascular resistance
possibly due to increased NO synthase
why does natriuresis occur
increased GFR - increased delivery
also increased progesterone - mild natruietic and vasodilator
why does glucose excretion rise in pregnancy?
TmG falls to a level below glucose delivery
glucose deliver increases due to increased GFR
what does glucose excretion in pregnancy cause?
low plasma glucose levels in first trimester
what happens to amino acid excretion in pregnancy?
increased GFR - increased amino acids filtere
increased excretion
can cause environemnt for UTIs
also sig. nutrient loss
what happens to carbohydrate metabolism in 1st trimester?
low glucose levels
switch to fatty acid metabolism
placental somatomammatropin encourages switch to fatty acid metabolism and decreased use of glucose by mother
storing of glucose
what happens to the mothers response to glucose load in pregnancy?
gets less effective
requires more insulin to achieve baseline / takes longer
what happens to insulin in first trimester?
insulin secretion increases
insuiln sensitivity increases
at what week is there a change in carbohydrate metabolism?
week 20
what occurs at week 20?
insulin resistance begins to take over
further change to fatty acid metabolism
hepatic gluconeogenesis and glycogen breakdown
increased glucose levels
what hormones are involved in insulin secretion and action ?
estrogen
progesterone
leptin
placental lactogen
cortisol
placental somatommammotrophin
what does estrogen do to insulin?
increases secretion
increases sensitivity
why is the mucosa of the endometrium unique?
must be immunocompetent butt not reject fetus
what does leptin do?
increases insulin resistance
what does cortisol do?
increaes insulin resistance
discuss lympocyte trafficking from uterus
does not occur
what kind of MHCs does endometrium have?
HLA G and C
what is dilution of antigens?
idea that antibodies do cross
but are diluted as many cells have antigens
does not occur in rhesus antibodies
what is placental selectivity
theory that placenta is selective for IgG but does not allow anti-fetal antibodies across
problem = rhesus
describe fetal allograft hypothesis
1) MHCs on EVTs switched to G and C
2) uterine killer cells interact, regulate invasion and immunity
3) lymphatic supply decreases
4) dendritic cell distribution occurs. may release cytokines Il10 which are antiinflammatory
5) T reg cells dampen immune response
what is the chnaging maternal self hypothesis?
syncytial knots released from placenta
phagocytosed
dendritic cells interact with T cells
cause T cell apoptosis or conversion to T reg cells
describe changes to cervix in preparation for labour?
softening and dilation
relaxin - dissociation of tough connective tissue
what is the placental clock?
CRH increases thorughout pregnancy
oestrogen increases
how does the uterus prepare for brith?
increased connexons due to high oestrogen levels
increased sensitivity (100x) to oxytocin
what kind of contraction occurs in 3rd trimester?
Braxton Hick's contractions
false labour
what is labour?
positive feedback cycle
involves oxytocin and prostaglandin
describe involution of uterus?
caused by oxytocin
stimulated by breastfeeding