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Repro > Parturition and Menopause > Flashcards

Parturition and Menopause Flashcards

1
Q

normal pregnancy duration

A
  • A normal pregnancy lasts for ~ 40 weeks or 280 days after the last menstrual period
  • Naegele’s formula can be used to estimate the date of birth: add seven days to the last menstrual period, subtract three from the month and add one to the year. For example, if the LMP was 14.8.98, add 7 days = 21.8.98, subtract three from the month = 21.5.98, add one year = 21.5.99.
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2
Q

signs of labour

A
  • Mucous plug in the cervix, which acts as a seal during pregnancy, is passed as a blood stained or brownish discharge
  • Coordinated muscular contractions are generated in the upper part of the uterus, the fundus –> helps to gradually open, or dilate, the cervix
  • Water breaks: Amniotic sac surrounding the baby ruptures, or breaks, allowing colourless amniotic fluid to pass out through the birth canal
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3
Q

three stages of labour

A
  1. Dilation of cervix: Longest stage of labor
    o Cervical opening enlarges eight to ten centimeters
  2. Delivery of the baby:
    o Begins when cervix is completely dilated
    o Baby moves farther down the birth canal, usually head first.
    o Mother pushes, and the muscles in the uterus contract to push the baby out
    o Baby’s head will be visible = called crowning
    o Ends with the delivery of the baby
  3. Delivery of the Placenta:
    o Expulsion of the afterbirth = placenta is expelled after delivery
    o If this does not occur naturally the physician removes it
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4
Q

types of birth - natural vs induced

A

Natural birth: Delivery of a baby without using drugs or surgery during birth

Induced labor: Stimulation of uterine contractions before they occur spontaneously

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5
Q

types of birth - breech vs cesarean section

A

Breech birth: When baby delivered either foot first or buttocks first

Cesarean Section (C-Section): Form of childbirth in which a surgical incision is made through a mother’s abdomen and uterus to deliver the baby

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6
Q

types of birth - episiotomy vs vacuum extraction vs forceps

A

Episiotomy: Incision between the vagina and anus (perineum) help with crowning of the baby, to prevent muscles from tearing

Vacuum extraction: Assist mother if she becomes too tired, cup on baby’s head with slight suction

Forceps: To guide baby’s head out of birth canal

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7
Q

epidural

A
  • Pain relief administered in the woman’s lower back using a needle
  • Local anaesthetic injected in to the space around the spinal nerve
  • Injection is usually made in the lumber region at the L2/3 or L3/4 space
  • Usually done when 4-5cm dilated with regular contractions (epidural might slow down contractions)
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8
Q

apgar scale

A

assessment test of the newborn on a scale of 1-10, activity, pulse, grimace (reflex), appearance (skin colour,) respiration
7+ baby in good condition
4-6: baby needs assistance
<4: baby needs life saving techniques

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9
Q

pregnant uterus and associated hormones

A

myometrium: oxytocin receptors

placenta & placental villi: progesterone, oestrogen, prostagladin

decidua: PGF2
cervix: IL-8
amnion: PGE2
chorion: PG dehydrogenase

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10
Q

phases of uterine function

A
  • Hormonal trigger to initiate parturition in humans has not been identified
  • Most likely to be of fetal origins
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11
Q

regulation of parturition - cortisol

A
  • Increased levels of Corticotropin Releasing Hormone (CRH)
  • Stimulates fetal pituitary to release ACTH (adrenocorticotropic hormone)
  • Stimulates mature fetal adrenal glands to release:
    A) Cortisol
  • Stimulates fetal lung development
  • Production of surfactant
  • Ready to breath air
  • Stimulates PG synthesis
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12
Q

regulation of parturition - DHEA

A

(dehydroepiandro-sterone sulfate)
- Produced by the adrenal cortex
- Converted to Estrogen in the placenta
o decrease in Prog/Estr ratio
o Increased gap junctions in myometrium: Prepared for contraction
o Increased oxytocin receptors: Uterus can respond to oxytocin
o Increased prostaglandin production: Causes cervical ripening, Uterine contractions

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13
Q

important hormones (progesterone and oestrogens)

A 
Progesterone (maintains pregnancy)
o Relaxation of uterine muscle
o Suppresses spontaneous contractions
o Down-regulates oxytocin receptors
o Inhibits formation of gap junctions myometrium

Estrogens (labor)
o Stimulate myometrial contractions
o Up-regulates oxytocin receptors
o Stimulates formation of gap junctions myometrium
o Preps uterus for coordinated contractions

