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YR2: Reproduction, Ageing and Development > Labour > Flashcards

Labour Flashcards

1
Q

How many weeks of gestation is defined as “term”?

A

37-41

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2
Q

What are the the boundaries of “pre-term” and “very pre-term” delivery?

A

Pre-term: 22-37 weeks

Very pre-term: 28-32 weeks

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3
Q

What moderates the cervical changes that occur in labour?

A

PGE2
IL8
MMPs

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4
Q

What moderates the myometrial contractions occurring in labour?

A

PGE2
Oxytocin receptor upregulation
Contraction associated proteins increased

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5
Q

Where is PGE2 produced in labour?

A

Foetal membranes

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6
Q

Describe the changes in the foetal membranes during labour

A

Foetal membranes rupture

Inflammatory process occur, + FMs secrete PGs, ILs + MMPs

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7
Q

What can up-regulate inflammatory pathways in fetal membranes, and thus are candidate initiators of term labour?

A

CRH + PAF upregulate pro-inflammatory cytokines

Progesterone loses its anti-labour effects at term

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8
Q

Summarise how progesterone loses its anti-labour effects at term

A

NF-KB levels rise, progesterone receptor levels fall

Free NF-KB drives pro-labour processes

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9
Q

What is the role of NFKB in labour?

A

Involved in pro-inflammatory processes, upregulates cytokines, oxytocin + PG receptors

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10
Q

Describe the epithelial changes in the foetal membranes during labour

A

Amnion epithelium on BM loses strength

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11
Q

What 2 processes are undergone by the cervix in labour?

A

Effacement: softer + flexible
Dilatation: thinner + stretched sideways

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12
Q

What must happen in order for cervical effacement and dilatation to occur? What accelerates this process?

A

Excessive ECM remodelling

Increasing pressure of fetal head on cervix due to increasing strength + frequency of myometrial contractions

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13
Q

Recall the key mediators in uterine contraction in labour

A

PGE2 from foetal membranes

Oxytocin receptor

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14
Q

How long does the onset of uterine contraction last in labour?

A

~8 hours

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15
Q

When do foetal membranes usually rupture?

A

During onset of labour

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16
Q

What is the 2nd stage of uterine contraction, and how long does it last?

A

Expulsive effort

~30 mins

17
Q

Name the 3 stages of labour

A
  1. Cervical ripening + effacement + onset of myometrial contraction
  2. Complete cervical dilation + expulsion of infant
  3. Expulsion of placenta
18
Q

How long should the 3rd stage of labour last?

A

30 minutes

19
Q

Summarise the non-haematological events of the 3rd stage of labour

A

Uterus contracts very powerfully to expel placenta, causing a rupture between uterus + placenta –> delivery

20
Q

What conditions are required in the spiral arteries in order to achieve successful haemostasis in placental delivery

A

High flow + low pressure

21
Q

How does the myometrium control haemostasis following placental delivery?

A

Contracts forecefully

22
Q

What is involution and what drives it?

A

Powerful myometrial contraction that causes haemostasis of spiral arteries (stops flow)
Driven by oxytocin (contractile hormone)

23
Q

Summarise the hypothesis for parturition

A

CRH increase
Foetal adrenal stimulated, produces cortisol
Positive feedback in placenta between CRH + cortisol
Cortisol drives IL, PG + PAF production = pro-labour factors

24
Q

What is labour?

A

Final stage of pregnancy

Expulsion of fetus + placenta from the uterus

25
Q

What are the key tissues involved in labour?

A

Cervix
Myometrium
Foetal membranes

26
Q

What factors may predispose to labour?

A

Anything increasing CRH levels e.g. stress
Anything increasing muscle contraction e.g. excess stretch of uterus
Anything activating inflammatory cascades e.g. infection

27
Q

How is the cervix assessed before the onset of labour?

A

Bishop’s score: predicting whether induction of labour will be required + likelihood of spontaneous preterm delivery
Manual vaginal examination:
Cervical dilation in cm
Cervical effacement as %
Cervical consistency
Cervical position
Foetal station: position of foetal head in relation to pelvic bones
“Call PEDS For Parturition! = Cervical Position, Effacement, Dilation, Softness; Foetal Station”

YR2: Reproduction, Ageing and Development (9 decks)

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