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HD 201 E3 > Parturition Physiology and Mechanism: Phases of Parturition > Flashcards

Parturition Physiology and Mechanism: Phases of Parturition Flashcards

0
Q

Activation makes up how much of parturition?

A

<5%

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1
Q

Quiescence makes up how much of parturition?

A

95%

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2
Q

Stimulation makes up how much of parturition?

A

.2%

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3
Q

Which phase involves the “softening cervix”?

A

Quiescence

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4
Q

Which phase involves the “ripening cervix”?

A

Activation

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5
Q

Three stages of labor under Stimulation phase of parturition

A

uterine contraction, cervical dilation, fetal and placental expulsion

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6
Q

Phase of parturition involving uterine involution, cervical repair, and breastfeeding

A

Involution

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7
Q

What are synthesized during parturition?

A

Factors inducing parturition (self-explanatory)

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8
Q

What happens to pregnancy maintaining factors during parturition?

A

They are lost

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10
Q

True or False: During quiescence, cAMP levels are low.

A

False. Low cAMP levels induce labor contractions. High cAMP levels promote relaxation.

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10
Q

The duration in which quiescence is maintained

A

Implantation until late in gestation

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11
Q

Final product of quiescence (induces relaxation)

A

cGMP

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13
Q

3 Functions of the cervix during pregnancy

A
  • Maintenance of barrier function
  • Maintenance of cervical competence
  • Orchestrates extracellular matrix changes
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14
Q

The barrier of the cervix from infection during pregnancy

A

Mucus Plug

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14
Q

True or False: ECM structural changes are slow and progressive

A

True

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15
Q

Changes in the cervix during pregnancy

A
  • Increase in vascularity
  • Stromal hypertrophy
  • Glandular hypertrophy and hyperplasia
  • ECM structural changes

These changes begin weeks or days before the onset of contractions

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17
Q

In animal models, what are the changes in the cervix?

A

Collagen solubility, DECREASE in lysyl oxidase activity

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17
Q

Why are there more instances of preterm labor in twins?

A

Due to uterine stretch limit. Once the uterus reaches its stretch limit, contractions begin.

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18
Q

True or False: Non-classic progesterone withdrawal involves a decrease in progesterone secretion

A

False. It involves a decrease in progesterone EFFECTS, not necessarily the secreted amount.

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19
Q

What about the nuclear progesterone receptor changes during Phase 2 of parturition?

A

Expression

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20
Q

What happens to dermatan sulfate when cervical changes occur in ripening?

A

decrease, thus decreasing cross-linking of collagen fibers

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22
Q

What happens to dermatan sulfate when cervical changes occur in ripening?

A

Decrease, thus decreasing cross-linking of collagen fibers

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22
Q

Signs of uterine awakening or activation

A

Cervical ripening, increased frequency of Braxton-Hicks contractions, lower uterine segment development, myometrial irritability

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23
Q

What happens to hyaluronic acid when cervical changes occur in ripening?

A

Promotes the increase of water retention

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24
Q

2 Changes of cervical ripening

A
  1. Rearrangement of collagen fibers

2. Alterations in the relative amounts of the various GAGs

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26
Q

When does the uterine myometrial lining change to prepare for delivery?

A

Last 6-8 weeks of pregnancy, or 8th month of gestation

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26
Q

A gap junction protein that increases between myometrial cells when transitioning to contractile state

A

connexin 43

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27
Q

Contraction-associated proteins (CAPs) responsible for the shift from Braxton-Hicks (painless, irregular contractions) to more painful, frequent contractions.

A

Oxytocin receptor, prostaglandin F receptor, and connexin 43

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29
Q

What happens to uterine irritability and responsiveness to uterotonins during the transition to contractile state

A

Increases. Everything increases, actually- oxytocin receptors at the myometrium, connexin 43 between myometrial cells included.

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30
Q

What change in the uterus occurs to facilitate Lightening?

A

The development of the lower uterine segment.

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31
Q

When does the fundic height cease being a reliable measurement for AOG? This is due to what phenomenon?

A

32 weeks. Lightening

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32
Q

3 Stages of Labor (Phase 3)

A

1) Uterine Contractions and Cervical dilatation
2) Descent and Delivery of the Fetus
3) Placental delivery

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33
Q

2 Stages of contractions, cervical dilatations and effacement

A

Active and Latent

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33
Q

By how much should the cervix be dilated to be considered ready for delivery?

