Parturition Flashcards
Concurrently, the cervix begins an early stage of remodeling termed _____, yet maintains structural integrity
Softening
During the first _______ weeks of normal gestation, the myometrium is in a preparatory yet unresponsive state
36-38 weeks
Following this prolonged uterine quiescence, there is a _____ phase during which myometrial unresponsiveness is suspended, and the cervix undergoes ripening, effacement, and loss of structural integrity
Transitional
bringing forth of young, requires multiple transformations in both uterine and cervical function
Parturition
The phases of parturition includes:
Prelude
Preparation
Process
Recovery
Contractile unresponsiveness
Phase 1
Cervical softening
Phase 1
Uterine preparedness for labor
Phase 2
Cervical ripening
Phase 2
Uterine contraction
Phase 3
Cervical dilation
Phase 3
Fetal and placenta expulsion
Phase 3
Uterine involution
Phase 4
Cervical repair
Phase 4
Breast feeding
Phase 4
This phase begin even before implantation
Phase 1
This is characterized by smooth muscle tranquility with maintenance of cervical structural intergrity
Phase 1
The myometrial unresponsiveness of phase 1 continues until ____
Near end of pregnancy
Uterine myometrial smooth muscle is rendered unresponsive to natural stimuli
Phase 1
Uterine quiescence is characterized by their ____, ___, ____
Unpredictability
Low intensity
Brief duration
Any discomfort in the uterine quiescent phase is confined in the ____ and ___
Lower abdomen
Groin
Near the end of pregnancy, contractions of this type become more common especially in multiparous women
Braxton hicks contractions or False labor
The cervix has multiple functions during pregnancy which includes:
- maintenance of barrier function: protection form reproductive tract infection
- maintenance of cervical competence: despite increasing gravitational forces imposed by the expanding uterus
- orchestrating extracellular matrix changes: allow progressive increase in tissue compliance
In non-pregnant women, the cervix is ___ and ____, and its consistency is similar to the ____
By the end of pregnancy the cervix is easily ____
Closed and Firm
Nasal Cartilage
Distensible
Characterized by an increase in tissue compliance, yet the tissue remains firm and unyielding
Softening
Cervical shortening is between ____ and ____ weeks has been associated with an increased risk of _____
16-24 weeks
Preterm delivery
Cervical softening results from:
Increased vascularity
Stromal hypertrophy
Glandular hypertrophy and hyperplasia
Compositional or structural changes of the extracellular matrix
Physiological softening is preceded by an increased in ____
Collagen solubility
Uterine awakening and activation
Phase 2
Phase 2 of parturition represents a progression of changes in the uterus during the ____ of pregnancy
6-8 weeks
What are the contraction associated proteins?
Oxytocin receptors
Prostaglandin receptors
Connexin 43
Agents that stimulates contractions
Uterotonins
Myometrial oxytocin receptors markedly increase along with increased numbers and surface areas of gap junction proteins such as connexin 43
Phase 2
This phase leads to increase uterine irritabiltyand responsiveness of uterotonins
Phase2
The critical change in phase 2
Formations of the lower uterine segment from the isthmus
With this development, the fetal head often descend to or even through the pelvic inlet
Lightening
In phase 2 cervical modifications during the second phase principally involves the change in the connective tissue
Cervical ripening
The cervix is made up of only ____ % smooth muscles with the remaining tissue comprises mainly of connective tissues which includes:
10-15%
C - collagen type 1,3,4
G - GAG
P - proteoglycan
E - elastin
This material is the major component of the cervix and is largely responsible for its structural disposition
Collagen
Each collagen molecule is composed of ______ which wind around each other to form ____
Three alpha chains
Procollagen
High molecular weight polysaccharides that contain amino acids and can form complexes with proteins to form ____
GAG
Proteoglycans
Hyaluronans’ functions are dependent on the ____ and the ____ products which is carried out by a family of enzymes termed _____
Size
Breakdown of the large molecular weight HA to small molecular weight
Hyaluronidases
These glycoproteins are found in abundance in the cervix and changes in this composition also accompanies cervical ripening
Proteoglycans
At least two small leucine-rich proteoglycans are found in the cervix ____ and ____
Decorin
Biglycans
In these Phases there is increased cervical expression of chemokines and collagenase / proteases activity
Phase 3 and 4
This is considered an inflammatory process
Cervical ripening
Promotes cervical ripening for labor induction
Prostaglandin E2 and F2
Modify collagen and alter relative GAG concentration
PGE2 and PGF2
This phase is synonymous to active labor
Phase 3
This phase is customarily divided into three stages of labor
Phase 3
Begins when widely spaced uterine contractions of sufficient frequency, intensity, and duration are attained to bring about cervical thinning
Stage of cervical effacement and dilation
Term for cervical thinning
Effacement
This labor stage end when the cervix is fully dilated to allow passage of the fetal head
Cervical effacement and dilation
Begins when cervical dilatation completes and end with delivery
Stage of fetal expulsion
Begins immediately after delivery of the fetus and ends with the delivery of the placenta
Placental separation and expulsion
Predictive in the outcome of a particular labor
Acceleration phase
Good measure of over all efficiency of the uterus
Phase of maximum slope
Reflective of feto-pelvic relationship
Deceleration phase