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REPRO > Childbirth and lactation > Flashcards

Childbirth and lactation Flashcards

week 8

1
Q

How is date of delivery estimated?

A

Estimation = LNMP + 280days (9 months and 7 days) OR via ultrasound (earlier is more accurate)

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2
Q

Why is it important to determine the estimate day of delivery?

A

booking caesarian,

deciding if to induce labour (high BP or past DD)

, determine if the baby is growing well,

interpreting antenatal screening.

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3
Q
  1. What are the dates for a) pre-term, b) term and c) post-term
A

Pre= less then 37 weeks
term = 37-42 weeks
post = more than 42 weeks

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4
Q

What can cause pre-term birth?

A

uterine over-distension (twins),

infections, antepartum

hemorrhage, previous preterm delivery,
smoking,

maternal diabetes or HTN affecting placenta.

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5
Q

What do prostaglandins stimulate?

A

more vigorous contractions)

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6
Q

What is the role of Estrogen in the induction of labour?

A

up-regulates myometrial OT and PG receptors,

induces gap junctions

and opposes uterine relaxant actions of Progesterone.

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7
Q

What is the role of oxytocin (placental and maternal) in labour induction?

A

increases Ca influx into myometrial cells = lowers excitation

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8
Q

What is the role of Prostaglandins in the induction of pregnancy?

A

stimulate myometrial gap junctions and soften the cervix via relaxin.

Also stimulates contractions via positive feedback.

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9
Q

How is Progesterone decreased before labour and what does it all0ow for?

A

withdrawal due to down-regulation of PRs and up-regulation of ERs in uterine muscle.

Allows for myometrial contractability.

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10
Q

What are the three main events of labour initiation?

A

Placental CRH –> fetal HPA and Adrenal Glands increase cortisol

CRH –> estrogen and prostaglandins

Prostaglandins stimulate contractions.

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11
Q

What are the results (3) of the three events that initiate labour?

A

cervix softens and increases in elasticity

Myometrium gains capacity to contract forcibly and rhythmically

Maintenance of contractions

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12
Q

What are the stimuli of prostaglandins?

A

placental CRH/ cortisol
placental estrogen
placental/maternal oxytocin
contractions (positive feedback)

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13
Q

What changes occur to the cervix in pregnancy?

A

Softened (by relaxin and prostaglandins)

Dilation

Effacement (thinning of cervix from stretching)

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14
Q

When does dilation start, what is it caused by?

A

Starts
several days before parturition

driven by
E, PG, cytokines and cervical fibrocytes)

caused by
myometrial contractions

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15
Q

What does ‘breech position’ refer to and what are its three positions?

A

Baby bottom first

complete

footling (one leg first)

frank (bottom first, feet up near head)

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16
Q

What changes occur to the myometrium during pregnancy?

A

Contractibility (gap junctions and ion channels stimulated)

Hypertrophy

17
Q

What can be used to delay labour?

A

Antiprostaglandins, B-agonist (relax smooth muscles) and Ca channel inhibitors.

18
Q

methods for inducing labour

A

Use oxytocin, prostaglandins and break amniotic membrane

19
Q

What are (2) signs of labour onset and what are (2) misleading signs?

A

Labour
Regular contractions and progressive cervical effacement and dilation

misleading
release of blood-stained mucous from cervix
rupture of membranes

20
Q

When/defining feature of the 4 stages of labour

A

Pre-labour
Cervix softenes and becomes stretchable

Stage 1
From the start of regular contractions –> full dilation

Stage 2
Full dilation –> delivery

Stage 3
Baby delivery –> delivery of placenta

21
Q

What does a APGAR score tell us?

A

Assess how well the baby is adapting but is NOT an indicator of baby ouctomes.

22
Q

What makes up the criteria for APGAR test?

A

A- appearance
P- pulse
G- grimace
A- Activity
R- respirations

23
Q

What does a APGAR score of 7-10, 4-6 and 0-3 mean respectively?

A

7-10
-doing well, no resus needed
4-6
-may require assistance with breathing
0-3
-likely resus

24
Q

What is the role of glucocorticoids in preparing fetus for extrauterine life?

A

allows for maturation of systems:
-respirartion
-glucose regulation
- thermoregulation
Na/K ATPase activity
digestion enzymes

25
Q

What structures are present for fetal blood circulation but not neonatal circulation?

A

Ductus Venosus

Forarmen ovale

Ductus arterisus

umbilical vein and artery

26
Q

Name some major anatomical features of the breast.

A

15-25 lobes, subdivided into mammary gland lobules

lobules contain milk-producing alveoli

lobules are separated by fat and CT

CT forms suspensory ligaments

27
Q

Structure of breast lobules

A

lobules contain milk producing aveoli –> lactiferous ducts –> lactiferous sinus –> nipple

28
Q

Compare the histology of nonpreg, preg and lactating breast tissue.

A

Non
Mostly fat and CT\
Little grandular tissue

preg
Extensive gladnular system with ducts
(alvelor secretion begins 2nd tri)

lactating
Aveoli surrounded by myoepithelial cells
Avelolar lumens filled with milk secretioms

29
Q

What hormones are invloved in breast enlargement?

A

PRL, Oxytocin, E, HCS, P and hCG

30
Q

Describe the milk-letdown reflex

A
  1. suckling of nipple
  2. nervous stimulation of the hypothalamus
  3. posterior pituitary releases OT
  4. OT stimulates the contraction of myoepithelial cells → milk ejection
31
Q

Why doe E and P inhibit PRL?

A

do not need milk synthesis during pregnancy

32
Q

compare colostrum and human milk in lactation

A

Colostrum = yellowish fluid during the first few days after birth, less lactose than milk and almost no fat. It has more protein and vitamin A. Both have IgA antibodies to create immunity.

33
Q

Describe the positive feedback loop involving oxytocin that occurs in a normal labour.

A

stretch of uterus by baby’s head –> hypothalamus release GnRH –> pituitary release Oxytocin –> stimulates contractions –> further stretching –> repeats

34
Q

what hormone is vital for causing maturational change in the foetus at birth?

What does it do?

A

cortisol (glucocorticoids)

surfactant production in lungs = stops lungs sticking together

glucose regulation (decreases gly deposition in liver)

NaKATPase activity in kidney

REPRO (14 decks)

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