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Physio OB Midterm > Parturition II > Flashcards

Parturition II Flashcards

1
Q

Characteristics of smooth muscle

A

Shortening with contractions
Forces in multiple directions
Not organized as skeletal muscle
Greater multidirectional force

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2
Q

The interaction of myosin and actin activates

A

ATPase which hydrolyses ATP and generate force

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3
Q

Uterine relaxation

Maintained by

A

Increase Myocyte cAMP

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4
Q

Uterine relaxation

Activates protein kinase A to promote phosphodiesterase activity with de phosphorylation of

A

Myosin light chain kinase

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5
Q

Actin assumes a fibrillar form, and calcium enters the cell to combine with calmodulin to form complexes.

A

Uterine contraction

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6
Q

The complexes activate MLCK to bring about the phosphorylation of the myosin light chains

A

Uterine contraction

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7
Q

Generates ATPase activity to cause sliding of myosin over the actin fibrils, which is a uterine contractor

A

Uterine contraction

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8
Q

Agents that promote contraction act on myometrial cells to increase intracellular cytosolic calcium concentration.

A

Intracellular calcium

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9
Q

Conditions that decrease calcium and increase intracellular concentration of cAMP and cGMP ordinarily promote

A

Uterine contraction

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10
Q

Cellular signals that control myometrial contraction and relaxation can effectively transferred between cells through intercellular junctional channels

A

Myometrial gap junction

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11
Q

Proteins of gap junction

A

Connexon 1 and 2

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12
Q

Cell surface receptors

Categorized into 3

A

G protein linked - activate phospholipase C
Ion channel linked
Enzyme linked

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13
Q

Cell surface receptors are transferred to the uterus by either

A

Endocrine- via maternal blood
Paracrine - near target cell
Autocrine - itself

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14
Q

Phase 1

A

Uterine quiescence and cervical competence

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15
Q

Phase 1 Uterine Quiescence and Cervical Competnce

Factors

A

Estrogen and progesterone
Increase in cAMP
Generation of cGMP
Modification of myometrial cell ion channels

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16
Q

Phase 1 Uterine Quiescence and Cervical Competnce

Components of a broader based molecular system that implements and maintains uterine quiescence.

A

Progesterone

Estrogen

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17
Q

Phase 1 Uterine Quiescence and Cervical Competnce

Inhibit parturition
Maintains uterine quiescence by various mechanism that cause decreased expression of the contraction associated proteins (prostaglandin, oxytocin, connexin)

A

Progesterone

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18
Q

Phase 1 Uterine Quiescence and Cervical Competnce

Directly precedes progression of phase 1 into phase 2 of parturition

A

Pretogestrone withdrawal

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19
Q

Phase 1 Uterine Quiescence and Cervical Competnce

Promote parturition

A

Estrogen

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20
Q

Phase 1 Uterine Quiescence and Cervical Competence

Would promote myometrial gap junction thereby, promoting uterine contraction

A

Estrogen

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21
Q

Phase 1 Uterine Quiescence and Cervical Competnce

A number are associated with Gas mediated activation of adenyl cyclase and increased levels of cAMO are present in myometrium

A

G protein Coupled Receptors

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22
Q

Phase 1 Uterine Quiescence and Cervical Competnc

Mediate gas stimulated increases in adenylyl cyclase, increased levels of cAMP, and myometrial cell relaxation

A

Beta adrenoreceptors

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23
Q

Phase 1 Uterine Quiescence and Cervical Competnce

Has been demonstrated in myometrial smooth muscle and blood vessels.

A

LH and HCG receptors

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24
Q

Phase 1 Uterine Quiescence and Cervical Competnce

Acts to activate adenyly cyclase by way of a plasma membrane receptors Gas linked system

A

Chorionic gonadotropin

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25
Q

Phase 1 Uterine Quiescence and Cervical Competnce

This decreases contraction frequency and force and decreases the number of tissue specific myometrial cell gap junctions.

High circulating levels of HCG may be one mechanism causing quiescence

A

LH and HCG receptor

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26
Q

Phase 1 Uterine Quiescence and Cervical Competnce

Peptide hormone that is a member of insulin like GF

A

Relaxin

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27
Q

Phase 1 Uterine Quiescence and Cervical Competnce

Relaxin originate exclusively from the

A

Corpus luteum

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28
Q

Phase 1 Uterine Quiescence and Cervical Competnce

Relaxin greates amount found between

A

8-12 weeks gestation

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29
Q

Phase 1 Uterine Quiescence and Cervical Competnce

Mediates activation of adenylyl cyclase
Effect on cervical softening
Promote myometrial quiescence

