Group 4 - Parturition and Post Party Period COMPLETE*** Flashcards

1
Q

When does Parturition occur?

A

after the signal for birth is given by the foetus, when the foetus is sufficiently mature to survive the traumatic birthing experience

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2
Q

Which hormone primarily controls parturition?

A

foetal cortisol

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3
Q

What is the consequence of foetal cortisol causing a reduction in prostaglandin levels just prior to parturition?

A

it removes progesterones block on myometrial contractions
so the uterus can now contract

it removes progesterones block on oestradiol production
so oestradiol can stimulate increased secretions to lubricate the reproductive tract

oestradiol also increases myometrial contractions

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4
Q

What is the function of foetal cortisol? 2

A

it reduces progesterone concentration and increases oestradiol concentration

it stimulates uterine prostaglandin production

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5
Q

How does Foetal Cortisol achieve the switch from progesterone dominance to oestradiol dominance?

A

it increases the activity and expression of catalytic enzymes which convert progesterone to oestradiol

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6
Q

What is the consequence of foetal cortisol stimulating uterine prostaglandin production? 3

A

prostaglandin stimulates uterine contraction

it also acts on the ovary causing luteolysis and further reducing progesterone concentration

it stimulates the secretion of relaxin
which relaxes pelvic ligaments allowing them to stretch for cervical dilation

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7
Q

Explain how the foetus initially migrates towards the cervix 3

A

increasing concentrations of oestradiol stimulate myometrial contractions
increasing concentrations of prostaglandin stimulate myometrial contractions
this increases the pressure in the uterus and moves the foetus towards the cervix

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8
Q

Which reflex occurs once the Foetus applies pressure against the cervix?
- How does this reflex work? 6

A

neuroendocrine oxytocin reflex

the young assumes a streamline position and migrates towards the cervix
the pressure sensitive neurones in the cervix are activated when the foetus pushes against the cervix
this information is relayed to the hypothalamus
it stimulates the paraventricular nuclei
this stimulates the posterior pituitary gland to release oxytocin
oxytocin generates strong myometrial contractions

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9
Q

Describe the mechanism of myometrial contractions 10

A

each monocyte contains voltage gated calcium channels
calcium ions enter the cell through these channels
or in response to oxytocin binding to receptors on the surface
or in response to mechanical stretch as the uterus reaches its maximal size

the calcium ions bind to calmodulin inside the cell
the complex formed interacts with and activates the enzyme myosin light chain kinase
the enzyme can now convert ATP to ADP
the removed phosphate group is added to the head of the myosin light chain
this conformational change of myosin enables it to form actin-myosin cross bridges
and contract with increasing force

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10
Q

Which enzyme regulates myometrial contractions and how?

A

phosphatase can remove the phosphate group from the myosin light chain to inactivate myosin

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11
Q

Contractions must be highly co-ordinated in the uterus.
- Which structure enables contractions to be highly co-ordinated?
- where are they found? 2
- what do they do?

A

gap junctions

in clusters on the plasma membranes of myometrial cells
between individual myometrial cells

they allow the passage of ions and small molecules between cells

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12
Q

What is the role of oxytocin in parturition?
- how does it do this?

A

to increase the force, duration and frequency of contractions

via second messenger inositol triphosphate

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13
Q

How do prostaglandins regulate contractions? 4

A

isoforms of prostaglandins act locally
prostaglandin F2 alpha stimulates contractions
prostaglandin I2 stimulates relaxation
prostaglandin E2 is important for cervical softening

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14
Q

How does neural input regulate contractions? 4

A

the autonomic nervous system acts via the pelvic plexus
it innervates the uterus through specific receptors
the activation of alpha 1 receptors stimulates contraction
the activation of beta 2 receptors stimulates relaxation

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15
Q

As the uterus and cervix stretches, what does this do to enzyme COX2?
- What is the function of this enzyme?
- Hence, what effect does increased stretch have?

A

it increases the activity of COX2

to convert arachidonic acid into prostaglandins

since prostaglandins increase the number of oxytocin receptors it increases sensitivity to oxytocin

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16
Q

Pharmacology: Why would you want to terminate a pregnancy?

A

in response to unintended mating, severe risk to the dam, twin pregnancy, suspected foetal abnormality

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17
Q

Pharmacology: State 3 ways we can Terminate a pregnancy

A

induce luteolysis
remove progesterone support
induce premature parturition

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18
Q

Pharmacology: How can we induce luteolysis to terminate a pregnancy? 2
- How could you remove luteotrophic support in the bitch or queen?
- Why is this method variably successful?