  • Prostaglandins stimulate myometrial contractions
  • Oxytocin is the strongest stimulator of uterine contractions
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14
Q

causes of premature labour

A

chronic inflammation, acute infection, non-inflammatory vascular lesions, growth disorders -> autocrine/paracrine/hormones/cytokines –> premature uterine contraction

mechanical disorders –> matrix metalloproteinases + TIMPS –> increased matrix degradation –> decreased tensile strength –> premature rupture of the fatal membranes

maternal stress –> autocrine/paracrine/ hormones/cytokines –> premature uterine contraction

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15
Q

foetal lung development

A

terminal bronchioli: 15-25 weeks gesation

primitive alveoli: from 26 weeks gestation

mature alveoli: after birth

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16
Q

comparison of male and female pelvises

A
  • The pelvic girdle = formed by 2 hip bones, sacrum & coccyx
  • Each hip bone is formed by fusion of ilium, ischium and pubis
  • The hip bones are joined anteriorly to form the symphysis pubis and each articulate with the sacrum through the sacro-iliac joint
17
Q

female pelvic characteristics

A

tilted forward, adapted for childbearing; true pelvis defines the birth canal; cavity of the true pelvis is broad, shallow, and has a greater capacity

less thick bones, lighter, thinner and smoother

acetabula smaller, further apart

18
Q

male pelvis characteristic

A

tilted less far forward, adapter for support of a male’s heavier build and stronger muscles; cavity of the true pelvis is narrow and deep

thicker bones, heavier, markings are more prominent

acetabula larger and closer together

19
Q

miscarriage

A

A miscarriage is the loss of a fetus before the 20th week of pregnancy

  • The medical term for a miscarriage is spontaneous abortion, but the condition is not an abortion in the common definition of the term
  • 50% of pregnancy ends in miscarriage, but usually before a women misses her menstrual period
  • 15% of recognized pregnancies end in a miscarriage
  • Symptoms: Bleeding which progresses from light to heavy, severe cramps, abdominal pain, fever, weakness, back pain
20
Q

stillbirth

A

Stillbirth is the death of a baby during pregnancy after 20 weeks of gestation but before delivery
- Stillbirth occurs in ~ 1 : 200 pregnancies

Possible Causes:

  • High Blood pressure
  • Diabetes
  • Blood-clotting problem
  • Infection of mother or fetus
  • Placental abruption (Tearing away from uterus to soon)
  • Umbilical cord twisting, which can cut off oxygen to fetus
  • Fetus may have a birth defect or slowed growth development
21
Q

menopause and causes

A
  • Has occurred when menses have ceased for an entire year
  • No equivalent to menopause in males: Males continue to produce sperm well into eighth decade of life, though numbers and motility decrease
  • Declining estrogen levels cause:
    o Atrophy of reproductive organs and breasts
    o Irritability and depression in some
    o Hot flashes as skin blood vessels undergo intense vasodilation
    o Gradual thinning of skin and bone loss
    o Increased total blood cholesterol levels and falling HDL
22
Q

changes due to menopause

A
  • Postmenopausal vagina shrinks in diameter, splits and tears easily and may cause severe dyspareunia = difficult or painful sexual intercourse
  • Decrease in elastic capacity of the bladder -> urinary frequency, nocturia
  • Average age of menopause = 50 to 55 years
  • Depletion of ovarian follicles/ova
23
Q

treatment of menopause

A
  • Treatment: estrogen-progesterone preparations has been given for years
    o Women’s Health Initiative research reported increased risk of heart disease (51%), invasive breast cancer (24%), and stroke (31%), and dementia risk doubled
    o Smallest doses for shortest time are allowable to reduce symptoms if no history of breast cancer and no presence of mutated BRCA gene
24
Q

hormone replacement theory (HRT) and CV disease

A

HRT is reported to reduce overall risk of CVD by 25-50%

Mechanisms

  1. Reduced cholesterol levels
  2. Restores endothelial function
  3. Decreases systolic and diastolic blood pressure
  4. Increases cardiac output
  5. Decreases vascular resistance
25
Q

male climacteric - symptoms

A
  • Circulating levels of testosterone decline with age
  • Depression nervousness
  • Flushes and sweats
  • Decreased libido
  • Erectile dysfunction
  • Tiredness
  • Poor concentration and memory
  • Declining sperm production and motility

Repro (16 decks)

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