Parturition Flashcards
[…]% of pregnancies are unintended.
~50
Unintended includes mistimed and unwanted
What are the health risks to the infant if they are born unintended?
This is largely due to the fact that minority, impoverished women with lots of comorbidities are at higher risk of having unintended pregnancies. Not inherent to the fact that the infant is unintended, just a factor of the health of the mother / environment
Goals of preconception care:
- Weight
- Supplementation
- Things to avoid
- Genetic considerations
- Other environmental factors
- Normalize weight prior to getting pregnant is ideal
- Folic acid
- Teratogens (including hyperglycemia)
- Screen for family Hx and genetic risk factors
- See image for bottom ones
What are the goals of prenatal care and what factors influence a woman’s satisfaction with her childbirth experience?
Pregnancy terms
- Estimated date of delivery
- Term
- Post-term
- Pre-term
- Macrosomia
- Low birth weight
- Large for gestational age
- Small for gestational age
- Intrauterine growth restrictions
What are the 2 routine elements of prenatal care in the 1st trimester?
What is the most notable thing to do during prenatal care in the 2nd trimester?
What is Naegele’s rule?
Human gestation is 280 days from LMP
What is the most notable thing to do during prenatal care during 3rd trimester?
What are 2 things to be aware of during postpartum care that are critically important?
What is the definition of labor?
Regular uterine contractions with progressive cervical dilation and effacement
What 3 variables determine the ability of the fetus to successfully negotiate the maternal pelvis during labor and delivery?
- In myometrial smooth muscle, when relaxed, the actin assumes the […] form and Ca++ is […]
- In myometrial smooth muscle, when contracted, the actin assumes the […] form and Ca++ is […]
- Globular; low
- Fibrillar; high
With respect to the conditions of the uterus and cervix, what conditions maintain pregnancy vs. promote labor?
Uterine quiescence and cervical rigidity maintain pregnancy, while uterine contractions and cervical ripening promote labor
What is the role of oxytocin in labor?
- Oxytocin IS NOT responsible for the induction of labor, but it is a hormone that is secreted to maintain uterine contractions due to response of pressure from head on tissue of cervix and stretching that results
What can IV oxytocin be used for clinically?
Induce and augment labor
Control postpartum hemorrhage
What is normal blood loss during vaginal and cesarean deliveries?
Vaginal = 500cc
Cesarean = 1000cc
What is the role of progesterone in labor?
What is a clinical use of intramuscular progesterone?
Maintains uterine quiescence –> promotes maintenance of pregnancy NOT labor
- What is the role of estrogen with respect to labor?
- Progesterone and estrogen are produced by the mother, but during pregnancy the fetus/placenta is also responsible for increasing levels of these hormones. Describe how this happens.
- Women with […] deficiency do not experience spontaneous labor.
- Estrogen promotes labor. It’s hypothesized that one of the factors leading to the induction of labor is the ratio of progesterone / estrogen
- See image
- Placental sulfatase
Prostaglandins and labor
- Which prostaglandins are important in labor?
- Where are they produced?
- What is their role in labor?
- How can they be used clinically as treatments related to pregnancy and labor?
So…what induces labor?
Initiated by a complex interplay between the fetus, mother and placenta. The ratio of progesterone: estrogen, along with oxytocin and prostaglandins are all important in this process. There is no one clear initiator.
There has been a lot of pushback against giving birth in a hospital, with the rationale that birth has been and continues to be something that many women in many cultures do at home and more “naturally” without issue. Which is correct - labor is a complex medical process that requires specialized care or a natural process that can be managed at home on your own?
Bits of both, see slide
What are the stages of labor?
Power of Uterine Contractions
- How often occur?
- Affect on fetal blood flow?
- What is measured on monitors during contractions?
The maternal pelvis does not accomodate all dimensions of the fetal skull. What must the fetus do to exit the pelvis?
Due to the rough nature of the passage out of the pelvis, what are some common deformities that can be seen on newly born babies?
Note: both these deformities are not permanent, they go away within a few days
What are some common deformities that can happen to the mother during delivery?
Describe the timing of labor seen in women and what factors affect the timing.
Note: prior poor understanding of timing led to a lot of C-sections b/c doctors thought the woman had failed to progress to labor successfully when really they may have just needed more time. Has led to increased complications for mothers after birth
What causes pain in the first stage of labor?
What causes pain in the second stage of labor?
How does a woman’s response to pain affect the delivery?
What are options for analgesia in the first and second stages of labor?
What changes must happen to the fetus’s lungs and heart during the transition to extrauterine life that happen during the birth process?
- What is neonatal respiratory distress syndrome?
- What can be used as a rescue treatment for this condition?
- What can be used prophylactically for this condition?
- If a neonate must delivered before 37 weeks, what must a physician do to assess lung maturity?
- Surfactant deficiency caused by premature birth, diabetic mothers, leads to alveolar collapse and impaired gas Ex
- Exogenous surfactant
- Exogenous surfactant and corticosteriods
- Do amniocentesis to check for surfactant components in amniotic fluid to determine if lungs are mature enough to breathe on their own
What changes to the CV system must occur in neonate to make transition to extrauterine life?
What is the apgar score?
What does it measure / not measure?
Lactation
- Describe the pathway and histology of breast milk and breast tissue
- What hormonal changes happen in the breast tissue during puberty and pregnancy?
- Pathway: Lobules produce milk –> lobes –> lactiferous ducts –> empty at nipple
- Histo: each lobe is made of lobules, which are composed of secretory alveoli, which have myoepithelial cells surrounding them for contraction and expulsion of milk
- See image
During Pregnancy […] stimulates prolactin secretion from pituitary lactotropes, however, high […] levels inhibit lactogenesis explaining why pregnant women don’t lactate
Estrogen
progesterone
At Parturition, following delivery of the […], the drop in […] levels allows prolactin to assume a lactogenic effect
placenta
progesterone
Discuss the physiology of lactation, beginning with infant suckling.
What is the colostrum?
What is lactational amenorrhea?
What are the recommendations surrounding breast feeding?
However bear in mind that not all women can breast feed!
Risk factors for postpartum depression?
