parturition Flashcards

(50 cards)

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
shape of actin during relaxation & contraction
R: globular C: filamentous
26
actin-myosin interaction
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
BKca channel during relaxation & contraction
R: enhance BKca channel opening C: inhibit BKca channel opening
28
how does progesterone maintains uterine quiescence?
lowers the CAPs | prolongs ERSR w/c promotes caspase 3 activation
29
GPCR promoting relaxation by inc cAMP
``` beta adrenergic receptors LH & hCG receptors PG E2 & E4 relaxin CRH (Gs-adenylate cAMP) PTHrP (Gs-adenylate cAMP) ```
30
what is lightening?
fetal head oftentimes descends to or even through the pelvic inlet "baby dropped"
31
action of estradiol & progesterone on oxytocin receptor?
E: inc myometrial oxytocin receptor P: enhance oxytocin receptor degradation
32
overview of changes in cervical ripening
dec in collagen bundles inc HA dec dermatan sulfate inc cytokines
33
fetal contributions to parturition
``` uterine stretch fetal endocrine cascade (CRH) dec fetal lung surfactant & inc PAF fetal membrane senescene fetal anomalies & delayed parturition ```
34
1st stage of labor
cervical effacement & dilation | ends when cervix is fully dilated (10cm)
35
2nd stage of labor
fetal expulsion | begins from full cervical dilation and ends in fetal expulsion
36
3rd stage of labor
placental separation & expulsion | begins w/ delivery of fetus and ends with stage of placental separation & expulsion
37
dependable sign of impending onset of active labor
show or bloody show
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
ferguson reflex
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
fetal axis pressure
40
this phase is variable and sensitive to chnages in extraneous factors and by sedation and myometrial stimulation
latent phase
41
predict the outcome of labor
acceleration phase
42
good measure of over-all efficiency of uterus
phase of maximum slope
43
reflective of feto-pelvic relationship
deceleration phase
44
descent pattern of normal labor
hyperbolic curve
45
in G0P0, engagement is accomplished before labor begins & further descent does not occur until late in labor, T or F?
true
46
gold standard for rates of cervical dilation & fetal descent during active labor
friedman's curve
47
sequence of 3rd stage of labor
separation of amniochorion placental separation placental extrusion
48
differentiate schultze from duncan mechanism
S: central; fetal surface D: peripheral; maternal surface
49
uterotonins in parturition phase 3
oxytocin PG endothelin-1 angiotensin II
50
phase 4
puerperium