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Development and Ageing > Later Foetal Development, Labour and Parturition > Flashcards

Later Foetal Development, Labour and Parturition Flashcards

1
Q

In late foetal development, are the ventricles working in parallel or series?

A

parallel

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2
Q

Vascular shunts bypass what circulation to close at birth?

A

pulmonary and hepatic

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3
Q

Primitive air sacs form when?

A

20 weeks

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4
Q

Vascularisation of lungs begins when?

A

28 weeks

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5
Q

Surfactant production begins when?

A

20 weeks, upregulated towards term

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6
Q

How many hours a day does foetus spend making rapid respiratory movements in REM sleep?

A

1-4 hrs

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7
Q

When is endocrine pancreas become functional?

A

start of 2nd trimester

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8
Q

Functional insulin from when?

A

mid 2nd trimester

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9
Q

Liver glycogen in foetal development?

A

progressively deposited, accelerates towards term

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10
Q

Debris and bile acids from swallowed amniotic fluid forms?

A

meconium

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11
Q

When do foetal movements begin?

A

late 1st trimester

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12
Q

Foetal movements are detectable by the mother around when?

A

14 weeks

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13
Q

Stress response starts around?

A

18 weeks

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14
Q

Thalamus cortex connections forming from?

A

24 weeks

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15
Q

What state of consciousness in the foetus in during development?

A

mostly slow wave or REM sleep

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16
Q

Organ maturation is co-ordinated by?

A

fetal corticosteriods

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17
Q

The process of labour includes?

A

safe expulsion of foetus at correct time, expulsion of placenta and foetal membranes, period of resolution/healing to permit future reproductive events

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18
Q

Labour has the characteristics of?

A

pro inflammatory reaction (immune cell infiltration and inflammatory cytokine and prostagladin secretion

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19
Q

What happens in the first stage of labour?

A

contractions start, cervix dilation

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20
Q

What occurs in the latent and active phases of the first stage of labour?

A

latent: slow dilation to 2-3cm
active: rapid dilation to 10cm

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21
Q

What happens in the second stage of labour?

A

maximal myometrial contractions, delivery of the foetus

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22
Q

What happens in the third stage of labour?

A

delivery of the placenta, expulsion of foetal membranes, postpartum repair

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23
Q

Why does the cervix have high connective tissue content?

A

provides rigidity

stretch resistant

24
Q

Describe the remodelling of the cervix.

A

Bundles of collagen fibres embedded in a proteo-glycan matrix

Changes to collagen bundle structure underlie softening, but mechanism unclear.

25
Q

What changes happen to the cervix beginning from the first trimester?

A

measurable changes in compliance but retains cervical competence

26
Q

What changes happen to the cervix in the weeks and days before birth?

A

ripening: Monocyte infiltration and IL-6 and IL-8 secretion

Hylaluron deposition

27
Q

What occurs during dilation?

A

increased elasticity
Increased hyaluronidase expression -> HA breakdown
MMPs decrease collagen content

28
Q

What happens during post partum repair?

A

Recovery of tissue integrity and competency

29
Q

What happens to CRH levels towards the end of the pregnancy?

A

rise exponentially

30
Q

Why does CRH bioavailability increase?

A

decline in CRH binding protein levels

31
Q

CRH functions in labour?

A

promotes fetal ACTH and cortisol release

Increasing cortisol drives placental production of CRH -> Positive feedback!

stimulates DHEAS production by the fetal adrenal cortex -> substrate for estrogen production

32
Q

What maintains uterine relaxation during pregnancy?

A

high progesterone levels

33
Q

At term approaches what happens to progesterone isoforms?

A

switch from PR-A (activating) to PR-B/C (repressive) > functional progesterone withdrawal

34
Q

At term approaches what happens to expression of estrogen receptor alpha?

A

increases

35
Q

How does the uterus change in terms of responsiveness to oestrogen and progesterone?

A

‘blinded’ to progesterone action

sensitised to oestrogen action

36
Q

Where is oxytocin synthesised?

A

utero-placental tissues

pituitary

37
Q

What happens to uterine oxytocin production at the onset of labour?

A

increases sharply

38
Q

Expression increase of oxytocin is driven by?

A

increase in oestrogen

39
Q

What is the Ferguson reflex?

A

self-sustaining cycle of uterine contractions initiated by pressure at the cervix (positive feedback loop)

40
Q

Oxytocin signals through what receptor?

A

G coupled oxytocin receptor (OXTR)

41
Q

What inhibits OXTR expression pre labour?

A

progesterone

42
Q

What stimulates expression of OXTR?

A

oestrogen rise

43
Q

Functions of oxytocin?

A

Increases connectivity of myocytes in myometrium,

destabilise membrane potentials to lower threshold for contraction, enhances liberation of intracellular Ca2+ ion stores

44
Q

What primary prostagladins are synthesized during labour?

A

PGE2
PGF2 alpha
PGI2

45
Q

What drives prostagladin action in the uterus?

A

rising oestrogen

46
Q

How does oestrogen drive prostagladin action?

A

activates phospholipase A2 enzyme > arachidonic acid for synthesis and stimulates OXTR > promotes PG release

47
Q

Effect of PGE2 in labour

A

cervix re-modelling: promotes leukocyte infiltration into the cervix, IL-8 release and collagen bundle re-modelling

48
Q

Effect of PGF2 alpha in labour

A

myometrial contractions: destabilises membrane potentials and promotes connectivity of myocytes (with oxytocin)

49
Q

Effect of PGI2 in labour

A

myometrium: promotes myometrial smooth muscle relaxation and relaxation of lower uterine segment.

50
Q

List factors other than prostagladins that have key effects in labour.

A

peptide hormone relaxin
nitric oxide
both implicated in cervix remodelling

51
Q

Describe formation of the birth canal.

A

Myometrial muscle cells form a syncytium (extensive gap junctions), brachystatic (fibres do not return to full length on relaxation) contractions start from the fundus, spread down upper segment
> lower segment and cervix to be pulled up

52
Q

List the steps of foetal expulsion.

A

head engages with pelvic space > pressure causes chin to press to chest > rotates belly to mother’s spine > head first > shoulders delivered sequentially > torso next

53
Q

What happens to uterus after foetal delivery?

A

rapid shrinking

54
Q

Uterine shrinking causes?

A

folding of fetal membranes, area of contact of placenta with endometrium shrinks

55
Q

How to stop foetal blood flow to placenta after birth?

A

clamp umbilical cord

56
Q

Why does uterus remain contracted after birth?

A

facilitate uterine vessel thrombosis

Development and Ageing (9 decks)

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