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RDA > Labour > Flashcards

Labour Flashcards

1
Q

Describe the process of labour?

A

Fundally dominant coordinated contractions of myometrium accompanied by cervical ripening and effacement
Rupture of fetal membranes
Delivery of infant and placenta
Contraction of uterus

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2
Q

What is meant by cervical ripening?

A

Cervix changes from being rigid to soft and flexible as it widens

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3
Q

Why is it important that the placenta is delivered fully?

A

Because if it’s left in the uterus, it could cause a haemorrhage

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4
Q

What happens during the three stages of labour and how long do they last?

A

Phase 1 - contractions and cervical changes (many hours)
Phase 2 - delivery of baby (hours)
Phase 3 delivery of placenta (30 mins)

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5
Q

Describe the process of cervical ripening and effacement

A

Change form rigid to flexible structure
Remodelling of ECM
Recruitment of leucocytes
Release of inflammatory mediators

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6
Q

Which inflammatory mediators are released during cervical ripening and effacement?

A

PGE2

IL8

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7
Q

What kind of action does IL8 have in the cervix during labour?

A

Paracrine local effects

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8
Q

Name a leucocyte recruited during cervical ripening

A

Neutrophils

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9
Q

Describe the process of coordinated myometrial contractions

A

Dominant fundal contractions
Increased coordination and power of contractions
Release of more mediators
Increase in oxytocin receptors

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10
Q

Which mediators are released during coordinated myometrial contractions? State where they are released from

A

PGF2alpha (E2) - released from fetal membranes

Contraction associated proteins

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11
Q

What causes the fetal membrane to rupture?

A

Changes in amnion basement component causes loss of strength

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12
Q

What mediators are released from the rupture of fetal membranes?

A

Prostaglandins
Interleukins
Matrix-metaloproteinases

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13
Q

Describe the process of fetal membrane rupture

A 
Amnion basement changes
Loss of strength -> rupture 
Inflammatory changes 
Leucocyte recruitment 
Increased levels and activity of MMPs
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14
Q

Compare the inflammatory changes and leucocyte recruitment in normal labour vs preterm labour

A

These changes are modest in normal labour

Exacerbated in preterm labour

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15
Q

What is the target of many of the initiators of labour and what is the downstream effect?

A

NFkB - binds to promotor domains of prolabour genes and increases their activity

Also increases activity of inflammatory mediators

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16
Q

List some of the target genes of NFkB

A 
COX-2 PGs,
PG receptor
IL8
IL1b
MMPs
Oxytocin receptor
Contraction associated proteins
17
Q

Give some supporting evidence for NFkB being involved in labour

A

Modification of NFkB sites in promotor sequences leads to loss of expression of genes

18
Q

List some causes the initiation of labour during preterm

A

IU infection
IU bleeding
Multiple pregnancy
Maternal stress

19
Q

Why does an IU infection cause preterm labour?

A

Release of inflammatory mediators

20
Q

Increase in which three things are associated with term labour?

A

Increased CRH
Increased COX 2 synthesis
Increased PAF

21
Q

Describe the downstream effect of increased maternal CRH in the mother, and in the fetus

A 
In the mother:
Increased PG
Increased IL
In the fetus:
Increased ACTH
22
Q

What is the downstream effect of fetal ACTH?

A

Stimulates release of fetal cortisol, which provides POSTIVE FEEDBACK on maternal CRH production

23
Q

What else do fetal adrenals produce which help with parturition ?

A

Steroids

24
Q

What is PAF and when is it produced?

A

Platelet activating factor - produced by maturing fetus lung before birth (it’s a part of lung surfactant)

25
Q

What is PAF a sign of?

A

Fetal maturity

26
Q

Where do PAF levels increase near term?

A

In amniotic fluid

27
Q

What can predispose to labour/is seen in preterm labour?

A

Anything that increases CRH
Anything that increases muscle contraction
Anything that activates inflammatory cascades

28
Q

Give examples of what may increase CRH levels

A

Stress

Multiple infants

29
Q

Give an example of what may increase muscle contraction

A

Excess stretch of the uterus

30
Q

What hormone is needed to maintain pregnancy?

A

Progesterone

31
Q

How long do progesterone levels stay high for?

A

Until after delivery of the placenta

32
Q

What happens to the effect of progesterone during labour, and how?

A

It is lost, due to overall decrease in progesterone receptor levels and change in the balance of progesterone receptors (from PR-B>PR-A to PR-A>PR-B during term)

33
Q

What do you call this effect where progesterone levels remain high, but their effect is lost due to declining progesterone receptor levels?

A

Functional progesterone withdrawal

34
Q

Which receptor mediates the effect of progesterone and how?

A

PR-B - via gene expression

35
Q

Which progesterone receptor does not mediate the effect of progesterone very well?

A

PR-A

36
Q

What is the consequence of decreased levels of progesterone receptors besides loss of progesterone effects?

A

Increase in free NFkB levels

RDA (13 decks)

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