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2019 | OriginalPaper | Hoofdstuk

17. Maternal adaptations

Auteur : Sicco A. Scherjon

Gepubliceerd in: Textbook of Obstetrics and Gynaecology

Uitgeverij: Bohn Stafleu van Loghum

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Summary

The functional and subjective changes in the mother around her pregnancy are profound and may resemble signs and symptoms of diseases. Equally impressive is the quick return to a pre-pregnancy situation after delivery. These adaptations affect nearly every organ system and are essential for normal maternal pregnancy and normal foetal development. Changes in eating habits are one of the first physiological symptoms of pregnancy. During pregnancy, the maternal body weight increases by on average 12 kg. The importance of the placenta is well recognized. Pregnancy is characterized by a hyperdynamic cardiovascular state. Peripheral insulin resistance becomes more prominent during pregnancy making pregnancy a state of hyperinsulinism with increased glucose levels. Respiration is more efficient during pregnancy, although most pregnant women have a subjective feeling of mild dyspnoea. From early pregnancy onwards there is a substantial increase in renal plasma flow. Nowadays the importance of the human microbiome for normal development of pregnancy is well realized.
Bijlagen
Alleen toegankelijk voor geautoriseerde gebruikers
Woordenlijst
Basal metabolic rate
Amount of energy spent while at rest
Bicornuate uterus
Uterus composed of two ‘horns’, separated by a septum
BMI
Body mass index; kg/m2
Candidiasis
Fungal infection due to any type of Candida (a type of yeast)
Cholecalciferol
Vitamin D3, made by the skin following UVB light exposure and present in some foods, converted into calciferol (25-hydroxyvitamin D)
Cholestasis
Insufficient flow of bile from the liver to the duodenum due to obstruction or metabolic disturbances of bile formation
Colloid oncotic (or osmotic) pressure
Physiochemical phenomenon caused by differences in protein concentrations (notably albumin) in fluid compartments separated by a semipermeable membrane
Corpus luteum
‘Yellow body’; temporary endocrine structure in the ovaries remaining after ovulation, producing progesterone (and oestradiol and inhibin A)
Decidua
Uterine lining during pregnancy, already formed before pregnancy, under the influence of progesterone
Diabetes insipidus
Condition characterized by increased thirst and large amounts –up to 20 l/day- of diluted urine, probably caused by increased placental production of vasopressinase
Dyspnoea
Shortness of breath
Erythropoietin (EPO, haematopoietin)
Glycoprotein produced by the kidney after cellular hypoxia, stimulating red cell production in the bone marrow
Euthyroid
Normal thyroid function, with normal plasma levels of TSH and T4
Fibrinolysis
Process preventing blood clots from developing by degradation by plasmin of the fibrin mesh
Fundus
Top portion of the uterus, opposite of the cervix
Gingivae
(Gums); mucosal tissue inside the mouth
Haemochorial
Placentation –as in the human- whereby the chorion is in direct contact with maternal blood
Haemodilution
Increased plasma volume leading to a low haematocrit (low concentration of red blood cells) and hyponatraemia
Hyperdynamic circulation
Circulation characterized by high flow and low resistance to flow (relaxation of vessel walls)
Hyperfiltration (glomeruli)
Physiological state during pregnancy were the glomeruli in the kidney produce increased amounts of pro-urine
Hyperinsulinaemia
Excess levels of circulating insulin relative to the level of glucose
Hyperlipidaemia
Elevated levels of any/all lipids or lipoproteins in the blood
Hypothalamus
Brain portion, part of the limbic system, located below the thalamus, linking the nervous system to the endocrine system (regulating metabolic processes) via the pituitary glands
Lactotrophic cells
Cells located in the anterior pituitary producing prolactin, stimulated by thyrotropin-releasing hormone and also regulated by oxytocin
Lung volumes
Volumes of air in the different phases of the respiratory cycle; such as total lung capacity (TLC: 6 litres) and tidal volume (TV: volume of air inhaled in a single breath)
Macrosomic
Indicative of a high prenatal growth rate. Several –sometimes confusing- definitions are used such as large for gestational age (LGA: > P90 or > P97) or a weight > 4 kg or > 4.5 kg
Microbiome
Ecological community of commensal, symbiotic and pathogenic microorganisms, including bacteria, archaea, fungi and viruses, crucial for immunological, hormonal and metabolic homeostasis
Molar pregnancy (hydatidiform mole)
Gestational trophoblastic disease caused by a non-viable fertilized egg not containing the original maternal nucleus (DNA only originates from the sperm cells), resulting in trophoblast overgrowth
Nausea
A non-specific sense of discomfort in the upper stomach with an involuntary urge to vomit
(Maximal) oxygen uptake (VO2)
Maximum rate of oxygen consumption measured during incremental exercise, reflecting cardias fitness
Parasympathetic (nervous) system (PSNS)
Part of the autonomic nervous system, complementary to the sympathetic nervous system (‘fight or flight’), responsible for stimulation of a rest state (‘rest and digest’ and ‘feed and breed’) related to salivation, lacrimation, urination, digestion, defaecation and for sexual arousal
Procoagulants
Inactive coagulation protein (such as prothrombin, factor Xa), activated during the clotting process, producing serine protease or a co-factor resulting in the formation of a fibrin clot
Ptyalism
Increased production of saliva
Pyrosis
Burning sensation in the chest (oesophagus) due to gastric reflux
Shear stress
A force generated by blood on endothelial cells, deforming these cells in the direction of the flow, eliciting cytoskeletal remodelling and the release of e.g. NO (and eNOS), prostacyclin and ICAM-1
Semi-allograft
Foetal-placental unit: a ‘transplant’ where half of the genes come from another individual
Somatotropic cells
Cells constituting 20 % of the anterior pituitary cells, releasing growth hormone (GH) in response to GNRH and inhibited by GH inhibiting hormone (somatostatin) coming from the hypothalamus
Syncytiotrophoblast
Epithelial outer layer (syncytium: fused cytotrophoblast cells) of the trophoblast covering of (embryonic) villi
Trophoblast
Outer layer of the blastocyst (originally to trophectoderm), forming two layers around the core of the placental villi: an inner core of cytotrophoblast (mononuclear) and an outer core of syncytiotrophoblast (multinucleated)
Ureterocalyceal dilatation
Increase in ureter and kidney calyces diameter most prominent on the right side
Uterus myomatosus (uterine fibroids)
Uterine leiomyomas or fibroids are benign smooth muscle tumours of the uterus
(Arginine) vasopressin (AVP or ADH)
Antidiuretic hormone (ADH), in structure resembling oxytocin, produced by the hypothalamus, released in the bloodstream via the posterior pituitary, stimulating water reabsorption and constricting arterioles (increasing blood pressure)
Literatuur
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Metagegevens
Titel
Maternal adaptations
Auteur
Sicco A. Scherjon
Copyright
2019
Uitgeverij
Bohn Stafleu van Loghum
DOI
https://doi.org/10.1007/978-90-368-2131-5_17