A

Relaxin

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30
Q

Phase 1 Uterine Quiescence and Cervical Competnce

Synthesized in the placenta and hypothalamus

A

CRH

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31
Q

Phase 1 Uterine Quiescence and Cervical Competnce

CRn increase during the

A

Final 6-8 weeks of normal pregnancy

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32
Q

Phase 1 Uterine Quiescence and Cervical Competnce

CRH has dual effect

A

Utero relaxant at first

Utero contraction later

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33
Q

Phase 1 Uterine Quiescence and Cervical Competnce

These interact with a family of different G protein coupled receptors, several of which are expressed in myometrial

A

Prostaglandin

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34
Q

Phase 1 Uterine Quiescence and Cervical Competnce

Prostaglandin usually considered as

A

Uterotonins

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35
Q

Phase 1 Uterine Quiescence and Cervical Competnce

Prostaglandins with diverse effects

A

Prostacyclin E2 - relaxation

Prostacyclin F2- contraction

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36
Q

Phase 1 Uterine Quiescence and Cervical Competnce

Prostaglandin produced using plasma membrane derived arachidonic acid, which usually is released by the action of the

A

Phospholipase A2 or C

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37
Q

Phase 1 Uterine Quiescence and Cervical Competnce

Activation of gaunylyl cyclase increases intracellular cGMP levels, which promotes smooth muscle relaxation

A

ANP and BNP and cGMP

38
Q

Phase 1 Uterine Quiescence and Cervical Competnce

Striking increases in the activity of enzymes that degrade or inactivate endogenously produced uterotonins

A 
PGDH and prostaglandins
Enkephalins and endothelins
Oxytocinase and oxytocin
Diamine oxidase and histamine
Cetechol O methyl transferase and cathecolamines
Angiotensinases and angiotensin II
PAF acetylhydrolase and PAF
39
Q

Phase 2

A

Uterine activation and cervical ripening

40
Q

Phase 2 Uterine activation and cervical ripening

May be used to prevent preterm labor has been studied in trials

A

Progesterone containing injections or vaginal suppositories

41
Q

Phase 2 Uterine activation and cervical ripening

Administered during the latter phase of the ovarian cycle, which induces menstruation prematurely

A

Mifepristone (RU-486)

42
Q

Phase 2 Uterine activation and cervical ripening

Effective abortifacients in early pregnancy, not so much in the latter part

A

Mifepristone

43
Q

Phase 2 Uterine activation and cervical ripening

Must play a central role in spontaneous labor

A

Oxytocin

44
Q

Phase 2 Uterine activation and cervical ripening

Primary regulators of oxytocin receptor expression

A

Progesterone and estradiol

45
Q

Phase 2 Uterine activation and cervical ripening

In vivo or in myometrial explants increases myometrial oxytocin receptor concentration,
Promote parturition

A

Estradiol treatment

46
Q

Phase 2 Uterine activation and cervical ripening

Increase oxytocin receptor degradation and inhibit oxytocin activation at the cell surface

Inhibit parturition

A

Progesterone

47
Q

Phase 2 Uterine activation and cervical ripening

Remodeling of the ECm of the uterus, cervix, vagina, breast and pubic symphis as well as promoting cell proliferation and inhibiting apoptosis

A

Relaxin

48
Q

Phase 2 Uterine activation and cervical ripening

Promotes growth of the cervix, vagina, and pubic symphysis and is necessary for breast remodeling for lactation

A

Relaxin

49
Q

Phase 2 Uterine activation and cervical ripening

Also significant more common in pregnancies complicated by hydramnios

A

Preterm labor

50
Q

Phase 2 Uterine activation and cervical ripening

May include activation of cell surface receptors or ion channels, transmission of signals through ECM or release of Autocrine molecules that act directly on myometrium

A

Mechanotransduction

51
Q

Phase 2 Uterine activation and cervical ripening

Ability of the fetus to provide endocrine signals that initiate parturition has been demonstrated in several species.

A

Fetal endocrine cascades leading to parturition

52
Q

Phase 2 Uterine activation and cervical ripening

Synthesized by placenta in relatively large amounts
Maternal plasma CRH levels are low in the 1st T and rise from mend gestation to term

A

Placental CRH production

53
Q

Phase 2 Uterine activation and cervical ripening

Only tropic hormone releasing factor to have a specific serum binding protein

A

CRH

54
Q

Phase 2 Uterine activation and cervical ripening

Binds most maternal circulating CRH and this inactivated it

A

CRH binding protein

55
Q

Phase 2 Uterine activation and cervical ripening

CRH Bp levels in both maternal plasma and amniotic fluid decline, leading to markedly increase level of

A

Bio available CRH

56
Q

Phase 2 Uterine activation and cervical ripening

Placental CRH may enhance fetal cortisol production to provide positive feedback so that the placenta produces. Ore CRH

