complications and lactation Flashcards
what medications can be used during labor
-pain killers (eg: barbiturates, narcotics)
-N2O
-anesthetics (local, regional, general
how does an epidural work
injection of local anesthetics into the space surrounding spinal cord produces a block of nerve conduction
what is an effect of having an epidural
increases likelihood of using delivery aids (vacuum, C-section)
due to blocking action potentials to and from spinal cord
infant mortality between rich blacks and white moms
rich black mothers are twice as likely to have infants die in the first month/year of their lives than rich white moms
what defines a monozygotic twin
-genetically identical
-single inner cell mass divides in two
-random event
how many sperm and how many ova are involved in formation of monozygotic twins
one sperm, one ovum
what defines a dizygotic twin
-two ova “fraternal”
-either one or two placentas, depending on proximity during implantation
-early ultrasound => two placentas, assumed dizygotic
how many sperm and how many ova are involved in formation of dizygotic twins
two sperm, two ova
how might dizygotic twins arise as a result of abnormal hormone signaling (ie: FSH, LH)
-increase in FSH, increase in secondary to tertiary follicles, increase in granulosa cells, increase in E2, makes 2 graafian follicles
-increase/decrease of LH will not make dizygotic twins arise
based on what you already know about initiation of labor, why are twins more likely to have preterm births than singletons
-the trigger for labor is CRH which triggers a positive feedback loop, increase in E2, increase in prostaglandins
-CRH made by placenta so if there is 2 placentas, increase in CRH to initiate labor
what is a sesquizygotic twin
in between mono and dizygotic where they:
-share all maternal DNA
-share 75% paternal DNA
to feed our newborn infant, we need to:
- make milk: via prolactin, estrogen and progesterone
- eject milk at appropriate time: via oxytocin
what is the anatomy of a breast
-15-25 lobes, each with several lobules, with alveoli which are surrounded by myoepithelium, and empty into ducts
-5-10 major ducts that exit the nipple
what hormones develop the alveoli and the ducts
estrogen and P4
why do we need alveoli cells
make prolactin
what is prolactin inhibited by
dopamine
what hormone increases the production of prolactin
estrogen
how does E2 contribute to lactation
-reduces dopamine-mediated inhibition of prolactin
-increases # and size of prolactin-producing cells
-induces genes required for prolactin production
where is prolactin released from
anterior pituitary
how does progesterone affect prolactin
suppresses action of PRL and when P4 levels fall at birth then PRL starts producing milk (takes 24-48 hours)
what should breast milk contain
-casein: phosphoprotein that provides: amino acids, carbs, calcium, and phosphorus
-lactose: sugar
-fat
what is colostrum
-made by alveoli cells in small quantities in place of PRL
-high in protein, antibodies (IgA) and immune cells; mild laxative
how do PRL levels and suckling correlate
suckling initiates PRL release when there are low levels of estrogen after pregnancy
how does suckling feed back to the hypothalamus
-reduces dopaminergic inhibition of prolactin-secreting neurons
-no estrogen, no PRL
what is feedback inhibitor of lactation (FIL)
-secreted into milk, stopping production of more milk in a paracrine fashion
what happens to alveoli cells when PRL levels drop
-undergo apoptosis
-ducts return to same state as pre-pregnancy
