Review Practice Exercise 3

Physiological Maternal Changes > Maternal Newborn

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Practice Exercise 3

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Total Questions : 5

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Question 1:

What is the primary role of human chorionic gonadotropin (hCG) in early pregnancy?

A. Promotes insulin resistance B. Maintains the corpus luteum C. Increases thyroid hormone production D. Relaxes smooth muscles

Answer and Explanation

Choice A:

Promoting insulin resistance is primarily mediated by human placental lactogen (hPL), not hCG. hPL increases maternal lipolysis and reduces insulin sensitivity, ensuring more glucose is available for the fetus. hCG has no direct role in glucose regulation.

Choice B:

hCG maintains the corpus luteum in the first trimester. This prevents luteal regression and ensures sustained progesterone production, which maintains endometrial decidualization and prevents menstruation. The question stem asking about the primary role makes this the correct response.

Choice C:

hCG has mild thyrotropic activity due to structural similarity with thyroid-stimulating hormone (TSH), which may increase thyroid hormone levels in some women, but this is not its primary role. Normal TSH range is 0.4–4.0 mIU/L, and clinically significant changes are uncommon in healthy pregnancy.

Choice D:

Relaxation of smooth muscles, such as the uterus and gastrointestinal tract, is primarily mediated by progesterone, not hCG. Progesterone reduces uterine contractility and slows intestinal motility, leading to symptoms su

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Question 2:

Which hormone is primarily responsible for relaxing smooth muscles throughout the body during pregnancy, leading to effects such as heartburn and constipation?

A. Estrogen B. Human chorionic gonadotropin (hCG) C. Progesterone D. Human placental lactogen (hPL)

Answer and Explanation

Choice A:

Estrogen primarily stimulates uterine growth, increases blood flow, and enhances oxytocin receptor expression in the myometrium. It does not relax smooth muscle but instead contributes to uterine excitability in later pregnancy.

Choice B:

Human chorionic gonadotropin (hCG) maintains the corpus luteum in early pregnancy, ensuring continued progesterone secretion. It does not directly act on smooth muscle relaxation.

Choice C:

Progesterone relaxes smooth muscle by reducing myometrial excitability, lowering uterine contractility, and suppressing prostaglandin activity. This action prevents preterm uterine contractions while also leading to systemic smooth muscle relaxation effects like gastroesophageal reflux and constipation.

Choice D:

Human placental lactogen (hPL) regulates maternal metabolism by promoting lipolysis and inducing insulin resistance, ensuring glucose availability for the fetus. It has no role in smooth muscle tone regulation.

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Question 3:

Which hormone promotes insulin resistance in pregnancy?

A. Human chorionic gonadotropin B. Human placental lactogen C. Estrogen D. Progesterone

Answer and Explanation

Choice A:

Human chorionic gonadotropin (hCG) maintains the corpus luteum in early pregnancy and supports progesterone secretion. It does not influence insulin sensitivity or glucose regulation.

Choice B:

hPL promotes insulin resistance by antagonizing insulin action in maternal tissues. This spares glucose for the fetus while shifting maternal metabolism toward lipolysis. The physiologic insulin resistance peaks in the second and third trimesters, helping maintain fetal growth.

Choice C:

Estrogen promotes uterine growth, increases uteroplacental blood flow, and enhances myometrial oxytocin receptor expression. It does not play a significant role in maternal insulin resistance.

Choice D:

Progesterone relaxes smooth muscles, maintaining uterine quiescence and reducing gastrointestinal motility. While it indirectly affects glucose metabolism, it is not the primary hormone responsible for insulin resistance in pregnancy.

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Question 4:

The primary role of human placental lactogen (hPL) is to:

A. Relax uterine smooth muscle B. Maintain the corpus luteum C. Increase maternal resistance to insulin, making more glucose available for the fetus D. Promote cervical softening

Answer and Explanation

Choice A:

Relaxation of uterine smooth muscle is mediated by progesterone, not hPL. Progesterone maintains uterine quiescence by reducing myometrial excitability and preventing premature contractions.

Choice B:

Maintenance of the corpus luteum is the role of human chorionic gonadotropin (hCG), which supports progesterone production in early pregnancy. hPL has no direct function in corpus luteum support.

Choice C:

hPL increases maternal insulin resistance, which decreases maternal glucose utilization and increases circulating glucose for fetal transport. This adaptive mechanism ensures that fetal energy needs are prioritized, especially during the second and third trimesters.

Choice D:

Cervical softening is mediated by prostaglandins and relaxin, which remodel collagen in cervical tissue. hPL does not directly influence cervical ripening.

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Question 5:

Which of the following are hormonal changes that support pregnancy? Select all that apply.

A. Increased human chorionic gonadotropin B. Increased human placental lactogen C. Decreased estrogen D. Increased progesterone E. Decreased thyroid hormone production

Answer and Explanation

Choice A:

Increased hCG supports the corpus luteum in early pregnancy, ensuring continuous progesterone production until placental steroidogenesis becomes sufficient.

Choice B:

Increased hPL promotes maternal insulin resistance, sparing glucose for fetal use and enhancing maternal lipolysis for alternative energy sources.

Choice C:

Estrogen does not decrease; it significantly increases during pregnancy, stimulating uterine growth, breast development, and increasing uteroplacental perfusion.

Choice D:

Increased progesterone maintains uterine quiescence by reducing myometrial excitability, while also contributing to smooth muscle relaxation in other systems.

Choice E:

Thyroid hormone production does not decrease; in fact, mild increases occur due to hCG’s thyrotropic effect, with free thyroxine (T4) levels slightly rising in early pregnancy. Normal maternal free T4 range is 0.7–1.9 ng/dL.

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Practice Exercise 3

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