A

CRH and parturition timing

57
Q

Phase 2 Uterine activation and cervical ripening

Some have proposed that the rising levels of CRH at the end of gestation reflects

A

Fetal placental clock

58
Q

Phase 2 Uterine activation and cervical ripening

Produced by the fetal lung is required for lung maturation

A

Surfactant protein A

59
Q

Phase 2 Uterine activation and cervical ripening

Activate fluid macrophage to migrate into the myometrium and induce NF-KB factor that activated inflammatory response

A

Increased SP-A

60
Q

Phase 2 Uterine activation and cervical ripening

Diminished estrogen production

A

Fetal anomalies and delayed parturition

61
Q

Phase 3 uterine stimulation

A

Oxytocin and phase 4 parturition

62
Q

Phase 3 uterine stimulation

Literally, quick birth, first uterotonin to be implicated in parturition initiation

A

Oxytocin

63
Q

Phase 3 uterine stimulation

Nano peptide synthesized in the magnocellular neurons of the supraoptic and para ventricular neurons

A

Oxytocin

64
Q

Phase 3 uterine stimulation

Pro hormone-> oxytocin during transport

A

Neurophysin

65
Q

Phase 3 uterine stimulation

Role of oxytocin in phase 3 and 4

A

Increase near the end of gestation
Promote prostaglandin release
Synthesized directly in decidual and extra embryonic fetal tissues and in the placenta

66
Q

Phase 3 uterine stimulation

End of phase 3 of parturition

A

2nd stage of labor

67
Q

Phase 3 uterine stimulation

Early past partum period

A

Early puerperum

68
Q

Phase 3 uterine stimulation

Phase 4
Oxytocin infusions promotes increased levels of mRNAs from myometrial genes that encode proteins essential for uterine involution

A

Breast feeding

69
Q

Prostaglandin and phase 4 of parturition

Levels of prostaglandin or their metabolites in amniotic fluid, maternal plasma, and maternal urine are increased during

A

Labor

70
Q

Prostaglandin and phase 4 of parturition

Treatment of pregnant women with prostaglandin by any route causes

A

Abortion or labor on all gestational ages

71
Q

Prostaglandin and phase 4 of parturition

Inhibitors to pregnant women will delay spontaneous labor onset and sometimes arrest preterm labor

A

Administration of prostaglandin H synthase type 2

72
Q

Prostaglandin and phase 4 of parturition

Prostaglandin synthesis is high and unchanging in the decidua during

A

Phase 2 and 3 of parturition

73
Q

Prostaglandin and phase 4 of parturition

Increased in the decidua at term

A

PGF2

74
Q

Prostaglandin and phase 4 of parturition

Myometrium synthesis PGHS-2 with labor onset but most prostaglandins likely come from the

A

Decidua

75
Q

Prostaglandin and phase 4 of parturition

Also produce prostaglandins

A

Fetal membrane

Placenta

76
Q

Prostaglandin and phase 4 of parturition

Further degrade the ECM weakening of fetal membranes

A

Increase in cytokines

Prostaglandins

77
Q

Endothelin 1

Is preferentially expressed in smooth muscle and effects an increase in intracellular calcium

A

Endothelin A receptor

78
Q

Endothelin 1

Evidence of pathologies and aberrant expression.

A

Premature birth and uterine leiomyomas

79
Q

Angiotensin I

There are two G protein linked angiotensin II receptors expressed in the uterus

A

AT1

AT2

80
Q

Angiotensin I

Non pregnant

A

AT2

81
Q

Angiotensin I

Pregnant

A

AT1

82
Q

Angiotensin I

Evokes contraction

A

Angiotensin II

83
Q

Maybe another component of the uterotonin system of parturition phase 3

A

Angiotensin II

84
Q

Highly resistant to penetration leukocytes, microorganism and neoplastic cells

A

Amnion

85
Q

Constitute a selective filter to prevent fetal particulate bound lung and skin secretions from reaching the maternal compartment

A

Amnion

86
Q

Amnion

Late pregnancy, amniotic prostaglandin biosynthesis is increased and ________ show increased activity too

A

A2 and PGH-2

87
Q

Primary protective and provides immunological acceptance

Relaxation

Also enriched with enzymes that inactivate uterotonin a

A

Chorion laeve

88
Q

Generation of decidual uterotonins that act in a paracrine manner on contagious myometrium

Contraction

A

Decidua

89
Q

Which of the following is/are not related to uterine contraction?

A. Prostaglandin
B. Estrogen
C. Oxytocin
D. Angiotensin 2
E. Progesterone
F. D and E
G. NOTA
A

E. Progesterone

90
Q

Two general contemporaneous theorems concerning labor initiation

A

Functional loss of pregnancy maintenance factors

Synthesis of factors that induce parturition

Physio OB Midterm (6 decks)

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