Labour and Delivery

Question 1

What is the difference between miscarriage and stillbirth

Answer 1

<24 weeks – miscarriage

>24 weeks – stillbirth

Question 2

What is preterm and term defined as

Answer 2

Preterm: 23-37 weeks of gestation
Term: 37-41 weeks of gestation

Question 3

What is the definition of labour

Answer 3

Fundally dominant contraction

Question 4

Describe the process of labour

Answer 4

1. Cervical ripening and effacement (increasing)
2. Co-ordinated myometrial contractions (increasing)
3. Rupture of fetal membranes
4. Delivery of infant
5. Delivery of placenta
6. Contraction of uterus

Question 5

How does gestational age affect the labour process

Answer 5

Labour process is independent of gestational age

Question 6

What may initiate labour in preterm labours

Answer 6

Intrauterine infection
Intrauterine bleeding
Multiple pregnancy
Stress (maternal)
Others

Question 7

Describe what occurs in cervical ripening and effacement

Answer 7

Change from rigid to flexible structure
Remodelling (loss) of extracellular matrix
Recruitment of leukocytes (neutrophils)
Inflammatory process

Question 8

Which mediators are involved in cervical ripening and effacement

Answer 8

Prostaglandin E2, interleukin-8

Local (paracrine) change in IL-8

Question 9

Describe what occurs in co-ordinated myometrial contractions

Answer 9

Fundal dominance
Increased co-ordination of contractions
Increased power of contractions

Question 10

Which mediators are involved in co-ordinated myometrial contractions

Answer 10

Prostaglandin F2a (E2) levels increased from foetal membranes
Oxytocin receptor increased
Contraction associated proteins

Question 11

Describe what occurs in rupture of foetal membranes

Answer 11

Loss of strength due to changes in amnion basement component
Inflammatory changes, leukocyte recruitment
Increased levels and activity of MMPs
Inflammatory process in foetal membranes

Question 12

What is the difference between rupture of foetal membranes in normal and preterm labour

Answer 12

Inflammatory changes, leukocyte recruitment

Modest in normal labour, exacerbated in preterm labour

Question 13

Which mediators are involved in co-ordinated myometrial contractions

Answer 13

Prostaglandins, interleukins, MMPs

Question 14

Which transcription factor plays the greatest role in labour

Answer 14

NFkB

Upregulation of other labour factors

Question 15

Which factors are candidate imitators for term human labour

Answer 15

CRH and PAF can up-regulate inflammatory pathways in fetal membranes

Question 16

What is the significance of progesterone in pregnancy

Answer 16

Progesterone is needed to sustain pregnancy
Progesterone receptor blockade leads to pregnancy loss
Progesterone levels remain very high until after delivery of the placenta
Effect of progesterone lost in normal term labour