1. Digestion and invasion of decidual cells, which release stored nutrient that are used by embryo for growth and development (endometrial cells --> decidual cells by progesterone).

2. Secretes hCG until placenta takes over

3. Forms the chorion and grow into lucunae filled with maternal blood to form the chorionic villi (carries fetal blood) of the placenta.

4. Amniotic cavity and its fluid surround the embryo and offers protection

1. Human chorionic gonadotropin (hcG)

2. Estrogen

3. Progesterone

4. Lactogen

5. Relaxin

10-fold increase = progesterone

30-fold increase = estrogen

1. development of decidual cells into uterine endometrium

2. Prevention of uterine contractions and sloughing of the endometrium

3. Prepare breast for lactation

1. Nausea and vomitting - 90%

2. GI reflux - 80%

3. Constipation - 25-40%

4. Hemorrhoids - prevalence higher in pregnant women

1. Gestation HTN = >140/90

2. Preeclampsia = HTN + proteinuria

3. Eclampsia = Preecclampsia (HTN + proteinuria) + seizures

Last few months (end of preggy)

- ●Rapid rise in BP in last few months of pregnancy

Cause: abnormal placentation - imperfect vascular exchange, fetal hypoxia and inflammatory mediators from placenta into maternal circulation

Preeclampsia - 

●Impaired function of vascular endothelium in kidney, brain, liver

●Leads to HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) and impaired function of kidney, liver and brain 

Preeclampsia - 

●Impaired function of vascular endothelium in kidney, brain, liver

●Leads to HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) and impaired function of kidney, liver and brain 

May be needed = Emergency C-section

Anti-convulsant = Magnesium sulfate therapy (do not give anti-seizure drugs due to teragenocity)

Unfractionated heparin and LMWH (low molecular weight heparin)

- treat through out pregnancy

- Never use warfarin = teragenonic

1. Beta blockers

2. Magnesium sulfate

3. Calcium channel blockers

4. NSAIDs

1. low molecular weight < 500

2. Lipophilic > lipophobic

3. Protein binding drugs (binds less to mother due to decrease albumin, but binds more to fetus due to increased albumin in fetus)

4. Neutral drugs and Weak bases (due to fetal pH>mother pH)

5. Active efflux transport

1. P.glycoprotein (Pgp or Mdr-1)

2. Multi-drug resistance protein-2 (MRP-2)

3. Breast Cancer Resistance Protein (BCRP)

4. Organ Anion Transporter-4 (OAT-4)

1. Organic cation transporter N-2 

2. Multi-drug resistance protein - 1 & 3 (MRP-1 and MRP-3)

1. Corticosteroids - stimulates lung maturation 

2. Antiarrhythmics - treat fetal cardiac arrhythmias

3. Anti-retrovirals - treat HIV transmission

Oxytocin - contraction of mammary myoepithelial cells causes ejection of milk from nipples

1.5 liters/day of milk

100g of lactose

2-3g of calcium phosphate

acidic

protein and fat

No irons

IgA - from mammary epithelial cells

IgG - form transplacental transport (passive immunity)

Colostrium - early mammary secretion after birth (high in immunoglobulins)

__ types of drugs are usually able to get into mother's milk and passed to baby

low orally bioavailable drugs

shorter t1/2

high protein-binding

lower lipid solubility

280 days;

40 weeks

Woman has been 

G4 - pregnant 4 times

P2 - two term deliveries

1 premature

1 ectopic pregnancy

3 living children

Dose of folic acid supplement for:

1. women of childbearing age

2. to prevent neural tube defect

1. women of childbearing age = 400 mcg of folic acid/day

2. to prevent neural tube defect = 4mg of folic acid/day

Influenza

Rubella

Hep B

Calcium

Iron 

Folic acid

Supplemental fiber +/- stool softener: Colace (Docusate sodium) and Surfak (docusate calcium)

or

Occassional use of Osmotic Laxatives: Miralax (polyethylene glycol) <-- ideal laxative in pregnancy

