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Physiologic Changes of Pregnancy Questions with Answers
1.What are the largest cell in the human body?: oocyte 2.True or false: oocytes are usually fertilized within 12 hrs of ovulation: true 3.What are the smallest cells in the human body?: sperm
- What is the relationship between uterine contractions and sperm?: uterine contractions facilitate sperm transport through the uterus to the fallopian tubes
- What is capacitation?: when sperm rub off their protective glycoprotein layer while waiting for the oocyte 6.Where does fertilization most often occur?: ampulla of the fallopian tubes 7.What are sperm able to secrete after capacitation occurs?: hyaluronidase 8.What is the role of hyaluronidase?: helps the sperm break down hyaluronic acid (major component of the follicular layers surrounding the egg) 9.What does penetration of a single sperm into the ovum result in?: zygote 10.Which stage of pregnancy begins with fertilization and ends with implan- tation of the zygote into the endometrium?: germinal stage 11.What occurs as the zygote travels through the fallopian tube?: rapid
mitotic division 12.What are the 2 parts of the germinal stage?: morula & blastocyst 13.What is the morula part of the germinal stage?: when rapid mitotic divisions occur producing a "mulberry like" mass of cells 14.What is the first mitotic division of the germinal stage known as?: cleavage (occurs 36 hrs post-fertilization) 15.When does the morula stage end?: when the zygote secretes enough fluid to develop/form a fluid-filled cavity within the mass of cells 16.What is the hollow, fluid-filled sphere of cells left at the end of the morula stage known as?: blastocyst 17.What surrounds the blastocyst?: zona pellucida (eventually will dissolve and allow the zygote to influence the endometrium) 18.What are the 2 parts that the blastula differentiate into?: - the inner cell mass (5 embryo-producing cells)
- placental precursors (53 cells destined to form trophoblasts) 19.How does the blastocyst implant into the endometrial decidua?: adheres, then burrows until it is completely covered by the endometrium 20.What do trophoblasts produce after invading the endometrium?:
30.Where do the chorionic villi emerge? What is their role?: emerge from the chorion and have a rich blood supply so they allow for transfer of nutrients/oxy- gen/waste products between maternal and fetal blood without mixing 31.What are the branching chorionic villi located where the placenta is at- tached known as?: chorion frondosum (resemble a leafy tree) 32.What happens to the chorionic villi located against the uterus? What is this called?: the villi atrophy resulting in chorion leave (flat chorion) 33.What is the inner layer of the fetal membrane?: amnion 34.What is the amnion and what is its purpose?: envelops the embryo in a fluid filled balloon to act as a buffer against mechanical injury, accommodate growth, allow movement, protect fetus from adhesions, provide a barrier to infection and body temp control
35. How is amniotic fluid secreted/diffused early in pregnancy (first 20 wks)?- : diffuses directly through the fetal skin and is secreted directly by the amniotic membrane 36.How is amniotic fluid secreted in later pregnancy?: fetal urine 37.How is amniotic fluid removed?: reabsorbed by fetal swallowing & GI
tract via the placenta and into the maternal bloodstream 38.Compare polyhydramnios and oligohydramnios:: polyhydramnios = too much amniotic fluid oligohydramnios = not enough amniotic fluid 39.What is another name for dizygotic twinning?: fraternal twins 40.How does dizygotic twinning occur?: fertilization of 2+ eggs produced in the same menstrual cycle 41.What are 3 things that increase the incidence of dizygotic twinning?: family hx, ethnicity (MC in African populations), maternal age (increasing age more likely) 42.What is another name for monozygotic twinning?: identical twins 43.How does monozygotic twinning occur?: splitting of a single embryo 44.True or false: zygosity can be determined using US, examination of the placenta, sex of the fetus, blood grouping, HLA typing, and DNA analysis: true 45.What type of placenta do dizygotic twins have?: dichorionic diamniotic (ba- sically boils down to 2 separate pregnancies in the uterus at the same time)