A

using natural or synthetic prostaglandins
or by removing luteotrophic support

using prolactin inhibitors

success relies on the extent of reliance on the corpus luteum and timing of the lute-placental shift

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19
Q

Pharmacology: Aside from inducing luteolysis, how can we remove progesterone support to terminate a pregnancy? 2

A

by inhibiting progesterone synthesis
or inhibiting progesterone receptor action

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20
Q

Pharmacology: Why might you want to induce parturition? 5

A

reduce late calvings
ensures calving coincides with good pasture
reduces risk of foetal oversize
due to disease of dam or offspring
history of high risk pregnancy

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21
Q

Pharmacology: Generally, how is induced parturition achieved? 2

A

by mimicking normal pathways
using glucocorticoids, prostaglandins and oxytocin alone or in combination

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22
Q

Pharmacology: What is the risk of inducing parturition?
- when is this risk highest?

A

a premature foetus has reduced survival odds

for species where young develop late

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23
Q

Pharmacology: Why might you want to accelerate parturition? 3

A

due to uterine inertia
haemorrhage
retained placenta

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24
Q

Pharmacology: What drugs could you use to accelerate parturition?

A

oxytocin
prostaglandin f2 alpha agonist
glucocorticoids like dexamethasone

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25
Pharmacology: Accelerating Parturition - what is the risk when using Oxytocin? 2
could cause foetal death or uterine rupture if there is obstructive dystocia or if the cervix has not dilated it could also cause unco-ordinated contractions
26
Pharmacology: Accelerating parturition - What risks are associated with using prostaglandin F2 alpha to induce parturition?
could cause explosive expulsions and weak offspring
27
Pharmacology: When would you want to reduce or prevent contractions? 4
to delay delivery to aid obstetrical manoeuvres to relax the uterus for a C section to replace a prolapsed uterus
28
Pharmacology: Give an example of a drug which can be used to reduce or prevent contractions - what type of drug is this? - What does it do?
clenbuterol a beta 2 adrenergic agonist it inhibits contractions and stimulates relaxation
29
Parturition: State the 3 stages of parturition
initiation of myometrial contractions expulsion of foetus expulsion of foetal membranes
30
Parturition: Describe the events occurring in stage 1 parturition 7
increase in foetal cortisol increase in enzyme converting progesterone to oestradiol progesterone concentration decreases oestradiol concentration increase prostaglandin concentration increases elevated oestradiol increases tract secretions decreasing progesterone removes the block on uterine contractions
31
Parturition: How does progesterone actually suppress myometrial contractions?
by increasing the expression of beta 2 adrenergic receptors
32
Parturition: In stage 1 of parturition, how does a foal and pup assume the disposition for expulsion? 2 - what about in a calf and lamb?
rotation from a ventral to dorsal position extension of the forelimbs and head and neck extension of the forelimbs and head and neck
33
Parturition: State some clinical signs relating to stage 1 of parturition
uterine contractions anorexia shivering nesting behaviour vulval discharge
34
Parturition: Stage 2 - What is the sign of onset of stage 2 from stage 1? - How is this stimulated?
abdominal contractions when the Fergusons reflex is initiated as this release oxytocin so increases the intensity and frequency of myometrial contractions
35
Parturition: Stage 2 - What happens when umbilical rupture occurs?
the 2 umbilical arteries and rachis retract into the abdomen to prevent haemorrhage
36
Parturition: Stage 2 - What happens? 10
the chorioallantois ruptures allantoic fluid escapes the vulva the amnion arrives at the vulva foetal limbs appear in the amnion the amnion may or may not rupture as the foetus enters the birth canal it become hypoxic this promotes foetal movement which stimulates myometrial contractions the foetal head reaches the vulva contractions of the uterine and abdominal muscle reach a climax the foetus is expelled
37
Parturition: Stage 2 - What is the stimulus for breathing? - What effect does lateral recumbency have on the umbilical cord? - Why is umbilical rupture important?
the impact of air on the nostrils the offspring will usually have an intact umbilical cord artificial and premature rupture could deprive the newborn of a large volume of blood which normally passes from the placenta
38
Parturition: Stage 2 How long should it last in the following species- cow ewe sow mare bitch queen
1 hour 1 hour 3 hours 30 minutes 6 hours 2 hours
39
Parturition: Stage 2 - What position are 40% of foetuses delivered in?
caudal presentation
40
Parturition: Stage 3 - Describe and explain the events for passing a Cotyledonary placenta
