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Y2 LCRS Reproduction, Development and Ageing > labour > Flashcards

labour Flashcards

1
Q

define miscarriage

A

delivery of non-viable infant (usually within 13 weeks due to switchover of blood supply causing failed anchorage)

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2
Q

define term and when it happens

A

delivery of viable infant (usually 37-41 weeks with labour or elective Caesarean section)

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3
Q

define pre-term and when it happens

A

delivery of viable infant (usually 23-37 weeks, usually due to early labour or medically compromised so preterm emergency Caesarean section)

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4
Q

define labour and changes to tissue function

A

fundally dominant contractions (pushing from above) coupled with cervical ripening (cervix becomes soft and flexible) and effacement (cervix thins out and moves sideways)

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5
Q

2 other tissue changes which occur during labour

A

foetal membrane remodelling, lower segment relaxation

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6
Q

process of labour

A

cervical ripening and effacement -> co-ordinated myometrial contractions -> rupture of foetal membranes -> delivery of infant -> delivery of placenta -> contraction of uterus

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7
Q

3 labour stages (12-48 hours)

A

phase 1 (contractions and cervical changes over many hours) -> phase 2 (baby delivered over hours) -> phase 3 (placenta delivered over 30 minutes)

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8
Q

relative durations of consecutive labours

A

faster

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9
Q

what 4 things could initiate labour (relatively unknown)

A

oestrogens, low progesterone, CRH, oxytocin

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10
Q

preterm inducers of labour

A

intrauterine infection, intrauterine bleeding, multiple pregnancy, stress (maternal)

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11
Q

what happens during cervical ripening and effacement

A

change from rigid to flexible structure, remodelling (loss) of extracellular matrix, recruitment of leukocytes (neutrophils), inflammatory process and local (paracrine) change in IL-8

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12
Q

main inflammatory mediators of cervical ripening and effacement

A

prostaglandin E2, interleukin-8

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13
Q

what happens during co-ordinated myometrial contractions

A

fundal dominance, increased co-ordination of contractions, increased power of contractions, key mediators
Prostaglandin F2a (E2) levels increased from fetal membranes
Oxytocin receptor increased
Contraction associated proteins

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14
Q

main pro-inflammatory transcription factor in labour

A

NF-kB (drives itself forward by production of COX and ILs)

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15
Q

labour overview

A

many initiators -> NF-kB -> many genes which are mostly inflammatory, as well as oxytocin and prostaglandin receptors

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16
Q

supporting evidence for NF-kB

A

S50

17
Q

causes of preterm labour

A

inflammatory changes e.g. infection

18
Q

-

A

-

19
Q

-

A

-

20
Q

-

A

-

21
Q

-

A

-

22
Q

-

A

-

23
Q

describe process of constitutive PGE2 synthesis to support prostaglandin induction of labour

A

following incubation of foetal membranes, baseline production of prostaglandins already high so couldn’t be increased any further

24
Q

2 key drivers of term labour

A

PAF and CRH (upregulate inflammatory pathways in foetal membranes to initiate labour)

25
Q

evidence for CRH as key driver for term labour

A

rises sharply in last few weeks of pregnancy, as do COX-2 enzymes (make prostaglandins)

26
Q

platelet activating factor (PAF) location and how it is a foetal signal of maturity before labour

A

part of lung surfactant (proteins and complexes produced before birth by maturing lung - last organ to mature before birth), with levels in amniotic fluid increasing near term

27
Q

what else can PAF and prostaglandins drive

A

IL-1B which further drives labour

28
Q

describe hypothesis of parturition

A

CRH made in placenta -> stimulates cascades in foetal membranes, and goes through umbilical cord -> stimulates release of ACTH from foetal pituitary gland -> cortisol produced in foetal adrenal gland -> enters maternal circulation -> positve feedback up-regulating CRH production in female (-> prostaglandins); adrenal gland also produces steroids which mature lung -> lungs produce PAF (-> prostaglandins); adrenal gland also make precursors for oestrogens -> allow endometrium to contract

29
Q

things that upregulate labour

A

S60

30
Q

what is needed to sustain pregnancy

A

progesterone

31
Q

S61, 62

A

inhibits NF-kB, so labour not inhibited as low progesterone receptor presence

32
Q

progesterone receptor

A

S63

33
Q

summary

A

S65

34
Q

why must uterus contract at end of pregnancy

A

in uterus are remodel spiral arteries which provide lots of blood to placenta, however when placenta is delivered these are open into uterine cavity, and have lost lots of smooth muscle cells so can’t contract in normal way, so uterus must contract to ensure mother doesn’t bleed out

Y2 LCRS Reproduction, Development and Ageing (10 decks)

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