stopped if the uterine muscles contracts around them 52.What happens to the placental blood flow during a Braxton Hicks contrac- tion?: this is a weak contraction so while venous exits close, the arteries are only slightly narrowed which means the blood supply remains mostly uninterrupted 53.What happens the the placental blood flow during a true labor contrac- tion?: this is a strong contraction so most of the arteries are devoid of any flow which means that intermittently maternoplacental flow virtually ceases (reduce oxygen to the fetus) 54.What stage of fetal development begins with implantation of the blastocyst and ends when the bone cells begin to replace cartilage (ossification)?: em- bryonic stage 55.What are the 3 cell structures that the blastocyst has differentiated into by the embryonic stage?: yolk sac, amniotic cavity, embryonic disc 56.What is the double layer of cells which will form the embryo?: embryonic disc 57.What is responsible for producing fetal blood cells until the spleen, liver, and bone marrow are mature enough to take over?: yolk sac 58.What surrounds the developing fetus in a cushion of shock
absorbing fluid?: amniotic cavity 59.Which trimester is primarily made up of the embryonic stage and is when most of the differentiation of cells occurs?: first trimester (wk 1-13) 60.Which trimester has an emphasis mostly on growth of organs?: second trimester (wk 14-27) 61.Which trimester revolves around refinement of the organ systems?: third trimester (wk 28-40) 62.What 4 things occur during the first 1-2 wks of the embryonic stage?:
- implantation occurs
- embryonic disc is formed
- amniotic & yolk sacs form
- chorionic villi begin to form 63.What 3 things occur during the 3d wk of the embryonic stage?: - major development in CNS & heart
- chorionic sac begins to develop around embryo
- embryonic disc well defined 64.What 2 things occur during the 4th wk of the embryonic stage?: - heart and pericardium are prominent
- heart begins to contract effectively
- embryo now resembles a human
- if male, gonads start to develop 68.What stage of fetal development starts with the ossification of bone to replace cartilage and ends with confinement (delivery)?: fetal stage 69.What occurs at 9 wks during the fetal stage?: start of ossification in the bones 70.What 5 things occur during wk 10 of the fetal stage?: - primitive reflexes of nervous system
- appearance of finger & toe nails
- teeth begin to form
- liver & spleen begin to take over blood formation from the yolk sac
- if female, gonad development occurs 71.What occurs at wk 11 of the fetal stage?: respiratory like chest movements 72.What 2 things occur at wk 14 of the fetal stage?: - sexual differentiation is definite
- renal & GI fxn begins 73.When does the fetal stage enter the stage of organ growth rather than differentiation?: 18 wks (2nd trimester)
74.True or false: from 22 wks & onward the fetus can hear sounds, lungs and GI tract continue to mature, and the brain continues to develop: true 75.When does the placenta begin to deteriorate?: 2 wks before delivery 76.What are the 3 components to the endocrinology of pregnancy?: fetus, placenta, mother (mother is least important) 77.True or false: the fetoplacental until largely controls the endocrine events of pregnancy: true 78.How long does the corpus luteum secret gestational steroids (proges- terone)?: conception to 12-13 wks 79.What takes over steroid (progesterone) production at 13 wks?: placenta (takes over as the corpus luteum phases out) 80.When is hCG detectable?: 8 days after ovulation (1 day after implantation) 81.How much does hCG change?: doubles every 1-3 days (can rise as little as 66% in 48 hrs) 82.What is the discrimination zone that indicates the threshold of viable intrauterine pregnancy?: 1500-2000 mIU/mL hCG
89. What hormone causes cervical ripening and uterine contractions?: - prostaglandins 90.What happens to the blood volume during pregnancy?: blood volume in- creases 91.What causes the physiologic anemia of pregnancy?: plasma volume dispro- portionately increases more than RBCs causing a drop in HCT by 3-+% by 30 wks 92.What happens to peripheral resistance and BP during pregnancy?: both will decrease slightly but rise back to near normal at term 93.True or false: increasing uterine size can result in left upward displacement of the heart and left axis deviation on EKG: true 94.What happens to HR, SV, and CO in pregnancy?: they all increase early in pregnancy (12-24ish wks) 95.What type of murmur is commonly heard during pregnancy?: systolic ejec- tion murmurs 96.What is supine hypotensive syndrome? What relieves it?: when a pregnant women assumes a supine position she accentuates venous compression (baby sits on IVC) which results in a fall in BP
