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Y2 LCRS 1 - RDA > 3. Pregnancy & Labour > Flashcards

3. Pregnancy & Labour Flashcards

1
Q

What are the maternal changes that occur from 1st trimester?

A 
Altered brain function
Altered hormones
Altered appetite (GI imbalance)
Altered emotional state
Altered immune system
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2
Q

What are the maternal changes that occur from 2nd trimester?

A 
Increased blood volume
Increased blood clotting tendency
Decreased blood pressure
Altered fluid balance
Altered joints
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3
Q

Which maternal hormone peaks at around (1st trimester) 10 weeks?
Where is it produced?

A

hCG

Maternal placenta

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4
Q

What are the placental functions?

A 
SEBIC
Separation
Exchange
Biosynthesis
Immunoregulation
Connection
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5
Q

What is the sources of production of progesterone?

A
  • From fertilization to about 8 weeks gestation, corpus luteum is the main source of progesterone, which is sustained by increasing levels of hCG
  • Placenta can also produce progesterone (but small size in 8 weeks)
  • By 10 weeks of gestation, the placenta is the source of all progesterone
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6
Q

Describe what major event critical for later growth of foetus happens at around 8 week gestational age?

A

Remodelling of spiral arteries of placenta by cytotrophoblast cells (1st trimester to 16-18 weeks GA)

i. Cytotrophoblast shell limits blood (oxygen) supply to embryo during early development
i. Vascular endothelium, and underlying smooth muscle cells are lost, replaced by cytotrophoblast (from shell)
ii. Narrow, vasoactive spiral arteries are slowly converted to wide-bore vessels that transport large volumes of maternal blood to placenta

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7
Q

What is the definition of labour?

A

Onset of regular uterine contractions accompanied by progressive effacement and dilatation of the cervix

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8
Q

What happens in the 3 stages of labour?

A 
1st: (many hours)
Onset of regular myometrial contractions
Associated dilatation and effacement of cervix (until full dilatation)
2nd: (hours)
Rupture of foetal membranes
Delivery of infant
3rd: (30 mins)
Delivery of placenta and membranes
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9
Q

What are the factors resulting in initiation of PRETERM labour?

A

Intrauterine infection
Intrauterine bleeding
Multiple pregnancy
Maternal stress

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10
Q

Describe changes in cervical ripening and effacement.

A
  • Change from rigid to thin, flexible structure
  • Remodelling (loss) of ECM
  • Recruitment is leukocytes (neutrophils)
  • Inflammatory process
    Prostaglandins E2, IL-8
    Local paracrine change in IL-8
    Inhibits collagen synthesis and encourage collagen breakdown
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11
Q

What are some key mediators in co-ordinated myometrial contractions.

A

Prostaglandin F2-alpha and E2 levels increased from foetal membranes
Oxytocin receptors increased
Contraction associated proteins

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12
Q

What causes the rupture of foetal membranes?

A

Loss of strength due to changes in amnion basement membrane

  • Due to inflammatory changes, leukocyte recruitment
  • Increased levels of MMPs
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13
Q

What is an important pro-inflammatory transcription factor involved in regulation of labour?

A

NF-kappaB

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14
Q

Which genes do NF-kappaB activate

A
  • Enzymes: COX-2, CPLA2
  • Chemokines: IL-8
  • Cytokines: IL-1beta, IL-6
  • Receptors: Oxytocin recepr, PG receptor
  • Contraction-associated proteins
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15
Q

What factors are important for the initiation of term labour?

A
  • Corticotrophin Releasing Hormone (stress, multiple infants)
  • Platelet-activating factor (produced by maturing lung, before birth)
  • PGE2
  • COX2
  • IL1beta
  • CRH and PAF can up-regulate inflammatory pathways in fetal membranes
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16
Q

What happens when you administer progesterone receptor blockade to pregnant women?

A

Pregnancy loss

Progesterone is needed to sustain pregnancy

17
Q

What are the 2 progesterone receptors?

A

PR-B (mediates main effects of progesterone via gene expression)
PR-A (less able to mediate these effects)

18
Q

What happens to the ratio of PR-A: PR-B at term?

A

Increases

19
Q

What does a loss/ change in PR lead to?

A

Functional progesterone withdrawal –> parturition

20
Q

Which factors (enzymes, chemokines) and processes are affected by progesterone?

A
  • PGF2a –> Oxytocin-R
  • COX-2
  • IL-1, IL-6
    IL-8
  • Metabolites of PGE2
21
Q

What is the hypothesis for parturition?

A
  • Progesterone withdrawal precedes
  • Increased PAF –> IL + PG
  • Increased CRH –> IL +PG

Y2 LCRS 1 - RDA (9 decks)

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