1. Calcium carbonate  and Sucralfate (Carafate) - Antacids

2. Ramitidine (Zantac) and Cimetidine (Tagamet) - H2 receptor antagonists

3. Metoclopramide - promotility drug

4. Omeprazole (prilosec) and Esomeprazole (Nexum) - proton pump inhibitors for COMPLICATED or SEVERE GERD

1. Vitamin B6 (pyridoxine)

2. Doxylamine (Unisom) and Dimenhydrinate (Dramamine) - Antihistamines 

3. Phenothiazines (Compazine), Promethazine (phenergan)  and Benzamide (Metoclopramide - Reglan) - Dopamine agonists

4. Ondansetron (zofran) - serotonin antagonist

5. Corticosteroid

6. Ginger

OGTT (performed in morning after 8-hour fasting) : GDM if 

1. Fasting >92 mg/dL

2. 1hr >180 mg/dL

3. 2h >153 mg/dL

6–12

A1C - do not use for GDM post-partum

dietary modification

and

additional caloric restriction (for obese women)

1. Insulin

2. Glybyride (micronase)

3. Metformin

systolic <160 mmHg

diastolic <100-105 mmHg

1. labetalol 200-2400 mg/day

2. Methyldopa 0.5-3 g per day

3. Nifedipine XL 30-120mg per day

Avoid ACEI/ARB

Carbamazepine or Lamotrigine

supplement with folic acid 0.4-5mg

False: Risk of NOT treating is greater than risk of medication.

1. Endocrine problems causing ovulatory dysfunction

2. polycystic ovarian syndrome (PCOS)

3. Uterine tube or pelvic abnormalities

4. Endometriosis or uterine factors

5. Damage from infections or antigenicity of sperm

1. Dopamine blockers - can cause hyperprolactinemia

2. Serotonic enhancers - can cause hyperprolactinemia

3. alcohol, cocaine and marijuana etc.

Nonsteroidal estrogen receptor

modulator. Blocks feedback inhibition

of hypothalamus.  Raises FSH & LH

leading and HPG function

Primary - estrogen receptors in ovaries

secondary - direct effect on ovaries

Clomiphene is converted to metabolites via CYP ___and its metabolites are eliminated primarily in the feces. 

1. ovulation induction or intrauterine insemination

2. PCOS

3. Women with normal GnRH

Women for whom clomiphene does not work are candidates for more advanced therapies.

are expensive, must be administered parenterally on a daily basis, and require extensive monitoring

Males - stimulates spermatogenesis

Female - FSH stimulates maturation and development of follicle; LH causes ovulation and stimulates the corpus luteum

____ works well in women who have infertility due to lack of midcycle gonadotropin surge. Is given IM.

Adverse effects – headache, irritability, restlessness, fatigue, edema, gynecomastia, and pain at injection site.

It is administered via portable pump with ~90 min min infusion pulse interval. Can be given SC or IV. Plasma t1/2 = 2 min.

Relates to enlarge ovaries with multiple developing ovarian follicles or cysts.  Vascular endothelial growth (VEGF) hormone makes hyper permeable blood vessels leading of shift of fluid from vascular system to abdominal and pleural cavities.

After a transient stimulation of gonadotropin secretion, they down-regulate the GnRH receptor and inhibit gonadotropin secretion

Pulsatile delivery : increase release of gonadotropin from pituitary

Continous delivery: temporary increase, then inhibits release of gonadotropin after a few weeks

 suppress LH surge but do not have initial flare stage of secretion seen with GnRH agonists

Sometimes used to stimulate endometrial growth and cervical mucus production in follicular phase

Sometimes used to promote endometrial development and maintenance during luteal phase to improve implantation and success of embryo

Can be used for treatment of infertility related to hyperprolactinemia.

Dopamine Agonists :

Adverse effects – Headache & dizziness.  Psychiatric symptoms in <1% of patients 

May increase uterine and ovarian blood flow velocity to improve function