to relieve the symptoms (nausea, dizziness, bradycardia, syncope) pt should roll onto her side 97.What causes an exacerbation in varicose veins in the LE during pregnan- cy?: elevated LE venous pressure 98.True or false: pregnant pts have a propensity for thrombosis: true (gotta watch out for DVT/PE) 99.True or false: oxygen consumption by peripheral body tissues increases during pregnancy: true
- What happens to TV and RR in pregnancy?: both increase, resulting in increased ventilation
- What is a protective mechanism to prevent the fetus from being exposed to high levels of CO2? What does the mother develop because of this?: hyper- ventilation -> mild respiratory alkalosis & high pO
- Why does maternal renal blood flow increase during pregnancy?: improve filtration
- What happens to the eGFR in pregnancy?: increased
- True or false: hydronephrosis can be a physiologic part of pregnancy: true
- What can urinary stasis increase the risk of in a pregnant pt?:
pregnancy)
- Why are gallstones rarely symptomatic during pregnancy?: progesterone relaxes the gallbladder
- Why is it important for a pregnant woman to take prenatal vitamins w/iron supplement?: because increased erythropoiesis increases the consumption of iron both by the mother and by the fetus (who takes from the mom's iron stores)
- True or false: a physiologic leukocytosis is normal in pregnancy: true 116. True or false: a physiologic thrombocytopenia is normal in pregnancy: - true
- What are pregnant women at an increased risk of developing due to their hypercoagulable state?: DVT
- What is key to the fetal allograft (mom and fetus being immunologically aware of one another yet a tolerance exists)?: placenta -
acts as a barrier & produces hormones that suppress maternal immune response locally 119. True or false: the specific mechanisms of the immune response
are not significantly affected in the mother (NOT immunosuppressed), however, pregnant women are at a higher rise for severe infection & death from viruses, bacteria, and parasites: true
- What is the only immunoglobulin that crosses the placental barrier and provides passive immunity to the fetus?: IgG
- What are striae gravidarum?: stretch marks; there is a genetic predisposition for their devlopement
- What is diastasis recti?: separation of the left and right sides of the rectus abdominis muscle by stretching the linea alba (weak spot in the abdominal wall)
- What is linea nigra?: darkening of the linea alba that stretches from the umbilicus to the pubis
- What physical sign can be the earliest sign of pregnancy?: beast tingling and tenderness
- Describe some of the breast changes seen in pregnancy:: - become more nodular
- nipples enlarge, are more erectile, more deeply pigmented
- areola become broader & darker
- What are 4 MSK changes that occur in pregnancy?: - increased joint mo- bility
- progressive lordosis (weight & position of uterus)
- carpal tunnel syndrome (fluid accumulation)
- leg cramps
- True or false: pregnancy increases nutritional requirements: true
- What is pica?: Eating non-food items including ice, paper, dirt, hair.
- What happens to protein metabolism in pregnancy?: there is an increase in demand from the fetus, placenta, and mom
- What happens to insulin levels throughout pregnancy?: early on insulin levels will be slightly higher leading to a low fasting glucose but by mid-pregnancy insulin resistance occurs and hyperglycemia can result
- What happens to lipid levels in pregnancy?: increase
- Normal function of what is critical for normal fetal development, especial- ly intellectual development?: thyroid
- What thyroid changes are seen during pregnancy?: thyroid enlarges, basal metabolic rate (BMR) increases, TBF increases so T
and T4 increase
- When is the uterus palpable above the pubic symphysis and fetal heart tones noted?: week 12
- When is the uterus palpable midway between the pubic symphysis and umbilicus?: 14-16 weeks
- When is the uterus palpable at the level of the umbilicus?: 20 weeks
- When does the height of the uterine fundus correspond roughly to ges- tational age?: 20-38 wks
- When is the uterus palpable 2-3 cm below the xiphoid process?: 38-40 wks (term) 147. What are some changes that the cervix undergoes during pregnancy?: - softens, becoming thinner and more elastic cervical cyanosis may be present cervical glands give the cervix a velvety appearance
- What is the role of the cervical mucus plug in pregnancy?: acts as a barrier against ascending pathogens
