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obstetrics > parturition > Flashcards

parturition Flashcards

1
Q

hallmark of phase 1

A

uterine quiescence

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2
Q

functions of cervix during pregnacy

A

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

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3
Q

phase 2 endometrium

A

inc oxytocin & CAP receptors

inc responsiveness to uterotonic agents

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4
Q

phase 2 cervix

A

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

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5
Q

phase 2 endocervical glands

A

hyperplasia, inc mucus

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6
Q

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

A

inhibition of prokinase enzymes
progesterone
cervical cerclage

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7
Q

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

A

PGE2 and PGF2 alpha

progesterone antagonist

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8
Q

first stage of labor starts & ends when?

A

latent phase until deceleration

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9
Q

latent phase uterine contractions

A

mild contractions

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10
Q

latent phase cervix

A

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

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11
Q

causes of labor pain

A

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

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12
Q

differentiate physiologic ring from pathologic ring

A

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

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13
Q

explain fetal descent in terms of station

A

basis is maternal ischial spine

above is negative, below is positive

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14
Q

what is engagement?

A

fetal head enters into pelvis

biparietal diameter transverse pelvic inlet

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15
Q

what happens to pelvic floor during labor?

A

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

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16
Q

what happens to levator ani muscle

A

hypertrophy

fibers will stretch and accommodate fetal head

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17
Q

what is stage 3?

A

delivery of placenta & membrane

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18
Q

what induces delivery of placenta?

A

dec intrauterine volume, myometrium contracts & induces placenta separation

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19
Q

3 general theories describing labor initiation

A

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

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20
Q

advantages of SM qualities for uterine contraction & fetal delivery

A

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

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21
Q

serves primarily as a protective tissue providing immunological acceptance

A

chorion laeve

22
Q

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

A

braxton-hicks contractions

23
Q

quiescence is achieved by

A

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

24
Q

contractility results from

A

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

25
Q

shape of actin during relaxation & contraction

A

R: globular
C: filamentous

26
Q

actin-myosin interaction

A

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

27
Q

BKca channel during relaxation & contraction

A

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

28
Q

how does progesterone maintains uterine quiescence?

A

lowers the CAPs

prolongs ERSR w/c promotes caspase 3 activation

29
Q

GPCR promoting relaxation by inc cAMP

A 
beta adrenergic receptors
LH & hCG receptors
PG E2 & E4
relaxin
CRH (Gs-adenylate cAMP)
PTHrP (Gs-adenylate cAMP)
30
Q

what is lightening?

A

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

31
Q

action of estradiol & progesterone on oxytocin receptor?

A

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

32
Q

overview of changes in cervical ripening

A

dec in collagen bundles
inc HA
dec dermatan sulfate
inc cytokines

33
Q

fetal contributions to parturition

A 
uterine stretch
fetal endocrine cascade (CRH)
dec fetal lung surfactant & inc PAF
fetal membrane senescene
fetal anomalies & delayed parturition
34
Q

1st stage of labor

A

cervical effacement & dilation

ends when cervix is fully dilated (10cm)

35
Q

2nd stage of labor

A

fetal expulsion

begins from full cervical dilation and ends in fetal expulsion

36
Q

3rd stage of labor

A

placental separation & expulsion

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

37
Q

dependable sign of impending onset of active labor

A

show or bloody show

38
Q

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

A

ferguson reflex

39
Q

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

A

fetal axis pressure

40
Q

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

A

latent phase

41
Q

predict the outcome of labor

A

acceleration phase

42
Q

good measure of over-all efficiency of uterus

A

phase of maximum slope

43
Q

reflective of feto-pelvic relationship

A

deceleration phase

44
Q

descent pattern of normal labor

A

hyperbolic curve

45
Q

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

A

true

46
Q

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

A

friedman’s curve

47
Q

sequence of 3rd stage of labor

A

separation of amniochorion
placental separation
placental extrusion

48
Q

differentiate schultze from duncan mechanism

A

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

49
Q

uterotonins in parturition phase 3

A

oxytocin
PG
endothelin-1
angiotensin II

50
Q

phase 4

A

puerperium

obstetrics (11 decks)

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