A

10 cm

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34
Q

The “active stage” of contractions, dilatations, and effacement consists of what substages?

A

Acceleration, Point of Maximum Slope, Deceleration

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36
Q

Fresh blood expelled from the vagina during labor contractions may be indicative of what condition?

A

Placenta Previa

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37
Q

The water component that is expelled during labor contractions may consist of all or any of the ff

A

Leukorrhea, Urine, Amniotic Fluid

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38
Q

Unremitting contractions compromising uteroplacental blood flow may cause what condition to the fetus?

A

Fetal Hypoxemia. Periodic contractions are needed not just to help mother bear the pain, but also for the fetus to breathe properly throughout the duration of labor.

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39
Q

The mechanical stretching of the cervix enhancing uterine activity

A

Ferguson’s Reflex

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39
Q

True or false: the lower uterine segment is the active part of the uterus during labor and works to push the fetus out

A

False. The upper uterine segment is the active one. The lower uterine segment is passive and allows for accommodation of the baby’s head

41
Q

True or False: The lower uterine segment is the active part of the uterus during labor and works to push the fetus out

A

False. The upper uterine segment is the active one. It contracts and retracts to expel fetus. The lower uterine segment is passive and allows for accommodation of the baby’s head.

42
Q

Does the myometrium of the upper uterine segment relax between contractions?

A

No. It only becomes shorter and thicker, and is relatively fixed that way.

43
Q

True or False: The upper segment retracts only to the extent that the lower segment distends and the cervix dilates.

43
Q

What ring is seen in the extremely thinned out lower uterine segment?

A

Ring of Bandl

44
Q

What happens to the lower uterine fibers as the labor progresses?

A

Lengthens and thins

45
Q

Why does the uterus shorten and thicken (retract in general)?

A

Why the hell would it go back to pregnant state when it doesn’t have a baby anymore? It HAS to!

47
Q

Where is uterine retraction dependent on?

A

The DECREASE in VOLUME of the uterus.

48
Q

What happens to the muscle tone of upper uterine segment contraction during labor?

49
Q

What happens to fetal axis pressure during labor uterine contractions?

A

It increases

50
Q

What happens to the fetal vertebral column as the uterus undergoes changes during labor contractions?

A

It straightens

50
Q

For how long should pushing be done?

51
Q

Which pole of the fetal vertebral column is pressed agains the fundus?

A

Upper Pole

53
Q

What happens to the birth canal during cervical effacement?

A

Shorten from 2 cm to a ring-like orifice with paper-thin edges

54
Q

What characterizes cervical effacement?

A

Obliteration or “taking up” of the cervix, expulsion of mucus plug

54
Q

When does cervical effacement occur in nulligravids?

A

Before dilatation

55
Q

True or False: The muscular fibers at about the level of the external cervical os are
pulled upward, or “taken up” into the lower uterine segment during cervical effacement

A

False. This occurs at the level of the internal os.

56
Q

When does cervical effacement occur in multigravids?

A

May be in full dilatation but effacement only takes up about 50%

58
Q

Before labor, dilatation of both ext and int os prior to effacement occurs in which?

a. Primigravid
b. Multipara

A

b. Multipara

59
Q

Complete effacement: Dilatation is minimal

a. Primigravid
b. Multipara

A

a. Primigravid

60
Q

During effacement: dilatation and funneling of internal os

a. Primigravid
b. Multipara

A

b. Multipara

61
Q

When does the first stage of Phase 3 end?

A

When cervical dilatation is complete (bec. the 1st Stage of Phase 3 of Labor only consists of Cervical Dilatation)

62
Q

When does the Second stage of Phase 3 end?

A

Vaginal expulsion of the fetus

63
Q

What kind of curve is formed when the station of the fetal

head is plotted as a function of labor duration?

A

Hyperbolic Curve

64
Q

In nulliparas, when are increased rates of descent (during 2nd Stage of Phase 3) observed?

A

During cervical dilatation phase of maximal slope. This is maintained until the presenting part reaches the perineal floor

65
Q

The three functional divisions of the labor curve and the fetal descent curve

A

1) Preparatory
2) Dilatational
3) Pelvic

66
Q

The functional division including the Latent and Acceleration phases

A

Preparatory

67
Q

The functional division encompassing the Deceleration and the Phase of Maximum Slope of fetal descent

67
Q

Phases of placental expulsion

A
  1. Decrease in uterine size
  2. Decrease in area of placental implantation
  3. Hematoma formation
  4. Cleavage of decidua spongiosa
68
Q

What happens during the third stage of labor?