regular abdominal contractions mostly stop after foetal expulsion myometrial contractions decrease in amplitude but become more frequent and less regular the lack of foetus results in vasoconstriction of arteries supplying chorionic villi villi decrease in size and are released from the crypts uterine contractions eventually expelled the placenta
41
Parturition: Stage 3 - how is passing a Diffuse placenta different? 7 - Which species does this occur in?
the apex of the chorioallantois becomes inverted the sac is rolled down the uterine horns the placenta is everted when a large portion of inverted membrane forms a mass within the pelvis abdominal contractions are stimulated the chorioallantois is expelled the allantoic surface is outermost the mare
42
Parturition: stage 3 - How long does this stage last in the mare? - How long in the cow?
up to 1 hour up to 6 hours
43
Parturition: Why is it impossible to differentiate between stages 2 and 3 in polytoccus species?
because expulsion of the placenta is interspersed between foetal births
44
Parturition: After stage 3, what process now needs to happen? - What does this mean?
puerperium the reproductive tract needs to reduce to a size similar to before pregnancy
45
Foetal Disposition: Which 3 ways do we describe foetal disposition?
presentation position posture
46
Foetal Disposition: Presentation - What is meant by 'presentation'? - Describe the possibilities for different presentations
the relation between the longitudinal axis of the foetus and the maternal birth canal cranial longitudinal caudal longitudinal dorsal transverse ventral transverse
47
Foetal Disposition: Position - What is meant by 'position'? - Describe different types of positions
position indicates which surface of the maternal birth canal is apposed to the vertebral column of the foetus dorsal position ventral position left lateral position right lateral position
48
Foetal Disposition: Posture - Give examples of different postures
extended posture flexed posture
49
Foetal Disposition: State the normal disposition
cranial longitudinal presentation dorsal position extended posture
50
Dystocia: What does Dystocia mean? - What are some common reasons for dystocia? 4
difficult birth foetus is too big or dam is too small abnormal foetal disposition multiple foetuses poor or absent uterine contractions
51
Dystocia: Approach to Dystocia - State the 3 stages in an approach to dystocia
clinical history clinical exam obstetrical exam conclusion
52
Dystocia: Approach to Dystocia Clinical History - Give examples of questions to ask for the clinical history
is the foetus premature or overdue is this her first pregnancy give details about the sire size what has been observed has there been vulval discharge have you seen uterine or abdominal contractions and when have you observed any foetal membranes has any fluid been expulsed? have any foetuses been delivered
53
Dystocia: Approach to Dystocia Clinical Exam - Give some things you'd be looking at during the clinical exam
bright or dull body condition can she stand or walk clinical parameters are there foetal parts at the vulva is there vulval discharge what colour is the vulval discharge
54
Dystocia: Approach to Dystocia - State the general principles for dealing with dystocia in increasing severity 5
conservative treatment manipulative treatment drug therapy surgical treatment euthanasia
55
Dystocia: Approach to Dystocia Obstetrical Exam - What must you do to the dam for this? - How would you prepare for the exam? - What things are you going to be looking and feeling for?
restrain the dam wash the perineum and vulva short fingernails clean PPE wash hands and arms use rectal gloves use obstetrical lubricant is the vestibule dilated is the cervix open is the tract lubricated are any foetuses present are the present foetuses dead or alive foetal disposition are foetal membranes intact or detached relative size of the birth canal to the foetus any lacerations
56
Dystocia: Approach to Dystocia - For manipulative treatment, give details of considerations to make 2 - What are the first 2 things you must do
can oxygen be given to the foetus via a nasal tube is an epidural needed apply lube apply an anchoring device to any identifiable structures
57
Dystocia: Approach to Dystocia - What term is given to describe correcting a presentation, position or posture? - What does it involve? 2
mutation pushing the foetus back into the abdomen to obtain more room correcting the abnormal disposition
58
Dystocia: Approach to Dystocia Manipulation - Which aids can be used to provide more traction and when? 2 - When is best to provide traction? - How should traction be applied and why?
ropes and snares when the foetus is alive hooks can be used if the foetus is dead during contractions downwards towards the dams hocks to prevent damage to tissues
59
Dystocia: Approach to Dystocia Manipulation - When applying traction, what considerations should be made and why?
the orientation of the foetus as it passes through the birth canal because the largest diameter of the birth canal is at 5 past 7 on a clock
60
Dystocia: Approach to Dystocia Manipulation - Why must the foetus be delivered rapidly when in caudal presentation?
as the umbilicus will be engaging with the pelvis and could rupture before birth
61
