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2nd Repro > Partuition > Flashcards

Partuition Flashcards

1
Q

Four phases cervix goes through in pregnancy

A

Softening occurs during the majority of pregnancy,

Ripening occurs 1-2 weeks before labor,
Dilation occurs during labor
Postpartum repair occurs after delivery.

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2
Q

Cervical dilation is likely a result of t

A

he mechanical force from contractions and fetal head descent, and changes in cervical composition leading to increased compliance.

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3
Q

In early pregnancy, uterine growth is secondary to _________; myometrial cell hypertrophy leads to uterine growth from mid gestation onward. Uterine fibrous and connective tissue, blood vessels and lymphatics also increase during pregnancy.

A

myometrial cell proliferation

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4
Q

Myometrial cells proliferate in early pregnancy

  • Myometrial cells hypertrophy in____ half of pregnancy
  • ______between myometrial cells increase during pregnancy
  • Major increase in the blood supply to the uterus
A

later

Gap junctions

*17% gravid and 2% non-preggers

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5
Q

• Myometrium is comprised of smooth muscle: Contractility is dependent on

A

spontaneous action potentials increasing intracellular calcium leading to activation of ATPase through a phosphorylation pathway.

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6
Q

Myometrial cells contract in synchrony during labor leading to frequent, forceful, and longer contractions. Synchrony is achieved by

A

the passage of currents through gap junctions made of proteins called connexons. These increase in size and abundance during pregnancy.

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7
Q

Myometrial Cells can spontaneously contract

A
  • Spontaneous action potential
  • No hormonal input is needed
  • No nervous input is needed
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8
Q

How are uterie contractions generated?

A

• Myometrial action potential–> Increase in intracellular

calcium–> Calcium binds calmodulin–>Myosin light chain kinase

activated–> Myosin is phosphorylated –>ATP is hydrolyzed

Myosin undergoes structural change–> Myosin forms a crossbridge with actin leading to contraction

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9
Q

Transition from the quiescence phase to labor phase involves a shift from_____ dominance to____ dominance

A

progesterone –> estrogen

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10
Q

Inhibits intracellular Ca entry

Inhibits release from sarcoplasmic reticulum

Membrane hyperpolarization via potassium channels

Inhibits expression of CAP genes

Levels are constant before and during labor, tissue level may vary

A

Progesterone

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11
Q

Increases gap junctions btwn myometrial cells allowing for contraction synchrony between cells

Increases oxytocin receptor and prostaglandin receptor expression in myometrium.

A

Estrogen

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12
Q
  • Initiate excitation
  • Increase frequency and amplitude of contractions

see more of these going into labor

A

• Uterine stretch and Estrogen upregulate contraction-associated proteins (CAP) in the myometrium

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13
Q

Gap Junction protein connexin-43

Oxytocin receptor

Corticotropin-releasing hormone receptor

Cyclo-oxygenase (COX)-2 enzyme

A

all upregulated in labor

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14
Q

What type of contraction do we see during labor

A

G protein coupled receptor –> Activates phospholipase C –>Stimulates release of calcium from intracellular stores–> Myosin light chain kinase activation

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15
Q

_____synthesized by hypothalamus, stored in the posterior pituitary, increases prostaglandin and estrogen level

A

Oxytocin

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16
Q

Possible triggers for labor

A
  • Fetal adrenal gland plays an important role
  • Contributes to the idea of fetal signal
  • Increased maternal estrogens
  • Increased prostaglandins
  • Increase in CAP
17
Q

Once the baby has fnx adrenal gland, increases production of ______ that can get converted into estriol to upregulate CAPS as the fetal/maternal membrane

A

baby makes DHEAS

18
Q

The baby can make _____ which will increase placental oxytocin, prostaglandinsand placental CRH during induciton of labor which goes to mom to further stimulate labor

A

cortisol

19
Q

Latent phase: contraction with slow cervical dilation

Active phase: contractions with fast cervical dilation

A

First stage of labor

20
Q

Complete dilation until delivery of fetus

Post delivery of fetus to delivery of placenta

A

SEcond phase

Third phase

21
Q

Lasts one hour after delivery of placenta Constant myometrial contraction that limits blood loss

A

Fourth stage

22
Q

delivery between 20 weeks gestation and 37 weeks gestation

  • Contraction mechanism is the same
  • What leads to the contractions is likely different

leading cause of infant mortality and long term neurological disabilities

A

Preterm Labor

23
Q

4 factors involved in preterm labor

A

Uterine distension

Maternal fetal stress

Premature rupture of membranes

infection

24
Q

How can infetion lead to premature labor?

A

• Toxins produced by bacteria stimulate to cytokine production leading to prostaglandin release

25
Q

How does uterine distension lead to preterm labor?

A
  • CAP expression
  • CRH and Estrogen increase
  • Oxytocin release
  • Uterine activation
26
Q

How does maternal-fetal stress lead to premature labor

A

• Premature rise in cortisol and estrogens can induce labor phenotype and stimulate fetal adrenal c19 hormones

27
Q

Identifiable preterm labor risk factors

A

infection, periodontal disease, smoking, genetics, cervical shortening, decreased uterine space, low pregnancy weight

28
Q

Used to Tx preterm labor

A

magnesium, Ca+ channel blockers, Prostaglandin synthesis inhibitors, B-2 adrenertic receptor agonist

(via inhibiting intracell Ca+ influx)

29
Q

is used to prevent preterm delivery in patients with a history of preterm delivery and for patients with a shortened cervical length by ultrasoun

A

Progesterone therapy

30
Q

is best defined as bleeding leading to symptoms of hypovolemia

> 500 mL blood loss after a vaginal delivery

>1000 mL blood loss after a cesarean delivery

A

Post partum hemorrhage

*• Hemorrhage is the leading cause of maternal mortality

31
Q

Whe do we see post partum hemorrhage?

A

occurs during 3rd stage of labor during delivery of placenta

32
Q

uterine relaxation during the 4th stage leading to excessive blood loss

  • Treated with uterine massage
  • Pharmacologic treatment with **oxytocin, prostaglandins, ergot alkaloid **
A

• Atony

33
Q

Risk for atony

A

Precipitous Labor, Large Fetal Weight , Multifetal Gestation, Polyhydramnios, Prolonged Labor, Retained Placenta, Grand Multiparity, Intrauterine Infection, Uterine Relaxation Agents

34
Q
  • Hypovolemia from obstetrical blood loss leads to pituitary infarction or necrosis
  • Symptoms may not develop immediately : lactation failure, hypoglycemia, and life threatening hypotension from adrenal insufficiency.
  • Symptoms are varied secondary to the many end organ targets of pituitary hormones
A

Sheehan Syndrome

35
Q

Pt not contracting after delivery and starting to see lots of blood loss, what may help stimulate contractions and prevent lss of blood?

A

prostaglandins

2nd Repro (16 decks)

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