A

Expulsion of fetus, placenta, and fetal contents; aka Stage of placental separation and expulsion

70
Q

True or false: The hematoma that forms during placental expulsion is the cause of the separation of the placenta and the decidua spongiosa

A

False. Hematoma is usually the RESULT, rather than the cause of separation. In some cases, the hematoma is negligible. However, the hematoma may accelerate cleavage

70
Q

During the amnio-chorion separation, what undergoes contraction, which undergoes traction?

A

myometrium : contraction :: separated placenta: traction

71
Q

2 actions that permit the separation of the amnio-chorion part

A

Contraction and Traction

72
Q

True or false: The regulation of the phases of parturition is multifactorial

73
Q

The amnion-chorion separation is due to what?

A

Due to a decrease in the surface area of the uterine cavity causing the fetal membranes – the AMNIOCHORION and DECIDUAS PARIETALIS – to be thrown into several folds

74
Q

What can be done to an incompetent cervix to prevent spontaneous abortion?

A

It may be tied up

75
Q

During quiescence, as the uterus expands, what happens to the cervix?

A

It contracts or stays firm

76
Q

During Braxton-Hicks contractions, where is the discomfort localized?

A

Lower abdomen and groin

77
Q

The maintenance of cervical competence can be likened to what?

A

An expanding balloon (uterus) and its blow hole (cervix). The more it expands, the easier it is to expel air (the baby/fetus) but the cervix will keep it closed

78
Q

What happens during the “orchestration of ECM changes” during cervical softening?

A

Progressive increases in tissue compliance

79
Q

True or False: Modifications of Progestin Receptors in Phase 2: Preparation for Labor are posttranscriptional

A

False. The changes are POST-TRANSLATIONAL

80
Q

How is progesterone inactivated during Phase 2: Preparation for Labor?

A

Locally, by steroid-metabolizing enzymes, or via synthesis of natural antagonists

81
Q

What do you ask the patient regarding contractions to determine whether these are False or True?

A

Interval, duration, intensity, frequency, localization

82
Q

Increased activation of G-protein-coupled receptors cause ________

A

Inhibition of cAMP formation

83
Q

When does the inhibition of cAMP formation occur among the phases of parturition?

A

3rd Stage: Labor

84
Q

What happens to Phase 1 and Phase 2 according to the Uterotonin Theory of Labor Initiation?

A

Phase 1 is suspended and Phase 2 is implemented

85
Q

Hormone suspected to cause Ferguson’s Reflex

86
Q

Uterine area with the greatest contraction during labor

87
Q

True or False: The Ring of Bandl is a physiological retraction ring.

A

False. It is a PATHOLOGICAL retraction ring, found commonly in cases of obstructed labor

88
Q

True or False: The horizontal diameter is increased during uterine contractions

A

False. Fetal axis pressure is increased during uterine contractions and for this to happen, the horizontal diameter must be decreased.

89
Q

Medical term for “pushing”/ “pag-irê” during labor

A

Ancillary Forces

90
Q

When should you ask the patient to push during labor?

A

Only when contractions are present. Otherwise, the patient will get tired easily.

91
Q

True or False: Pushing is more effective if the mouth is kept closed.

92
Q

True or False: A centrifugal pull exerted on the cervix allows it to distend/dilate

A

True. This is due to the LOW resistance of lower uterine segment and the cervix

93
Q

True or False: In nulliparas, engagement of the fetal head is accomplished during labor

A

False. Engagement of the fetal head occurs BEFORE labor, causing it to descend further late in labor already.

94
Q

Repair processes of placental expulsion serves what purposes?

A

Resolve inflammatory responses and remove GAGs, proteoglycans, and structurally-compromised collagen

95
Q

What are synthesized in the dense connective tissue to restore the structural integrity of the cervix?

A

Matrix and collagen

96
Q

Involution of the uterus and cervical repair at Puerperium occurs at?

97
Q

“Doc, liliit pa ba tiyan ko?” - Patient

A

Yes, within 4-6 weeks, ESPECIALLY if you’re breastfeeding. :)

HD 201 E3 (4 decks)

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