Dystocia: Approach to Dystocia After delivery, what 3 things must you check for? 4
other foetuses lacerations or perforations pelvic fractures mastitis
62
Post Partum: What 4 things need to happen post partum
uterine involution and restoration of the endometrium elimination of bacterial contamination resumption of ovarian function lactation and suckling
63
Post Partum: Uterine Involution - what happens with uterine involution? 3
the uterus reduces in size the endometrium is repaired lochia is expulsed
64
Post Partum: Uterine Involution - What happens on day 1 postpartum in a cow? 2 - What about day 4? 3 - What about day 10? - What about day 20?
the cervix is closing the uterus is large the cervix is fully closed the uterus is shrinking lochia follicle growth is restarting nearly involuted
65
Post Partum: Uterine Involution - Describe the mechanism for Uterine Involution 3
prostaglandin and oxytocin stimulate myometrial contractions this sends peristaltic waves towards the cervix causing the discharge of fluid and tissue debris co-ordinated atrophy occurs to reduce myometrial cell size
66
Post Partum: Uterine Involution - What is Lochia? - What does the second cleansing in some species consist of? - How does this come about? - What should the lochia smell like?
excess coracle tissue necrosis leads to sloughing of the placentome to leave caruncle stubs it should be odourless
67
Post Partum: Uterine Involution - How long does it take in the following species - - Beef cow - Dairy cow - Ewe - Bitch - Mare
30 days 35 days 30 days 90 days 14 days
68
Post Partum: Uterine Involution The Mare has a very short uterine involution - What is common in horses in the post partum period? - What is this usually eliminated by?
infection foal heat
69
Post Partum: Uterine Involution - How many lochia does the Bitch have? - What does the first one look like? - When does the second one occur? - what is the second one composed of?
2 green 4-6 weeks later sloughed tissue mass
70
Post Partum: Elimination of Bacteria - why do we often get bacteria inside the reproductive tract? - How is it normally eliminated within a reasonable amount of time? 2
because the cervix is dilated during parturition by increased myometrial contractions by oestradiol promoting phagocytosis by leukocytes
71
Post Partum: Elimination of Bacteria Sometimes bacteria in the reproductive tract can be pathological. - What can it cause? - What is this? - When can we use this term to describe an infection? - What is one major possible consequence?
endometritis inflammation of the endometrium for a persistent infection lasting more than 3 weeks it is a significant cause of infertility
72
Post Partum: Returning to Cyclicity - Does lactation suppress pregnancy in many species?
no
73
Post Partum: Returning to Cyclicity - How do animals return to cyclicity after parturition? 4
as the corpus luteum regresses the dam enters a period of low progesterone and oestradiol so there is limited negative feedback so the hypothalamus is no longer being suppressed the hypothalamus starts producing GnRH
74
Post Partum: Returning to Cyclicity - If the hypothalamus starts producing GnRH very shortly after parturition, why dont they start cycling normally again for a little longer? 7
because the pituitary gland doesn't respond to the hypothalamus for a short period of time there is some FSH release this enables follicles to continue to grow the anterior pituitary becomes increasingly more sensitive to GnRH as the follicles grow oestradiol concentration starts to increase to levels where we get positive feedback on LH the LH surge occurs Ovulation occurs
75
Post Partum: Returning to Cyclicity - What type of oestrus do you normally get on the first oestrus after parturition? -What else is different about the first cycle after parturition?
silent oestrus the first cycle is generally shorter
76
Post Partum: Returning to Cyclicity - In the mare, is ovarian rebound quick or slow? - how long after parturition does it take to get foal heat? - can pregnancy be established during foal heat? - Why might foal heat be delayed? 2
quick 5-9 days yes but with lower fertility rates due to season foal shy
77
Post Partum: Returning to Cyclicity - How does a Sow return to cyclicity? 2
prolactin suppresses LH during lactation so no ovulation occurs weaning initiates oestrus and an LH surge within 7 days
78
Post Partum: Returning to Cyclicity - What happens to dogs after parturition? - How long is this for the pregnant bitch? - How about the non-pregnant bitch? - What starts to happen towards the end? 3
they enter an obligatory period of anoestrus 135 days slightly shorter increase in oestradiol leading to suppression of FSH new follicular wave coming LH surge and ovulation
79
Post Partum: Returning to Cyclicity Give and explain some factors which can affect ovarian rebound 4
suckling - prolactin or presence of offspring milk yield/nutrition - causing decreased bcc or negative energy balance periparturient abnormalities - retained foetal membranes or endometritis seasonal - melatonin in ewes and horses
80
Post Partum: Returning to Cyclicity Abnormal ovarian Rebound - State 3 different types
delayed onset of cyclicity cessation of ovarian activity after initial resumption persistent corpus luteum or ovarian cysts