parturition

Question 1

hallmark of phase 1

Answer 1

uterine quiescence

Question 2

functions of cervix during pregnacy

Answer 2

protects repro tract from infx
maintains cervical competence
inc in tissue compliance

Question 3

phase 2 endometrium

Answer 3

inc oxytocin & CAP receptors

inc responsiveness to uterotonic agents

Question 4

phase 2 cervix

Answer 4

collagen breakdown, CT change
proteoglycans, GAGs, fibroblast
inc in inflamm cells

Question 5

phase 2 endocervical glands

Answer 5

hyperplasia, inc mucus

Question 6

what can be done to delay cervical opening, softening, dilatation, and effacement?

Answer 6

inhibition of prokinase enzymes
progesterone
cervical cerclage

Question 7

what can be done to inc cervical opening, softening, dilatation, and effacement?

Answer 7

PGE2 and PGF2 alpha

progesterone antagonist

Question 8

first stage of labor starts & ends when?

Answer 8

latent phase until deceleration

Question 9

latent phase uterine contractions

Answer 9

mild contractions

Question 10

latent phase cervix

Answer 10

“show”, mucus plug is rmeoved w/ some blood from the cervix

Question 11

causes of labor pain

Answer 11

hypoxia
compression of nerve bundle in paracervical area (cervical dilation)
peritoneum is contracted (fundal stretching)

Question 12

differentiate physiologic ring from pathologic ring

Answer 12

physio: upper highly contracting active segment & lower dilating passive segment
patho: contractions are stronger & the thinning out is more prominent

Question 13

explain fetal descent in terms of station

Answer 13

basis is maternal ischial spine

above is negative, below is positive

Question 14

what is engagement?

Answer 14

fetal head enters into pelvis

biparietal diameter transverse pelvic inlet

Question 15

what happens to pelvic floor during labor?

Answer 15

levator ani muscle closes the lower end of pelvic cavity like diaphragm

Question 16

what happens to levator ani muscle

Answer 16

hypertrophy

fibers will stretch and accommodate fetal head

Question 17

what is stage 3?

Answer 17

delivery of placenta & membrane

Question 18

what induces delivery of placenta?

Answer 18

dec intrauterine volume, myometrium contracts & induces placenta separation

Question 19

3 general theories describing labor initiation

Answer 19

fxal loss of pregnancy maintenance factors
synthesis of factors that induce parturition
mature fetus

Question 20

advantages of SM qualities for uterine contraction & fetal delivery

Answer 20

degree of SM cell shortening
forces can be exerted at multiple directions
SM is not organized in same manner as skeletal muscle
greater multidirectional generation in uterine fundus vs lower uterine segment

Question 21

serves primarily as a protective tissue providing immunological acceptance

Answer 21

chorion laeve

Question 22

low intensity, brief myometrial contractions during quiescent phase normally not causing dilation

Answer 22

braxton-hicks contractions

Question 23

quiescence is achieved by

Answer 23

diminished intracellular crosstalk & reduced intracellular Ca level
activation of uterine ER stress-unfolded protein response
uterotonin degradation

Question 24

contractility results from

Answer 24

enhanced interactiond bet. myosin & actin
heightened excitability of indvl myometrial cell
promotion of intracellular crosstalk

Question 25

shape of actin during relaxation & contraction

Answer 25

R: globular C: filamentous

Question 26

actin-myosin interaction

Answer 26

ca binds to calmodulin w/c binds & activates MLCK w/c phosphorylates light chain of myosin coupling of actin & myosin activates ATPase w/c generates force

Question 27

BKca channel during relaxation & contraction

Answer 27

R: enhance BKca channel opening C: inhibit BKca channel opening

Question 28

how does progesterone maintains uterine quiescence?

Answer 28

lowers the CAPs | prolongs ERSR w/c promotes caspase 3 activation

Question 29

GPCR promoting relaxation by inc cAMP

Answer 29

``` beta adrenergic receptors LH & hCG receptors PG E2 & E4 relaxin CRH (Gs-adenylate cAMP) PTHrP (Gs-adenylate cAMP) ```

Question 30

what is lightening?

Answer 30

fetal head oftentimes descends to or even through the pelvic inlet "baby dropped"

Question 31

action of estradiol & progesterone on oxytocin receptor?

Answer 31

E: inc myometrial oxytocin receptor P: enhance oxytocin receptor degradation

Question 32

overview of changes in cervical ripening

Answer 32

dec in collagen bundles inc HA dec dermatan sulfate inc cytokines

Question 33

fetal contributions to parturition

Answer 33

``` uterine stretch fetal endocrine cascade (CRH) dec fetal lung surfactant & inc PAF fetal membrane senescene fetal anomalies & delayed parturition ```

Question 34

1st stage of labor

Answer 34

cervical effacement & dilation | ends when cervix is fully dilated (10cm)

Question 35

2nd stage of labor

Answer 35

fetal expulsion | begins from full cervical dilation and ends in fetal expulsion

Question 36

3rd stage of labor

Answer 36

placental separation & expulsion | begins w/ delivery of fetus and ends with stage of placental separation & expulsion

Question 37

dependable sign of impending onset of active labor

Answer 37

show or bloody show

Question 38

this is defined as mechanical dilation of cervix w/c can be d/t release of oxytocin or PGF2 w/c induce uterine contraction

Answer 38

ferguson reflex

Question 39

pressure exerted by the dec in horizontal diameter producing straightening of fetal vertebral column and this presses the upper pole of fetus firmly against the fundus whereas the lower pole id thrust farther downward and into the pelvis

Answer 39

fetal axis pressure

Question 40

this phase is variable and sensitive to chnages in extraneous factors and by sedation and myometrial stimulation

Answer 40

latent phase

Question 41

predict the outcome of labor

Answer 41

acceleration phase

Question 42

good measure of over-all efficiency of uterus

Answer 42

phase of maximum slope

Question 43

reflective of feto-pelvic relationship

Answer 43

deceleration phase

Question 44

descent pattern of normal labor

Answer 44

hyperbolic curve

Question 45

in G0P0, engagement is accomplished before labor begins & further descent does not occur until late in labor, T or F?

Answer 45

true

Question 46

gold standard for rates of cervical dilation & fetal descent during active labor

Answer 46

friedman's curve

Question 47

sequence of 3rd stage of labor

Answer 47

separation of amniochorion placental separation placental extrusion

Question 48

differentiate schultze from duncan mechanism

Answer 48

S: central; fetal surface D: peripheral; maternal surface

Question 49

uterotonins in parturition phase 3

Answer 49

oxytocin PG endothelin-1 angiotensin II

Question 50

phase 4

Answer 50

puerperium